|
Policy
Name:
|
Employer
Authorized Representatives
|
|
Policy #:
|
EP-05-01
|
|
Code/Rule
Reference
|
Ohio
Administrative Code (OAC) 4123-17-67, 4123-17-73, and 4123-3-09(E).
|
|
Effective
Date:
|
November
5, 2018
|
|
Approved:
|
Ronald L.
Suttles, Chief Employer Services
|
|
Origin:
|
Employer
Policy
|
|
Supersedes:
|
All
policies and procedures regarding employer representation that predate the
effective date of this policy.
|
|
History:
|
Revised
July 18, 2019; June 27, 2014. New policy effective March 1, 2010.
|
|
Review
Date:
|
November
5, 2023
|
I. Policy Purpose
The
Ohio Bureau of Workers’ Compensation (BWC) protects confidential employer
information and recognizes the proper authorized representative when appointed
by an employer.
II. Applicability
This
policy applies to BWC Employer Services, employers, sponsoring organizations,
affiliated organizations, and employer authorized representatives.
III. Definitions
A.
Affiliated
organization: An organization
whose members are brokered, borrowed, shared, or co-opted for inclusion in a
certified sponsoring organization’s group. All affiliated organizations are
required to be certified sponsoring organizations.
B.
Authorized
representative: A person,
company, or firm that has been retained by an employer to represent the
employer’s interests before BWC or the Industrial Commission (IC).
C.
Claim Management
Representative (CLM):
The employer’s authorized representative designated as the employer’s
representative on claims related issues.
D.
Employer
Risk/Claim Representative (ERC):
The employer’s authorized representative designated as the employer’s
representative on claims and risk related issues.
E.
Group Risk/Claim
Representative (GRC):
The authorized representative that is responsible for management of group
plans. The GRC is authorized by the sponsoring organization. The GRC is
designated as the authorized representative of each employer in the group for
claims and risk related issues.
F.
Payroll Service
Vendor (PSV): A vendor
who provides payroll services including reporting, withholding, and remittance
services for workers’ compensation premium payments.
G.
Risk Management
Representative (RISK):
The employer’s authorized representative designated as the employer’s
representative on risk related issues.
H.
Sponsoring
organization: An entity
with governing members, which has been certified by BWC to sponsor and market
group programs through BWC. Certification requirements for sponsoring
organizations are outlined in OAC 4123-17-61.1.
IV. Policy
A.
BWC recognizes
several different types of representatives. The type determines the issues that
a representative may handle. BWC distinguishes between risk and claims issues.
1.
The GRC will:
a.
Be copied on risk
and claims correspondence;
b.
Have full access to
each employer’s risk and claims information and authority to access such
information on www.bwc.ohio.gov;
and
c.
Be considered the
authorized representative in handling claims related issues unless a CLM has
been designated by the employer.
2.
The ERC will:
a.
Be copied on claims
and risk correspondence;
b.
Have access to the
employer’s risk and claims information and authority to access information on www.bwc.ohio.gov;
c.
Be considered the
authorized representative in handling risk related issues for an employer if a
GRC has not been designated; and
d.
Be considered the
authorized representative in handling claims related issues for the employer if
no GRC or CLM has been designated.
3.
The RISK will:
a.
Be copied on risk
correspondence;
b.
Have authority to
access risk information on www.bwc.ohio.gov; and
c.
Be considered the
authorized representative in handling risk related issues for an employer only
if a GRC or ERC has not been designated.
4.
The CLM will:
a.
Be copied on claims
correspondence;
b.
Have access to only
the information that pertains to workers’ compensation claims filed against the
employer and will have access to that information on www.bwc.ohio.gov; and
c.
Be considered the
authorized representative in handling claims related issues for an employer.
5.
The PSV will have
authority to access risk information on www.bwc.ohio.gov.
6.
