News and Updates
Category: workers comp
Clarifying "Direct Causation," Ohio Court sides with Employer
Last year, we told you about a case that left employers' use of the Voluntary Abandonment defense unclear, and could have long-term negative repercussions. Luckily, it’s been clarified by a recent ruling. The Supreme Court of Ohio officially interpreted a section of the Revised Code in a way that sincerely benefits employers. The employer, Autozone, was contesting claimant’s receipt of temporary total disability (TTD) compensation after an approved surgery that took place two months after the employer terminated the claimant for unrelated reasons. The claimant incurred a work-related injury in June of 2020, and returned to work on light duty following conservative treatment. The claimant was terminated in September 2020 for reasons unrelated to the claim. In November 2020, the claimant underwent an approved surgery for the allowed condition, and subsequently filed for TTD. Autozone argued that the claimant wasn’t entitled to TTD because there were no lost wages to replace - due to the claimant not working at the time of the surgery. The Industrial Commission greenlit the initial request for disability compensation starting on the surgery date. Autozone then filed an appeal with the Tenth Circuit Court of Appeals, requesting the order be vacated and the claimant be found ineligible for TTD. The court agreed with the Industrial Commission and rejected the employer’s argument to deny TTD. The employer then appealed to the Ohio Supreme
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
Preparing for BWC True Up
The end of the Ohio BWC policy year will be ending on June 30th, which means it’s time to start thinking about your payroll True Up. Whether you’re an employer who reported late, not at all, or were unable to pay a resulting balance – you’re one of thousands who may have been removed from Group Rating, Group Retro or several other programs as a result. BWC takes timely reporting and balance payment very seriously, so it’s important that Ohio employers do as well! Most employers are familiar with the process and requirements by now, but here’s a recap for new policyholders and the uninitiated: BWC’s policy year runs July 1 through June 30. Ohio BWC uses payroll from two years prior to determine your premiums. If you’re a new policyholder, the payroll projection made on your application is used to calculate premiums. When the policy year ends, policyholders have from July 1 until August 15 to report their actual payroll from the past policy year Actual payroll is compared to projections that your premiums were based on, and there are three potential outcomes: break even, the employer owes BWC or BWC owes the employer. Any balance owed by the employer must be paid at the time of reporting to be considered current and in good standing. There are currently no options for payment plans outside of the balance being turned over to the Ohio Attorney General’s office. BWC’s billing hierarchy d
Is Our Company Allowed to Pay Cash for Workers' Comp Treatment in Ohio?
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 b
How SuretyHR Fits Into the Spooner Family
You may have noticed some of the SuretyHR content looks a lot like the content published on Spooner Inc’s website and LinkedIn. Maybe you also picked up on our employees having multiple logos on their emails, or you might have both Surety and Spooner business cards for the same employee. We get plenty of questions about this, so we want to help you make sense of it all. Surety HR is part of the Spooner Risk Control family of companies. Spooner Inc (our TPA) and Spooner Medical Administrators (our MCO) both have long and storied histories of helping employers navigate the claimant-favoring, monopolistic Ohio workers’ compensation system. We’ve saved thousands of companies hundreds of thousands of dollars, with some even into the millions with our claims and program management. As Ohio BWC continued making changes to programs, eligibility and inflating administrative costs, we found that offering solutions for only our state-fund and self-insured clients wasn’t enough. Enter SuretyHR, our professional employer organization (PEO). We began building the departments that would make up Surety HR in 2015, with the addition of payroll services. By 2017, we had added in-house legal counsel, HR experts and additional support to our existing teams handling workers’ comp, safety, unemployment, and absence management. In September 2019, we were granted self-insured status by Ohio BWC, which greatly increased the amount of savings we could
Are Missing Group Retro Refunds Complicating Your Budget for 2022?
Back in August, we told you that Ohio BWC wouldn’t be paying Group Retrospective refunds to employers who participated in Retro during the 2018 and 2019 policy years. For the past 12 years, many businesses have counted on those checks to budget for the coming year. Normally, Retro refunds would have showed up last month (October), but this time those employers were left empty-handed. Companies that were anticipating tens of thousands (hundreds of thousands, in some cases) in Retro Refunds are now faced with an end of year shortfall and difficulty budgeting. Our actuarial department estimates that Group Retro refund totals for all participating policyholders during the 2018 and 2019 policy years would have been as follows: • $190,000,000 for the 2018 policy year • $155,000,000 for the 2019 policy year That’s $345 Million in refunds not being paid back! If you are concerned with how the state is managing your premium dollars - and more importantly, your refunds - you have options. Self-insuring is one option, or you can look into a partnership with SuretyHR through our Self-Insured PEO program. This provides a lot of the same savings and benefits of self-insuring for workers’ comp, but without the risk and financial burden of directly paying excess
Where is BWC's Group Retro Program Headed?
In our last few blogs and newsletters, we’ve been updating you on the changes we’re noticing in Ohio BWC’s Group Retro program. Initially, there was the withholding of 2018 and 2019 refunds (six total payouts for participating employers). Then, we began noticing the overall degradation of retro refunds. Most recently, we’ve noticed how BWC’s changes to their claim reserve calculations are having a tremendous impact on the performance of Group Retro pools. For those of you who didn’t read our post about reserve calculations, here’s an abridged version: workers’ comp claims have a dollar amount reserved at the onset of a claim (yes, even if you do salary continuation) for additional funds that the insurer thinks it may end up costing. BWC’s method of calculating reserves changed in January 2021 and Spooner’s tracking of these trends show reserves increasing as much as 1900% on some claims. Why does it matter? That pretend money is treated like real money when your experience is calculated for the next year, determining your premiums. That $5000 ankle sprain is now a $29,000 ankle sprain, and the insurer (BWC) will recoup their losses from you accordingly. We’ve been tracking the impact these reserves have on Group Retro, and it shows a vast majority of the pools underperforming. Some competitors even show the possibility of an assessment, meaning that policyholder
