4123-17-71 One claim program.

 

 

 

4123-17-71                  One  claim  program  for  experience  rated  and  base  rated employers.

 

 

Pursuant to division (E) of section 4123.34 of the Revised Code, the administrator may grant a discount on premium rates to an eligible employer that meets the one claim program (OCP) requirements under the provisions of this rule.

 

(A)  As used in this rule:

 

(1)    "One claim program" or "OCP" means the bureau's voluntary rate program which offers a private, state fund employer the opportunity to mitigate the impact of a significant claim that would be coming into the employer's experience for the first time from the green year.

 

(2)   "Significant claim" means a claim whose total value or maximum claim value, whichever is lower, will be greater than the employer's total limited losses (TLL).

 

(B)  Application and withdrawal processes.

 

An employer's participation in the OCP is voluntary and shall be for a maximum of four policy years in relationship to a specific significant claim. The bureau shall evaluate each application to determine the employer's current eligibility to participate in the OCP at the time of the application and for each year of continuing participation. The bureau shall have the final authority to approve an eligible employer for initial and continued participation in the OCP.

 

(1)   A private state fund employer shall submit a completed application by March thirty-first for the policy year beginning July first of that year; except that for the 2009 deadline only, the employer shall file the application by April 30, 2009.

 

(2)    An employer may withdraw from the OCP under this rule at any time. An employer that withdraws from the OCP after receiving a discount will return to its own individual experience rating for the rest of the policy year.

 

(3)   If the employer withdraws from the OCP and has any remaining years in which the significant claim is still in its experience, the employer may reapply for the OCP and designate the same significant claim as its one claim.

 

(C)  Eligibility requirements.

 

At the time of an employer's application for the OCP, the employer shall be currently enrolled in a group rating program and shall meet the following program

 

 

requirements:

(1)   The employer shall have no more than four claims in the next experience period including the most recent calendar year with the total cost value of the one significant claim or the employer's maximum claim value, whichever is lower, greater than the employer's TLL. The four claims may include up to three medical only claims and one significant claim.

(2)     The employer shall be current at the time of the application underwriting review. "Current" means that the employer is not more than forty-five days past due on any and all premiums, assessments, penalties or monies otherwise due to any fund administered by the bureau, including amounts due for retrospective rating at the time of the application deadline. The employer must continue to be current throughout its participation in OCP.

(3)      The employer cannot have cumulative lapses in workers' compensation coverage in excess of fifty-nine days within the eighteen months preceding the March thirty-first application deadline or any time thereafter while participating in the OCP.

(4)    An employer in the OCP shall continue to meet all eligibility requirements during each year of participation in the program.

(D)  General program requirements.

(1)     In signing the application form, the chief executive officer or designated management representative of the employer is certifying to the bureau that the employer will comply with all program requirements.

(2)   An employer may have a maximum of three medical only claims at any time in addition to the one significant claim. As a medical only claim exits the employer's experience period, the employer may include a new medical only claim.

(3)    The total number of medical only claims may not exceed three, and the total combined costs of these claims must be below the employer's TLL.

(4)   An employer may participate in the OCP on no more than one claim every four years from the date of the employer's initial participation in the program. If the combined claim costs for the three medical only claims increase over the TLL, the employer would not be eligible.

(5)   Once a claim has been designated as the one significant claim, an employer is not permitted to change the designated claim after the employer's initial enrollment in the program.

(6)    Settled and subrogated claims will be included in the employer's total claim count.

(7)    The employer shall attend the bureau's "Workers' Compensation University" and one other BWC-approved training class each participating policy year.

(E)  Program benefits.

(1)    The bureau will credit an employer that meets all the criteria with a forty per cent discount from the employer's base rate.

(a)    Any employer that has a lower EM% due to the one hundred-per cent year-to-year cap as provided in paragraph (G) or paragraph (H) of rule 4123-17-03 of the Administrative Code than the forty per cent discount offered under this rule would receive the EM% based on the one hundred-per cent capped EM.

(b)   The employer should still apply for the one claim program as provided in this rule to allow the employer to continue in the one claim program in subsequent policy years.

(2)   The employer shall be eligible to participate in the bureau's drug-free workplace program or drug-free EZ program and may add the drug-free discount in addition to the OCP discount.

(F)   Removal from program.

The bureau will remove an employer from participation in the OCP at the beginning of the next policy year and, upon removal, will return the employer to its individual experience modifier, under the following circumstances:

(1)   If the employer has more than four claims, lost time or medical only, including the one significant claim;

(2)    If the combined claim costs of the three medical only claims increase past the TLL;

(3)    If the employer fails to meet any of the eligibility or general requirements of paragraph (C) or paragraph (D) of this rule.

(G)      An employer may appeal the bureau's application rejection or the bureau's participation removal in the OCP to the bureau's adjudicating committee pursuant to section 4123.291 of the Revised Code and rule 4123-14-06 of the Administrative Code.

Effective:                                                     01/01/2010

CERTIFIED ELECTRONICALLY

Certification

11/27/2009

Date

Promulgated Under:                           111.15

Statutory Authority:                           4121.12, 4121.121

Rule Amplifies:                                  4123.29, 4123.34

Prior Effective Dates:                         1/1/05, 2/12/09