Employer Authorized
Representatives Summary Chart:
|
Type
|
Rep
Risk Issues
|
Rep
Claims Issues
|
Risk
Corresp
|
Claims
Corresp
|
Access
to Claims Info
|
Access
to Risk Info
|
How
auth is granted
|
|
GRC
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
AC-24,
U-151
|
|
ERC
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
AC-2
|
|
RISK
|
Yes
|
No
|
Yes
|
No
|
No
|
Yes
|
AC-2
|
|
CLM
|
No
|
Yes
|
No
|
Yes
|
Yes
|
No
|
AC-2
|
|
PSV
|
No
|
No
|
No
|
No
|
No
|
Yes
|
AC-2
|
7.
BWC Employer
Programs Unit updates GRC information, based on the designation made by the
group’s sponsor. Employer Programs Unit updates ERC, RISK, CLM, and PSV
information based on an individual employer’s request.
8.
BWC Self-Insured
Department updates ERC, RISK, and CLM information for self-insuring employers.
9.
The Temporary
Representative obtains authorization from the employer by using the Temporary
Authorization to Review Information (AC-3). The Temporary Representative may request limited risk or
claims information. See Temporary Authorization to Review Employer Information
section of this policy.
10.
An employer may
designate an authorized representative on an individual claim. See the Claims
Policy Authorized Representatives.
B.
Representative Identification
Number (RIN).
1.
The employer
authorized representative must file an Application for Representative
Identification Number (R-4) with BWC.
2.
BWC requires an RIN
in order to add the authorized representative to the employer’s policy on BWC
systems.
C.
Recognized representatives.
BWC will recognize authorized representative(s) for risk related issues and
claims related issues.
1.
The chart below
determines the representative(s) for risk issues and claims issues.
2.
The same
representative can be recognized for both risk and claims related issues.
3.
All representatives
have access to information as determined by their representative type (claims,
risk, or both).
4.
How to use the
chart: Place the employer on the row of the chart that describes its situation.
“Yes” means the employer has that representative type. For example: an employer
with an ERC and a CLM marked as “Yes” (and “No” marked for the other types),
will have the ERC as the representative for risk issues and the CLM and ERC as
representatives for claims issues.
|
GRC
|
ERC
|
RISK
|
CLM
|
Risk
Rep(s)
|
Claim
Rep(s)
|
Notes*
|
|
Yes
|
No
|
No
|
No
|
GRC
|
GRC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
No
|
No
|
Yes
|
GRC
|
CLM, GRC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
No
|
Yes
|
No
|
GRC, RISK
|
GRC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
No
|
Yes
|
Yes
|
GRC, RISK
|
CLM, GRC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
Yes
|
No
|
No
|
GRC, ERC
|
GRC, ERC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
Yes
|
Yes
|
No
|
GRC, ERC,
RISK
|
GRC, ERC
|
N/A for
SI, BL, MF, & PES
|
|
Yes
|
Yes
|
Yes
|
Yes
|
GRC, ERC, RISK
|
CLM, GRC,
ERC
|
N/A for
SI, BL, MF, & PES
|
|
No
|
No
|
No
|
No
|
None
|
None
|
|
|
No
|
No
|
No
|
Yes
|
None
|
CLM
|
|
|
No
|
No
|
Yes
|
Yes
|
RISK
|
CLM
|
|
|
No
|
No
|
Yes
|
No
|
RISK
|
None
|
|
|
No
|
Yes
|
Yes
|
Yes
|
ERC, RISK
|
CLM, ERC
|
|
|
No
|
Yes
|
No
|
No
|
ERC
|
ERC
|
|
|
No
|
Yes
|
Yes
|
No
|
ERC, RISK
|
ERC
|
|
|
No
|
Yes
|
No
|
Yes
|
ERC
|
CLM, ERC
|
|
|
* SI:
Self-Insured; BL: Black Lung; MF: Marine Fund; PES: Public Employer State
|
D.
