Workers' Compensation

Decoding the Language of Workers’ Compensation

Chelsea Bikner
Workers’ Compensation
Reading time 4 Mins
Published on Feb 25
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Reading through a workers’ compensation handbook or website can sometimes feel a lot like you’re browsing a text written in a foreign language. From acronyms to industry specific language, it’s not always easy to get a good handle on what exactly your Bureau of Workers’ Compensation representative or Third-Party Administrator (TPA) partner are even talking about. However, with the importance that workers’ compensation plays in the success and health of your business and employees, it’s important to get a handle on the most important terms, so here is a brief glossary of some common terms used in workers’ compensation that you might not be familiar with.

Benefit type

Benefit type is a common term that indicates the type of claim made. Most claims fall into one of two categories:

• Medical only claims are those claims on which medical benefits were paid out but no lost-time from work was made in the claim.
• Lost time claims include both medical benefits and lost-time payments in the claim.

Blended rates

Your blended rate is the actual rate that is used to calculate your workers’ compensation premiums. Your blended rate consists of assessments like administrative costs, the operating costs of BWC and the Industrial Commission of Ohio, and the Disabled Workers Relief Fund (DWRF).

BWC

While most states require employers to seek coverage through private insurance companies, in Ohio the state is the insurance company. Employers pay their premiums directly to the state for each rating year. Only Ohio, Washington, Wyoming, and North Dakota operate these state-monopolized BWC marketplaces.

After you submit your claim to your Managed Care Organization, the BWC assigned a Claim Service Specialist (CSS) to each claim and they make the first ruling on the compensability of the claim. The CSS communicates with all parties involved in the claim, including the injured worker, employer, medical provider, managed care organization, and third-party administrator.

Group experience rating

Group experience rating programs allow employers who operate similar businesses to group together to achieve lower premium rates than they could through individual rating. Savings opportunities vary depending on claim experience, industry, and payroll history. All participants must be a member of a sponsoring organization, like a chamber of commerce. Enrollment is for one rate year only and can be renewed annually, depending on eligibility.

Modified duty

Modified duty allow injured employees to get back to active employment as soon as possible, while allowing for job modifications or alterations that take into account each workers’ unique injury. By accommodating the restrictions imposed by your employee’s doctor, you are facilitating the safe and timely return of workers to the job, while minimizing their number of lost work days.

If your workplace is unable to accommodate a job modification onsite, there are options for off-site modified duty assignments as well. These placements are typically made for workers in industries for which on-site modified duty is difficult or nearly impossible, such as construction, some manufacturing, and other industries that require intensive amounts of manual labor. Such off-site placements are typically made with non-profit organizations in the community where the business operates or the worker lives.

Premium rates

Your premium rate is the cost of your company’s workers’ compensation coverage. The premium is determined by using the manual classification you were assigned by BWC, your claims history, and your experience rating. The BWC offers a number of discount programs to employers who participate in group rating programs or take advantage of other incentive opportunities that contribute to the overall health and safety of employees.

TPA

While the BWC mandates that all businesses work with an MCO, employers have the option to retain the services of a Third-Party Administrator (TPA) who acts as an advocate for the employer in the workers’ compensation process. TPAs offer businesses access to the many valuable BWC group discount programs, including Group Experience Rating and Group Retrospective Rating. TPAs can also provide future financial projections to help employers prepare for changes to their BWC premiums. Since the Ohio BWC doesn’t require employers to work with a TPA, fees for TPA services are paid for out-of-pocket by the employer.

Protecting your employees and your business

Workers’ compensation protects your business from costly litigation, while also protecting your most valuable resource – your employees. Made up of many moving parts, the BWC and its processes can be confusing for many people. Sheakley’s Workers’ Compensation experts are on your side – helping you understand the process and keeping you informed every step of the way. With more than 50 years to experience, our professionals are here to help you manage your costs while ensuring worker safety.

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