Last updated April 28, 2017.
If you get hurt on the job, you may be wondering how to recoup some of your expenses. It’s important to know how workers’ compensation works, and the distinctions between the rules based on your employer.
Below, we’ll go over the types of employers under workers’ compensation law, the qualifications and requirements for self-insured employers, how the Bureau of Workers’ Compensation may get involved in your self-insured case, and how you can get help with your claim from the experienced workers’ compensation attorneys of Plevin & Gallucci.
Self-insured vs. State Fund Employers
Ohio law requires employers with one or more employees to obtain workers’ compensation coverage or be self-insured for liabilities related to accidents on the job or occupational disease. There are two types of employers under workers’ compensation law in Ohio:
- State fund employers pay premiums directly to the state’s workers’ compensation fund. All compensation to their employees for “allowed claims” are paid out by the Ohio Bureau of Workers’ Compensation (BWC);
- Self-insurers are larger employers who are permitted to pay compensation directly to an injured worker. They pay providers for medical services and other benefits that injured or disabled workers are entitled to under the law, or furnish medical care where agreed to by the workers. Ohio Revised Code 4123.35; Ohio Administrative Code 4123-19.
About one-third of employers in Ohio are self-insurers, according to the BWC. Self-insured employers are given the authority to make decisions on workers’ compensation claims similar to that of a BWC administrator, and thus agrees to abide by BWC and Industrial Commission of Ohio rules and regulations.
The Qualifications and Requirements for Self-insured Employers
The main benefits of an employer becoming self-insured are potential cost savings by handling their own workers’ compensation claims. The BWC lists the following qualifications for employers seeking to become self-insurers, in addition to five years of certified financial statements and verifying that a public employer satisfies a number of additional financial requirements:
- Employers must be authorized to do business in Ohio from the Ohio Secretary of State;
- Employers must have two years of experience with the Ohio State Insurance Fund;
- Employers must have strong financial stability and possess the ability to administer a self-insured program;
- Employers need to maintain an account with an Ohio financial institution or draw any workers’ compensation checks from the same account with which they do payroll;
- Employers also need to have a BWC-certified Qualified Health Plan or medical-management plan.
Because ultimate responsibility of the claim resides with the self-insured employer, they must do the following by law:
- Make arrangements for reasonable medical care during working hours;
- Help employees complete workers’ compensation benefit forms or applications;
- Review workers’ compensation claims and issue payment in a timely manner;
- Keep an office in the state of Ohio that includes one or more employees who are capable of administering a workers’ compensation program, though a third-party administrator can assist the employer with this;
- Keep files in an orderly manner, and house these files within the state at one of the employer’s locations. Before housing claim files out of state, the employer must obtain approval from the BWC.
Self-insured Employer Privileges Can Be Revoked
The BWC has the right to revoke the self-insurer privileges of employers if they fail to properly carry out their responsibilities under the law.
Employees of self-insured employers should be aware of some important facts:
- Even if there is no dispute between the self-insurer and the injured worker about the injury and the employer is making payments, an injured worker must still show that a workers’ compensation claim has been made. A FROI-1 — First Report of an Injury form — should be filed with the BWC.
- If a self-insured employer engages in unfair workers’ compensation practices, an employee or his/her representative should notify the BWC.
- A self-insured employer must make timely payments of compensation, file medical reports as required, and otherwise meet minimum performance standards as set by the BWC. Where a self-insured employer fails to perform, there are grounds for filing for a public hearing to revoke the employer’s status as self-insured. The form number for filing a complaint against a self-insured employer is SI-28.
Get Help with Your Workers’ Compensation Claim
Whether your Ohio employer is a state fund employer or self-insured, it’s important to know your rights and protect your interests. If you’ve been injured on the job in Ohio, the experienced workers’ compensation attorneys of Plevin & Gallucci are available for a free, no-obligation consultation.
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