Temporary authorization
to review employer information. Third party administrators (TPAs) obtain
temporary authorizations from employers in order to provide quotes for Group
Experience and Group Retrospective Rating plans.
1.
TPAs are required to
use form AC-3 to obtain temporary authorization.
a.
Completion of the
temporary authorization provides a TPA limited authority to view an employer’s
payroll, National Council on Compensation Insurance (NCCI) classifications, and
loss experience.
b.
Additionally, the
TPA may request data from BWC’s Policy Information Request System (PIRS). The
PIRS system provides the following information.
i.
Claim demographics;
ii.
Claim reserve and
cost information;
iii. Claim to ICD (International
Classification of Diseases) information;
iv.
Policy to NCCI
manual re-class information;
v.
Policy combinations
& partial transfer information;
vi.
Employer experience
exhibit information; and
vii. Risk and accounts receivable information.
2.
If the TPA is
obtaining temporary authorization from an agent of the employer, such as a
certified public accountant (CPA), the agent must have written approval from
the employer client. This written approval must be verifiable by the TPA or BWC.
3.
An authorized AC-3
is valid for a nine month period, unless specified for a shorter period on the
AC-3 form. BWC requires the TPA to keep an approved AC-3 on file and available
for review by BWC for a period of one year from the expiration of the AC-3.
4.
The employer may
withdraw the temporary authorization prior to its expiration date by contacting
the TPA or BWC. In cases where BWC is contacted by the employer, BWC will
communicate the employer’s withdrawal to the TPA.
5.
A TPA may obtain
temporary authorization from an employer by:
a.
Written authorization.
i.
A signed
authorization may be sent via mail or fax. Additionally, a signed authorization
may be sent as a PDF attachment to an email.
ii.
Written authorization
is the preferred method of authorization.
b.
Electronic
authorization.
i.
BWC permits a TPA to
obtain AC-3 approval from an authorized employee or agent of the employer via
email or electronic submission through the TPA’s website.
ii.
The electronic
version of the AC-3 must contain all of the employer data and verbiage that is
on the paper version of the AC-3. The employer may provide an electronic
signature on the AC-3.
iii. If the electronic AC-3 does not contain
the same employer data as the AC-3, the TPA must complete a written AC-3 form
by entering the employer’s information, including printing the authorized employee
or agent’s name and the date the electronic approval was received.
iv.
The TPA
representative must print the AC-3 form and legibly print his/her name next to
the authorized employee or agent’s name.
v.
In all cases, the
TPA must mail or distribute a printed copy of the AC-3 with the authorization
information to the employer with a letter explaining the electronic approval
obtained.
c.
Verbal
authorization.
i.
BWC permits a TPA to
obtain AC-3 verbal approval from an authorized employee or agent of an employer.
ii.
The TPA must clearly
explain to the employer that the TPA will use the authorization to request the
employer’s claims and risk information from BWC.
iii. The TPA must print the authorized
employee or agent name, and date of approval, on the AC-3. The TPA representative
must legibly print his/her name next to the authorized employee or agent’s name.
iv.
The TPA must print
the words “verbal authorization” in the signature box of the AC-3.
v.
The TPA must mail or
distribute a completed copy of the AC-3 to the employer with a letter informing
the employer that verbal authorization has been obtained, and risk and claims
information will be requested from BWC.
vi.
The letter must
outline that the employer should contact the TPA within fourteen (14) days if
the employer wishes to revoke the temporary authorization.
vii. The TPA must wait fourteen (14) days
after the letter and AC-3 copy is sent to the employer before requesting
confidential information from BWC.
viii. The TPA must request the confidential information from
BWC’s PIRS system.
6.
BWC review of the
temporary authorization process. If a TPA obtains experience data without a
valid AC-3, BWC will require the TPA to provide a written explanation. BWC will
evaluate the written response and determine if the TPA violated the guidelines
of this policy. If BWC determines the TPA violated this policy, BWC may:
a.
