We know it happens. An employer pays cash at an urgent care for that “one and done” work-related injury visit, or maybe a handful of chiropractor visits. The employer didn’t want the claims costs hitting their experience and premiums, or to risk their EMR going even higher. Unless they’re in one of a few specific programs, employers paying cash for treatment of a work-related injury is prohibited. It can go left quickly and create some ugly scenarios for employers. We want to help you understand what can happen, and some above-board ways to reduce the impact of medical costs on future premiums.

Paying cash for an injured worker’s medical treatment is a slippery slope. Ohio BWC-approved providers should not be willing to accept an employer’s cash payment for treatment unless they are self-insured for workers’ comp in Ohio, part of the 15K program, or an Ohio-BWC approved deductible plan. If an employee hurts their back at work and claims they just want to see a chiropractor - it may seem both easy and tempting to pay cash for a few visits. No need to file a claim and make a big deal of it, right? Wrong. Especially with soft tissue injuries, treatment could go on for months (even years), and may eventually require an orthopedic surgeon. When BWC finds out that the initial injury wasn’t reported as a claim and the employer chose to pay cash for treatment, that employer now has a non-covered claim. That means the employer will bear all expenses associated with that claim going forward. In case you’re not familiar with the out-of-pocket price on something like a rotator cuff repair, it can average $25,000. 

We’re well aware that BWC over-recoups their costs on many claims, but you’re better off not trying to skirt the system. There are a few legitimate ways to achieve a similar goal.

Ohio BWC 15K program – This is a good way for businesses (who want to remain in the state fund) to keep small claims from impacting experience and premiums. The employer pays up to $15,000 in medical expenses on medical-only claims. If the claim moves into lost time territory (days away from work), it will be automatically removed from the 15K program. You can pick and choose which claims will be covered by $15K, and when to remove them from the program. Each claim doesn’t have to reach the full $15,000 in medical. If it’s sitting at $5,000 but headed towards surgery, it can be moved out of the program at your discretion.

Ohio BWC Deductible Program – This could be a good fit for some businesses that have a strong focus on safety and have historically kept claims costs low. Like other insurance deductible plans, the employer lowers premium expenses by choosing a deductible and paying the portion of the claim that falls under that amount. In this program, costs are initially paid by BWC, and the employer later reimburses them up to the deductible amount. For employers with more frequent or more costly claims, the ROI may not be appealing.

A self-insured PEO with deductible options – Possibly the best of both worlds for the right organization. In this scenario, the PEO is the insurer and carries the majority of the risk. Especially in Ohio, PEO clients already receive discounted workers’ comp premiums because PEOs can use their own underwriting guidelines (as opposed to BWC’s “only game in town” monopoly with the state fund). Some PEOs also offer the flexibility to create a deductible plan that works for your organization.

If you have questions about how to reduce your workers’ comp costs in Ohio and choose the best program for your business, contact us anytime at 440-249-5260 or sales@spoonerinc.com