Workers' Compensation

Understanding Roles in the Ohio BWC System

Chelsea Bikner
BWC
Reading time 3 Mins
Published on Dec 6
Share

The Ohio Bureau of Workers’ Compensation (BWC) and its inner workings can seem like a confusing mystery to most people. With so many moving parts that must work together to ensure the timely resolution of claims and the appropriate treatment of injuries, understanding the functions of each component of the BWC system can help ease tensions, reduce stress, and allow employers and employees to more fully trust the workers’ compensation system. Read on to learn more about the specific role that each organization plays within the BWC system.

 

The Ohio 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.

Managed Care Organizations

A Managed Care Organization (MCO) is a private company that employers select to medically manage their workers’ compensation claims for injured employees. The Ohio BWC requires that all employees select one of the state-approved MCOs to work with. Fees for the MCO are paid by the BWC out of the employer’s premium for the year. The MCO provides medical management for claims, including obtaining initial claim data and medical records for the BWC and managing and paying all medical provider bills, helping to ensure that all fees are reasonable and customary in addition to being appropriate for the claim. Additionally, the MCO authorizes and denies all medical treatment requests, coordinating with the medical care provider to facilitate the safe and timely return to work of injured workers.

Third-Party Administrators

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 Ohio Bureau of Workers’ Compensation 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.

Stay up-to-date on all things Sheakley by subscribing to our blog and following us on social media. Join in the discussion by commenting below.


You may want to read

See all articles
X
X
X
X