This page offers basic information to Ohio employers at different stages of the workers' compensation process, from establishing coverage to the administrative hearing process.
1. For new businesses, all Ohio employers with one or more employees must have workers' compensation coverage, which is only available through the Ohio Bureau of Workers' Compensation. A U-3 form should be completed with the $120 (minimum) application fee. Self-employed persons, partners in a business, or family farm corporation officers may elect coverage.
2. Homeowners should also obtain workers' compensation coverage for domestic workers such as babysitters, nannies, gardeners, and housekeepers if the person working in your residence is paid $160 or more per calendar quarter. A U-3 form should be completed along with submission of the application fee.
3. For companies with existing BWC policies which are in the process of purchasing another business or going through a merger process, a U-118 form should be completed. Before completing a business transaction such as a business acquisition or merger, review the BWC's successorship liability policy. The purchaser is usually responsible for the workers' compensation liabilities of the company being acquired, even if the sale is an "asset only" sale.
Ohio workers' compensation premium rates for state funded employers are based upon rates established for each job classification or type, which is determined by risk of injury. For example, the rate for an office worker will be much lower than the rate for a window washer. For established employers, the base rate is then adjusted based upon a four year claims history for that particular employer. An established employer with higher claims costs will often have a higher rate than a similar employer with very little in the way of claims activity. A "snapshot" of the claims history is taken on September 30 of each year, which will capture claim payment data used in formulation of rates. Once the employer's rate is calculated, the rate is multiplied by payroll for each corresponding job classification to determine the premium owed. A more detailed explanation of the premium rating process can be found below or here. (Retrieved from Ohio BWC.)
For private state funded employers, BWC sends a premium invoice in June of each year. Employers may select a payment installment option that will apply for a full year.
There are a number of discount programs designed to assist employers reduce their premiums, including deductible programs, drug free programs, and a variety of group rating plans, which are typically administered by companies called 'third party administrators."
Ohio state funded employers must select a managed care organization (MCO) to medically manage workers' compensation claims, which includes approval or denial of treatment requests, case management as needed, return to work services, and payment of medical bills at BWC-approved fee schedule. Employers do not pay the MCO for services directly. MCOs are reimbursed by BWC out of premiums collected. New employers must select a MCO when coverage is established. Employers may elect to change their MCO every two years during an open enrollment period.
The services of a third party administrator (TPA) are optional to Ohio employers. TPAs assist employers by helping them to find discount programs to reduce premiums, by helping to employ other strategies to reduce claims costs, and by helping to navigate the workers' compensation system. Some TPAs offer hearing representation before the Industrial Commission, though TPA representatives cannot practice law. The use of an attorney may be advisable for more complex claims. The services of a TPA are fee based.
When an employer and an injured worker do not agree on the initial allowance of a workers' compensation claim, or any subsequent issues such as treatment, lost time compensation, or additional allowances, the Industrial Commission of Ohio will adjudicate the dispute. BWC can also ask the Industrial Commission of Ohio to decide a disputed issue.
All parties to the claim and their representatives will have at least 14 days written notice of a hearing date. The Industrial Commission has 12 locations across the state, and hearings are scheduled at the location closest to the injured worker's residence.
The issue to be adjudicated will be heard initially by a District Hearing Officer (DHO). Decisions are not usually announced at the the hearing table, but are published in writing following the hearing. If a party disagrees with the DHO order, an appeal may be filed with the Industrial Commission within 14 days from receipt of the order. A second hearing will then be scheduled before a Staff Hearing Officer (SHO), who will also issue the decision in writing. While either party may appeal the decision of the SHO within 14 days of receipt of the SHO order, a third hearing is not guaranteed. An appeal to an SHO is necessary if a party intends on appealing an issue into a court of common pleas.The full Industrial Commission or a deputy may decide to grant a third hearing if there appears to be a mistake of fact or law identified in the appeal.