News and Updates
Category: Tpa
The Future of the Voluntary Abandonment Defense Remains Unclear
A recent House Bill made changes to Revised Code (R.C.) 4123.56, which became effective in September 2022. This part of the R.C. clarifies eligibility for Temporary Total Disability (TTD) compensation in workers’ comp claims. It was meant to provide clarity following the decades of case law that had complicated the “voluntary abandonment” defense often used by employers when a claimant takes voluntary action to end their employment. While the statute reads clearly enough, the changes resulted in ambiguity due to lack of detail. Ohio BWC or the Industrial Commission will often issue a clarification following such changes – but that didn’t happen this time. On March 2, 2023, the Tenth District Court of Appeals in Columbus issued a decision in State ex rel. Autozone Stores, Inc. v. Industrial Commission that could have a broad impact for Ohio employers. This was the first time an appellate court weighed in on the application of 4123.56(F) in a TTD claim, and it wasn’t a favorable ruling for businesses. Essentially, the ruling allowed the claimant to continue collecting TTD even though they were able to work with restrictions (for a different employer). The potential impact of this decision could hold employers hostage with no defense in TTD claims, driving up both EMRs and premiums for Ohio businesses. If you’d like to read more about the case surrounding this and its implications, click
Handicaps in Ohio Workers' Comp
When our team meets with prospective clients, we provide an in-depth analysis of their Ohio BWC policy. This allows us to show them how things got to where they are, where they’re headed, and if any of the damage done can be mitigated in some way. By the time we review the claims, it’s sometimes too late to un-ring most of those bells. However, one of the key items we focus on for our clients (especially new ones) is handicap potential. Ohio BWC has a list of pre-existing conditions that would delay a claimant’s recovery following a work-related injury. While some maladies on the list are rare in claimants, the top four are fairly common. If you have a lost time claim in your experience, it’s worth looking into. Here’s an example of what it could look like: Employee files a workers’ compensation claim that causes a 30% increase in premiums (once it enters the experience), to the tune of $20,000 additional each year for four years. Without a handicap, this claim is projected to cost the employer $80,000 in additional premium. Spooner locates medical evidence to indicate a pre-existing condition that qualifies for a handicap, and obtains a handicap at 30% from BWC. Employers receive a benefit from the handicap in either reduced premium payments in the future, or will receive a refund check from the BWC for overpaid premium - depending on when the handicap is granted by the BWC and how far along the claim is in the
Why You Need a TPA (and a Service Contract!) for Ohio Workers' Comp
If an Ohio employer wants to participate in a BWC sponsored discount program, they need to partner with a TPA (third-party administrator). Failure to do so can cost employers thousands, if not tens of thousands, in additional premiums annually. In addition to getting employers discounts on their workers’ comp premiums, TPAs work for the employer – not for BWC. Your TPA should be advocating on your behalf to manage all aspects of your workers’ comp claims and policy, including (but not limited to): Proper program placement Claims investigations Claims management Workplace safety programs Compliance and deadlines Attorney representation at Industrial Commission hearings If you rely on your TPA to manage workers’ comp claims (and you should be – you’ve paid them to!), you need a service agreement in place to protect you and provide terms for your relationship. Have you read your contract with your TPA? Do you even have one? If your TPA doesn’t have a service contract that spells out what services they are providing, ask them why that is. Often, we see that employers just get an invoice from their TPA with the amount due. In the event of a claim, do you know if you’re paying your TPA for anything more than a discount? Due to TPAs holding the key to BWC sponsored discount programs –many Ohio employers don’t realize that their TPA’s main objective should
