POLICY GOAL: An Efficient, Effective Workers’ Compensation System
The Ohio Manufacturers’ Association works with its member companies, the Ohio Bureau of Workers’ Compensation (BWC or Bureau), and the Ohio General Assembly to continually improve processes for injured workers and employers and to drive system costs down. An efficient and effective workers’ compensation system is built on the following principles:
Injured workers will receive fair and timely benefits they need for getting back to work quickly and safely.
All businesses will pay fair workers’ compensation rates commensurate with the risk they bring to the system.
Workers’ compensation rates will be driven by actuarial data, and the state’s workers’ compensation insurance system will remain stable, solvent and actuarially sound.
Workers’ compensation rates will not be structured in a way that punishes one class of employers to benefit another (such as the historical subsidization of group-rated employers by non-group-rated employers).
The Ohio Bureau of Workers’ Compensation will deploy best-in-class disability management practices to drive down costs for employers and improve service for injured parties.
These outcomes would be good for manufacturers and good for Ohio’s overall economy.
Workers’ compensation policy priorities include the following:
Design and deploy a competitive process that requires Managed Care Organizations (MCOs) to (a) meet rigorous performance standards established by the BWC and (b) compete on price for contracts with the BWC.
Eliminate the “reasonable suspicion” standard from Ohio’s rebuttable presumption drug statute
Incorporate the Louisiana Pacific standards of “voluntary abandonment” for benefits.
Improve claims management processes, transparency and accountability associated with Ohio’s Self-Insured Employers’ Guaranty Fund.
Require credentialing/certification of all claims management personnel based on accepted private insurance industry standards.
Establish retirement benefit offsets and/or age or number-of-weeks caps for permanent total disability (PTD) awards
Require claimants to show new and/or changed circumstances when filing for permanent total disability (PTD) or permanent partial disability (PPD) benefits more than once.
Require Industrial Commission hearings to be recorded to improve consistency in outcomes
Allow telephonic hearings for permanent partial disability (PPD) claims to lower transaction costs.
Establish an impairment standard (no consideration of non-medical factors) for permanent partial disability (PPD) cases.
Terminate the compensation paid for temporary total disability (TTD) effective the date determined by the medical evidence establishing maximum medical improvement.
Specify that if a temporary total disability (TTD) claim is suspended due to a claimant’s refusal to provide a signed medical release or attend the employer’s medical examination, the claimant forfeits his or her right to benefits during the period of the suspension.
Allow employers to pay compensation and medical bills without losing the right to contest a claim (payment without prejudice).
Require permanent partial disability (PPD) claims to be resolved by choosing either the claimant’s medical exam determination or the defendant’s medical exam determination – explicitly prohibiting an averaging of, or compromise between, the two.
Require MCOs to demonstrate their medical arrangements and agreements with a substantial number of medical, professional and pharmacy providers participating in the BWC’s Health Partnership Program. These providers should be selected on the basis of access, quality of care and cost, rather than solely claimant preference. The focus should be on getting injured workers back to work quickly and safely, benefitting both the employee and the employer.
Allow the BWC to require claimants to pay out-of-plan co-payments for selecting medical providers outside the approved MCO panel of providers, beginning the 46th day after the date of injury or the 46th day after starting treatment. However, employees should be allowed to use a provider outside the approved panel if they are located in certain parts of the state or outside the state where approved MCO providers cannot reasonably be accessed.
Allow the BWC to modify existing rules for the Bureau’s Health Partnership Program to include administrative and financial incentives that reward high-performing MCOs and other providers. Possible incentives include bonus payments to providers who greatly exceed quality benchmarks established by the BWC to help reduce costs without sacrificing quality of services or outcomes.
Collect and include in the BWC’s healthcare data program annual data measuring the outcomes and savings of MCOs and other providers participating in the Health Partnership Program. This data should be made available to employers and the public. The more performance data that are collected, the more efficient and effective the system will become.
Allow the BWC to recoup treatment costs from claims that ultimately are denied under BWC law. The Bureau should be able to request that an employee’s personal insurance or third-party payer reimburse the BWC for treatment amounts the Bureau paid on behalf of the employee. These payments should be deposited in the Surplus Fund Account. This will ensure injured workers will receive the treatments they need in a timely manner, while providing the Bureau a path to recoup payments that ultimately should not have been paid out by the system.
Allow the BWC to develop new rules permitting the BWC to pay for certain medical services within the first 45 days of an injury. This would ensure that injured employees receive treatment regardless of whether their claims are eventually denied in the process. Also allow the Bureau to create rules allowing for immediate payment of prescriptions in certain circumstances. If a claim is ultimately disallowed, the services paid must be charged to the Surplus Fund Account as long as the employer pays its assessments into the Surplus Fund Account in the State Insurance Fund.
Require injured workers to participate in the treatment process in a timely manner. Employees who refuse or unreasonably delay required treatment such as rehabilitation services, counseling, medical exams or vocational evaluations without a valid reason should forfeit their right to have the claim considered or to receive any compensation or benefits during the period of non-cooperation.