News and Updates
Category: TPA
Choosing the Best Workers' Comp Partner for '24-25
Even though the 2024 BWC policy year is just about to kick off, we’re already looking ahead to 2025 Group Rating and Group Retro programs. It can be hard to feel like a savvy buyer when it comes to workers’ comp in Ohio, but Spooner would like to share some pointers for how to understand the timeline and choose the best partner. If you’re thinking of changing your partner for Group Rating or Group Retro, be sure not to complete the renewal that your current TPA sends this summer. Most employers don’t realize that cutting a check for a renewal in summer of 2024 will obligate them to their current TPA through June of 2026. Make sure your accounting team is aware of this, too. We’ve seen too many unhappy customers of other TPAs get trapped this way. Are you under the impression that because you’re a member of XYZ Chamber of Commerce, you have to utilize their partner for workers’ comp programs? Not the case. The sponsoring organization frames it that way because there’s money on the table. For example, if you are an XYZ Chamber member (who happens to be partnered with a specific TPA) and you want to leave that TPA, XYZ Chamber makes less money. Naturally, they want you to stay with Sedgwick and may even advise you can’t get that discount outside of their partnership. This is patently false. Most TPAs have access to all of the same Group Rating and Group Retro programs for all industries, and the sponsoring org
2023-2024 Policy Year True Up with BWC
It’s almost True Up Time! BWC’s True Up window will begin on July 1, 2024 and will run through August 15, 2024. This is a process required by Ohio BWC at the end of each policy year, where your premiums based on projected payroll for the previous policy year are balanced with premiums based on your actual payroll over the past year. Compliance with both the reporting and payment of any balances affects your company’s eligibility for most savings programs (like Group and Group Retro). If your actual payroll was higher than projected, you’ll be expected to pay that balance to Ohio BWC no later than August 15th. If you are unable to pay the lump sum at that time, please note that any future premium installments will first be applied to your delinquent True Up Balance before being applied to your premium installments. Payment plans for True Up balances are only available through the Ohio Attorney General’s office following an application process. If this year’s True Up caught you by surprise, next year consider running a mock report in May or June to help your company prepare for any balance that may be owed. The payroll classifications and totals reported this summer will be used to determine your 2025 policy year premiums. For the 2024 policy year that will begin soon, BWC will be using payroll projections based on your True Up from July 2023. Adjustments to your estimated payroll can also be made throughout the year by contact
The Future of the Voluntary Abandonment Defense Remains Unclear
A recent House Bill made changes to Revised Code (R.C.) 4123.56, which became effective in September 2022. This part of the R.C. clarifies eligibility for Temporary Total Disability (TTD) compensation in workers’ comp claims. It was meant to provide clarity following the decades of case law that had complicated the “voluntary abandonment” defense often used by employers when a claimant takes voluntary action to end their employment. While the statute reads clearly enough, the changes resulted in ambiguity due to lack of detail. Ohio BWC or the Industrial Commission will often issue a clarification following such changes – but that didn’t happen this time. On March 2, 2023, the Tenth District Court of Appeals in Columbus issued a decision in State ex rel. Autozone Stores, Inc. v. Industrial Commission that could have a broad impact for Ohio employers. This was the first time an appellate court weighed in on the application of 4123.56(F) in a TTD claim, and it wasn’t a favorable ruling for businesses. Essentially, the ruling allowed the claimant to continue collecting TTD even though they were able to work with restrictions (for a different employer). The potential impact of this decision could hold employers hostage with no defense in TTD claims, driving up both EMRs and premiums for Ohio businesses. If you’d like to read more about the case surrounding this and its implications, click
Handicaps in Ohio Workers' Comp
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
Why You Need a TPA (and a Service Contract!) for Ohio Workers' Comp
If an Ohio employer wants to participate in a BWC sponsored discount program, they need to partner with a TPA (third-party administrator). Failure to do so can cost employers thousands, if not tens of thousands, in additional premiums annually. In addition to getting employers discounts on their workers’ comp premiums, TPAs work for the employer – not for BWC. Your TPA should be advocating on your behalf to manage all aspects of your workers’ comp claims and policy, including (but not limited to): Proper program placement Claims investigations Claims management Workplace safety programs Compliance and deadlines Attorney representation at Industrial Commission hearings If you rely on your TPA to manage workers’ comp claims (and you should be – you’ve paid them to!), you need a service agreement in place to protect you and provide terms for your relationship. Have you read your contract with your TPA? Do you even have one? If your TPA doesn’t have a service contract that spells out what services they are providing, ask them why that is. Often, we see that employers just get an invoice from their TPA with the amount due. In the event of a claim, do you know if you’re paying your TPA for anything more than a discount? Due to TPAs holding the key to BWC sponsored discount programs –many Ohio employers don’t realize that their TPA’s main objective should