Make recommendations
to the TPA to change its AC-3 procedures;
b.
May require the TPA
to use only written authorizations for a period of one year; or
c.
May take other
action as deemed appropriate, including, but not limited to, requiring the TPA
to provide a copy of an AC-3 with each request for employer data.
7.
BWC recommends that
TPAs communicate the AC-3 and temporary authorization requirements annually to
all TPA staff who market group programs.
8.
TPA revision of AC-3
form. To assist in limiting confusion over who is requesting the AC-3 form from
the employer, TPAs are required to revise the AC-3 form that will be sent in
mass mailings to employers, as follows:
a.
The TPA must remove
the BWC logo and return address from the AC-3 and replace it with the
sponsoring organization/TPA logo and return address.
b.
No other changes to
the form are permitted.
c.
The statements in
8.a. and 8.b. apply only to AC-3 forms that will be mass mailed to prospective
employers.
E.
Group program
employer representation. For Group Experience Rating, the Application for
Group-Experience-Rating Program (AC-24) establishes the GRC. For Group
Retrospective Rating, the Application for Group Retrospective Rating Program
(U-151) establishes the GRC.
F.
Employer risk and
claim representation. An employer may designate an authorized representative to
handle risk and/or claims matters on its behalf by using the Permanent
Authorization (AC-2).
1.
For a Group rated
employer:
a.
If the employer is a
group participant, the GRC will represent the employer on all risk related and
claims related matters.
b.
The employer may
designate a CLM. If the employer has a CLM, the CLM will represent the employer
on all claims related matters.
c.
The employer may
designate an ERC for risk and claims related matters.
d.
The employer may
designate a RISK for all risk related matters.
e.
If the employer is
not accepted into group rating the next policy year and does not have an ERC
designated, the GRC will automatically become the ERC for the employer.
2.
For a non Group
rated employer, the employer may designate:
a.
An ERC for risk and
claims related matters;
b.
A CLM for claims
related matters; or
c.
A RISK for risk
related matters.
3.
Employer representatives
may fill out AC-2 forms online via www.bwc.ohio.gov. This online process allows the
employer representative to be added as an authorized representative on the
employer’s policy. To use this online process, the employer representative must
have a properly signed and dated AC-2 form from the employer. The employer
representative must maintain the copy of the AC-2 as long as the employer is
represented.
G.
Updating, changing,
and dismissing employer authorized representatives.
1.
Only the sponsoring
organization can change the GRC for the group and the individual employers in
the group.
2.
To change a GRC, the
sponsoring organization that submitted group applications for the current
policy year must submit:
a.
A letter outlining
the specific request that includes:
i.
Name of the current
TPA;
ii.
Name of new TPA; and
iii. A listing of all group rating plans
(group number and name);
b.
A completed AC-2
authorizing the new TPA; and
c.
A completed AC-24,
or a completed U-151, indicating the new authorized representative, with all
groups listed on the employer roster.
3.
The following steps
must be completed when an affiliated organization requests a change to its TPA.
Since the affiliated organization is not the sponsoring organization for groups
submitted for the current rating year, the GRC cannot be updated. However, BWC
will add the new TPA as the ERC for each employer who is a member of the
affiliated organization, if all requirements are met.
a.
The new TPA must:
i.
Send a letter of
explanation to all impacted employers. This letter must be submitted to BWC for
review and approval prior to sending to employers. The letter must include:
a)
BWC approved
verbiage;
b)
Contact information
for the affiliated organization’s new TPA; and
c)
A timeframe for the
employer to notify the affiliated organization’s new TPA that the employer does
not want the new TPA to be added as the ERC on its policy. The holding period
is a minimum ten business days from the mail date.
ii.
Provide BWC with a
final copy of the letter referenced in section 3.a.i. above;
iii. Upon request, provide BWC with the name,
individual contact information, and relevant documentation for any employer who
declined to add the new TPA as an ERC;
iv.
