When our team meets with prospective clients, we provide an in-depth analysis of their Ohio BWC policy. This allows us to show them how things got to where they are, where they’re headed, and if any of the damage done can be mitigated in some way. By the time we review the claims, it’s sometimes too late to un-ring most of those bells. However, one of the key items we focus on for our clients (especially new ones) is handicap potential.

Ohio BWC has a list of pre-existing conditions that would delay a claimant’s recovery following a work-related injury.  While some maladies on the list are rare in claimants, the top four are fairly common. If you have a lost time claim in your experience, it’s worth looking into. Here’s an example of what it could look like:

Employee files a workers’ compensation claim that causes a 30% increase in premiums (once it enters the experience), to the tune of $20,000 additional each year for four years. Without a handicap, this claim is projected to cost the employer $80,000 in additional premium. Spooner locates medical evidence to indicate a pre-existing condition that qualifies for a handicap, and obtains a handicap at 30% from BWC.  Employers receive a benefit from the handicap in either reduced premium payments in the future, or will receive a refund check from the BWC for overpaid premium - depending on when the handicap is granted by the BWC and how far along the claim is in the employer’s experience.  In the example above, the employer would end up paying approximately $24,000 less in premium for the four years the claim is in the experience.

We’ve always thought of handicaps as a “low-hanging fruit,” because it’s no additional work on the client’s part (we do all of the legwork), doesn’t impact the claimant in any way, and costs nothing to file. The worst that can happen is that BWC disagrees and either offers a lower amount than asked for, or none at all. So why don’t all TPAs do this automatically? We don’t have the answer - but it’s simply part of doing business for us. Spooner has a handicap reimbursement team dedicated to identifying potential for handicaps, securing the medical evidence and obtaining a file review from a medical expert. After this is completed, our counsel attends an informal hearing with BWC’s legal team. At this point, BWC can agree with our requested percentage, make a counter offer, or decline to approve the handicap.

Claims that qualify to file for handicaps must be within the employer’s experience period, must be a lost time claim, and BWC must have paid one or all of the following: temporary total disability, permanent total disability, scheduled loss awards, death benefits, or the employer must have paid salary continuation (wages paid in lieu of BWC paying temporary total). The employer must be able to show that the condition either caused the claim or contributed to a delay in the claimant’s recovery.