Statutory Changes
HB 81 brings the following changes also effective September 15, 2020:
Post exposure testing: Self-insuring employers must pay for services used to determine whether a detention facility employee was injured or suffered an occupational disease after exposure to another person’s blood or bodily fluids. The same will apply to certain circumstances when specified safety officers are exposed to a drug or other chemical substance.
Violation of specific safety rule : For claims arising after Sept. 14, 2020, an additional award for a violation of a specific safety rule must be filed within one year of the date of injury or one year from the date of disability due to an occupational disease.
Funeral expenses: Funeral expenses are increased from a cap of $5,500 to $7,500.
Proposed Rule Changes
OAC 4123-6-21.1 (L) - We are proposing to clarify the time to address an authorization request for prescriptions to no more than three days. This is in line with BWC’s expectations, while allowing employers to ensure the prescriptions are appropriate and to avoid delays for injured workers to receive necessary medications.
OAC 4123-6-21.1 (I) - We are proposing to remove the requirement to obtain a drug use review before terminating certain prescriptions, including Oxycontin, which has been removed from BWC’s drug formulary.
TPA Portal
We rolled out a new portal specifically for third party administrators (TPAs) on Aug. 27, 2020. This portal has been designed to help TPA’s provide better services to Ohio’s employers. There will be direct access to policies, rules and other program tools. This site has a section specifically for TPA’s who work with self-insuring employers. This is designed to provide TPA’s with easy access to information including, employer demographics, a list of TPA clients with renewal dates, self-insuring employer forms and other reports. The portal will also to provide continual updates, important dates for self-insuring employers, and any relevant information that will assist self-insuring TPA’s in managing their client’s accounts.
You can access the TPA portal from the For Employers section of BWC home page.
https://www.bwc.ohio.gov/employer/TPAPortal/secure/TPAPortalHome.aspx
Claim File Maintenance Requirements
Self-insuring employers must maintain a record of all injuries and occupational diseases resulting in death or more than seven days of disability. These claims and all claims with contested issues must be reported to BWC. You must also keep a record of medical only claims, but you don't have to report them to BWC.
You must maintain these files for the life of the claim and make them available to us as needed. Please note that this is the official record, and you must also be make them available to the injured worker when requested in writing. Accordingly, the file must include a declaration of allowed and disallowed conditions.
The file must have the wages used to determine the injured worker’s compensation rate. The actual calculations should also be available in the record. The file should also include an incident report and/or a first report of injury (FROI-1), medical records, disability information (including a full duty release for all lost time and medical only claims). If there is a modified duty release, the record should also include documentation showing the injured worker worked while on modified duty. This can be a modified duty job offer letter, a time clock history or pay history.
Please ensure that the following are available in all official claim files:
- Service provider medical fee bills with received date clearly documented;
- Notification to claimant/provider if payment of fee bill is delayed, denied or not paid in full.
- Payment verification, which: must include the check number, date of payment, payee, pay period and type of payment. Can be electronic printout or check copy.
- Requests for authorization with received date clearly documented..
- Dated responses to requests for authorization.
- Return-to-work documentation.
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Request for Temporary Total Compensation (C-84).
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Physician’s Report of Work Ability (MEDCO-14).
- BWC and IC communication.
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Motion (C-86).
- Payroll information, either printout or Wage Statement (C-94-A).
- Working wage loss documentation and worksheets used to calculate wage loss benefits.
- Written job offers if claimant is working in a modified-duty position.
- Authorization for release of medical information (optional).
- Child support orders, if applicable.
- Change of physician communication, if applicable.
The claim files may be maintained electronically or in hard copy. They may be housed at your facility or with your representative, with a waiver. When we conduct our audits we'll ask for access to electronic files and recommend attention to proper labelling of the individual documents.
These requirements are for the life of the claim. As claims age it is important to remain attentive to the records, particularly if you change representation and the file is moved from one TPA to another. This will be crucial if a claim becomes allowed for permanent total disability benefits. BWC will require wage information to determine the proper rate for Disabled Workers Relief Fund payments.
Construction Wrap Up- Owner Controlled Insurance Program (OCIP) and Contractor Controlled Insurance Programs (CCIP)
Self-Insuring employers considering a construction project may have the privilege to manage the venture as part of its existing self-insured program. This wraps up all the workers' compensation exposure in one place. The project can be managed as an Owner Controlled Insurance Program (OCIP), meaning the employer is responsible for all workers’ compensation costs, or a Contractor Controlled Insurance Program (CCIP) with the designated self-insured contractor absorbing the workers’ compensation exposure. If approved, the employer or contractor will handle all worker’s compensation activity for all contractors and subcontractors participating in the program. These programs are often called wrap up projects.
An employer or contractor must meet several requirements to be eligible. Foremost, the employer or contractor must be self-insured. Additionally, the project cannot exceed six years from the effective date. The application must be submitted 90 days prior to the project start date, and the total project cost should exceed $100,000,000. Wrap ups can be used on large individual projects or on a “rolling” basis by aggregating smaller projects that are started and completed over a defined period.
When applying for a controlled insurance program , employers or contractors must complete the Self-Insured Construction Wrap-Up Application (SI-50). Email the completed application to SIINQ@bwc.state.oh.us.
The employer or contractor must also provide a listing of all contractors and sub-contractors participating in the program to ensure appropriate coverage for all involved employees. Also, the owner of the wrap up must ensure that all participants know how to report claims. While the wrap up is active, only designated contractor employees and sub-contractors will be covered under the wrap up program. Upon completion of the project, coverage returns to the employee’s original employer. Contractor and sub-contractor employees not working on the approved project will continue to be covered under their employer’s policy. Ohio Revised Code (ORC) 4323.35 provides direction and guidance for the OCIP and CCIP programs.
Important Dates
August 31, 2020- Assessment payments due (must use online payment method)
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