Provide BWC with
written confirmation and agreement signed by the sponsoring organization and
the current GRC that includes the following:
a)
Signatures from all
parties;
b)
Details regarding
the rating year and sponsoring organization;
c)
Name of current
sponsoring organization’s GRC;
d)
Name of affiliated
organization’s new ERC;
e)
Effective date (must
be after the date all employers are notified and the minimum holding period);
and
f)
A final list of all
employers who agreed to the ERC change that includes BWC policy number and
policy name.
b.
BWC will not process
the affiliated organization’s request without agreement from all parties (i.e.,
sponsoring organization and current authorized group TPA/GRC). If all parties
are not in agreement, each employer must complete and submit an AC-2 to add the
affiliated organization’s new TPA as an ERC on its policy.
c.
BWC will only add
the new TPA as an ERC for the employer if the employer is listed on the group
roster as a governing member of the affiliated organization.
d.
The affiliated
organization must submit a completed AC-2 authorizing the new TPA.
e.
BWC will process
requests meeting all requirements within seven working days.
4.
An employer may
update, change, or cancel an ERC, RISK, or CLM for its policy or claims.
However, these changes may be limited if the employer is a group program
participant. Specifically, the GRC will also represent the group rated employer
on all risk related matters and claims related matters.
5.
An employer must use
an AC-2 to add an authorized representative to its policy. The AC-2 can be used
to add an ERC, RISK, CLM or a PSV. The AC-2 should be submitted to BWC Employer
Programs or BWC Self-Insured Department. The most recently submitted AC-2
supersedes any prior permanent authorizations on file for the type of
representative indicated on the AC-2. Previously authorized representatives of
the same type on the recently submitted AC-2 will be placed in a dismissed
status.
6.
An employer or
authorized representative may use the online AC-2 service offering on BWC’s website to add, change, or
terminate an authorized representative. There must be a written copy of the
AC-2 at the employer’s or representative’s site before an online AC-2 may be
processed.
7.
If the employer
wishes to dismiss an authorized representative without adding an authorized
representative of the same type, the employer must submit a letter to BWC. The
letter must indicate the specific authorized representative being dismissed and
be signed by an authorized employee of the employer. The letter must include
the employee’s signature, name, and title.
8.
The authorized
representative may submit a signed letter withdrawing as the employer’s
representative. This letter must include specific employer information and be
signed by the authorized representative. The authorized representative may also
send an email to BWC with a list of employers, and the effective date(s) that
the authorized representative will no longer be representing these employers.
9.
If an employer
representative is acquired by another entity, BWC will not recognize the new
entity as an employer’s representative without proper authorization. An
employer impacted by the acquisition must sign an AC-2 if the employer wishes
to authorize a new employer representative.
H.
Scenarios:
1.
A subsidiary company
of an employer’s authorized representative requests data on the employer’s
policy. Can the data be released?
Answer: No, only the authorized
representative, as listed on the AC-2 or AC-3, can be given data for an
employer.
2.
An Application for
Disability Relief (CHP-4A) has been filed by the employer’s claim representative.
Can this application be processed?
Answer: Yes, BWC can process the
application. Disability relief has both claims and risk implications.
Therefore, BWC can process an application for disability relief, regardless if
the disability relief application is filed by an employer’s risk or claim
authorized representative. This scenario recognizes the unique nature of disability
relief as an issue that touches both claims and risk issues.
3.
How do successorship
situations impact the ability of a TPA to request risk data from BWC on a
predecessor or successor?
Answer: The successor’s TPA may obtain
predecessor employer risk data for any employers that were fully combined into
the successor’s policy. For partial transfers, the successor TPA may obtain
risk data that pertains to the partial transfer to the successor employer.
A predecessor TPA may not obtain any
data from the successor’s policy, regardless of the successorship being full or
partial.