Self-Insured Newsletter - June 2020
Self-Insured Department Update
Since our last newsletter, the world has changed around us. Like you, we had to adapt quickly to a whole new environment. We reconfigured to a social distancing situation, moving the entire Self-Insured (SI) Department to work from home to help minimize the spread of COVID-19. Overall, the transition has been smooth.
We continue to address our underwriting, compliance, and administrative functions. We’re using new technology to ensure we’re available to assist you and communicate effectively.
We recognize each of you is facing new challenges and looking for new paths to get as close to normal as possible. We’re available to address any issues or inquiries that arise. You can find answers to frequently asked questions regarding policy, claim, and medical information here. We update this information regularly. You can still access your SI Policy page and view most of your policy information when you log into your e-account. This includes policy demographic information, coverage status, renewal, SI-40 reporting, and invoice details.
Should you have questions, comments, or concerns, please feel free to contact us at SIINQ@bwc.state.oh.us.
BWC will issue self-insured assessment invoices on July 26, 2020, covering the period from Jan. 1, 2020, to June 30, 2020. The assessments will be based on the 2018 reported compensation and will be due on Aug. 31, 2020. The invoices will be available online on July 27, 2020, on your dashboard as you log into your e- account. Assessment and DWRF details will also be accessible from your dashboard page. We encourage you to opt to receive an e-notification when theinvoice is available, in lieu of a paper invoice. This option is also available from your dashboard.
When paying assessments, please remember to allow enough time for us to process and post the payment prior to the due date to avoid late payment penalties. Self-insured employers should pay assessments using an electronic check, automated clearing house (ACH) transfer, or credit card. This will ensure timely payment and provide an audit trail. You can schedule electronic payments in advance to ensure the correct payment date. Using other methods for paying assessments will make it harder for you to challenge late payment penalties. The Online Payment service is available directly from your dashboard when you login to your e-account.
The assessment rates for July 1, 2020,to June 30, 2021, have been presented to our Board of Directors for approval. The proposal is for the Mandatory Surplus Fund rate to decrease from 0.030 to 0.015 per dollar of reported compensation for 2019, while the Self-Insuring Employer’s Guaranty Fund (SIEGF) will increase from 0.100 to 0.1172. The BWC administrative cost fund is increasing from 0.0940 to 0.0950 and the Industrial Commission administrative cost fund is increasing from 0.0726 to 0.0826. The Safety and Hygiene Fund remains at 0.0100. The total assessment increase is 0.0132, or 1.32 cents per reported dollar. The optional Surplus Fund for Disallowed Claims is increasing from 0.0050 to 0.0060.
Direct Deposit of Compensation
During the COVID-19 pandemic, and even after, self-insuring employers may consider paying workers’ compensation benefits through an electronic fund transfer. This allows payments to deposit directly into the recipient’s bank account or into a benefit card in the injured worker’s name. This may be beneficial to the injured worker as well as the employer providing the benefits.
Before initiating this process, the injured worker must provide a written authorization to deposit the funds electronically and their account number. Please remember to have documentation in claim file and/or payment history that shows the:
· Date of the transaction.
· Transaction identification number.
· Benefit type.
· Recipient’s name.
· Period covered.
· Amount paid.
Online Claim Reporting
Self-insuring employers must report all claims with lost time or contested issues to BWC within one week of acquiring knowledge of the claim. You then must notify the injured worker and BWC of the allowed conditions within 30 days of reporting the claim. Injured workers, employers, and providers may notify BWC of claims through mail, fax, in person, or electronically.
Employers or their representatives can file claims online here. You must log in to your e-account. To report the claim online you must have all of the information required on the First Report of Injury (FROI-1) form. This includes your policy number and the injured worker’s name, Social Security number, mailing address, phone number, date of birth, gender, job title, and date of hire. You also must provide an accident description, type of injury, and body part affected, along with the date you were notified of the injury.
When reporting an injury, it is important to identify whether the claim is certified or contested here. You must also input the allowed conditions with the appropriate ICD or diagnosis code here. When you become aware of a claim that was initially reported directly to BWC, you can update your certification determination and ICD code and confirm the claim certification here after logging in. You can update the ICD code here. The ICD code is necessary to change the claim status to certified or contested. Reporting claims online will allow you to establish the allowed conditions, which will reduce follow-up from BWC and ensure the claim documentation is accurate in our system.
Proposed Rule Changes
OAC 4123-6-21.1 (M) - We are proposing to clarify the time to address an authorization request for prescriptions to no more than three days. This is in line with BWC’s expectations, while allowing employers to ensure the prescriptions are appropriate and the avoid delays for injured workers to received necessary medications.
OAC 4123-6-21.1 (I) - We are proposing to remove the requirement to obtain a drug utilization review before terminating certain prescriptions, including Oxycontin, which has been removed from BWC’s drug formulary.
We will resume scheduling Level 3 audits in June 2020. The Level 3 audits were usually conducted at the employer’s facility or at their representative’s office. They had been suspended due to travel restrictions. We will conduct the Level 3 audits remotely and will have wrap-up discussions through video or teleconference.
We mostly conduct remote Level 2 audits, which focus on timely and accurate compensation payments, claim reporting, SI-40 reporting, and permanent total disability claims. The Level 3 audits are more in-depth and include a review of medical bill payment, treatment requests, and claim reporting along with all items from the Level 2 audit. Level 3 audits are usually scheduled for a new self-insuring employer’s first audit, or as a follow-up to a non-compliant audit finding. We will also schedule random Level 3 audits as part of our scheduling process. Please feel free to contact Dave Sievert at firstname.lastname@example.org if you have any questions.
Aug. 31, 2020: Assessment payments due (must use online payment method)