Navigating Ohio’s workers’ compensation system

For most employers, workers’ compensation is one of a thousand items that require their attention  daily. Most workers’ compensation professionals will tell you that the best injury is one that never  happens. The reality is that there are 257,000 private and public Ohio employers incurring  approximately 67,432 allowable injuries in 2023. (Source: Ohio Bureau of Workers Compensation 2023 Annual Report). 

Managing a workers’ compensation program can be simplified by implementing a few standardized  processes that will make it easier for you to minimize lost days, control your costs and maintain  productivity in your business. 

Early Claim Intervention 

Having a standardized injury reporting process and claim investigation mandate in place before an  injury happens means that you will have tools at your disposal to quickly analyze what happened, is it  work related and are there any red flags that will lead you to contest the claim. 

Your Managed Care Organization (MCO) can provide your company with guidance on any questions  related to injury reporting and seeking BWC (Bureau of Workers Compensation) authorized provider  medical treatment. The injured worker will need to complete a First Report of Injury (FROI), which is the  BWC form required for filing a claim application. It is also a good best practice to have your employee  complete a supplemental accident report that is specific to your work environment and expands on  some of the important questions that arise during an injury investigation, such as – were there any  witnesses? Did you immediately notify your supervisor?  

Minimizing Claim Costs 

Once a claim application is filed with the BWC, things begin to move quickly and your window of  opportunity to minimize the impact is small. The most common type of compensation is Temporary  Total (TT). This is when the BWC pays the injured worker a portion of their regular pay to cover their  lost wages while recovering from an allowed injury. 

If you are not contesting the claim or its compensability, your focus should move to helping your  injured workers get the necessary treatment they need to quickly return to full duty employment. 

If you can accommodate a return to light duty while the treatment moves forward, then making a light  duty job offer will prevent the claim from flipping from “medical only” to “lost time”. It will also keep  your injured worker from getting used to being off work because of the injury. If light duty is not an  option, then another path is to pay the claimant their regular wages – also known as salary continuation  - while they are off work.

Other Cost Containment Options 

When a claim is allowed the BWC attaches a reserve to estimate and cover future costs. There are  several ways to minimize the impact a reserve has on your annual premiums: 

Settlement – the most effective way to close a claim and prevent future costs from being applied is to  negotiate a full and final settlement with the injured worker. The settlement amount is paid out of the  claim by the BWC, the cost is added to the overall claim cost and the injured worker receives monies in  lieu of future treatment and compensation.  

Disability Relief – The BWC currently has a program in place to recognize pre-existing conditions that  negatively impact the allowed conditions or the injured worker’s recovery from the allowed condition.  The BWC will hold an informal conference with the employer/Third Party Administrator (TPA) to review  the application and the medical that supports the request and then will determine an impact  percentage between 0% and 100%. This percentage relates to the amount of “relief” the employer will  receive due to filing a successful application. 

Subrogation/No Fault MVA (Motor Vehicle Accident) – When a third-party is the cause of a workplace  injury there may be relief that can be pursued to offset the cost of the claim. The most common  example is an employee’s claim that is the result of a non-at-fault vehicle accident involving a third  party.  

Navigating the workers’ compensation system can feel frustrating and at times complicated, but with  your MCO and TPA partners you have access to subject matter experts that can make your job easier  and keep your premiums down. 

If you have any questions, contact our Sedgwick program manager, Julia Bowling at julia.bowling@sedgwick.comor ph 513-218-4062.