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OhioBWC - Employer: (Self-Insurance Program Description)
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Self-Insurance Program Description
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Every employee in Ohio must be provided with workers' compensation coverage either through the
state fund or by an employer who has been granted the privilege of self-insurance. A self-insuring employer
agrees to abide by BWC and the Industrial Commission of Ohio rules and regulations as described in
OAC 4123-19-03 and
ORC 4123.35. The self-insuring employer agrees to provider
accurate and timely payments of compensation and benefits subject to the provisions of those rules.
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| Qualifications for Self-Insurance
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| To qualify for self-insurance, an employer must meet several requirements, including:
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Have a minimum of 500 employees within Ohio;
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Two-years experience with the state insurance fund;
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Demonstrate strong financial stability;
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Possess the ability to administer a self-insured program;
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Maintain an account with a financial institution in Ohio, or draw compensation checks from
the same account as the payroll checks;
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Have a BWC certified Qualified Health Plan (QHP).
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Program Administration
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Unless otherwise permitted by BWC, the self-insuring employer must have a company office located in
Ohio and shall designate one or more employees to be knowledgeable and capable of administering an efficient
workers' compensation program. The claims administration process includes, but is not limited to, the
allowance or disallowance of claims, payment of compensation and benefits, maintaining claim files, and making
the appropriate information available to the injured worker and/or their representatives for inspection. The
administrative process also includes assisting employees in filing their applications for benefits and completing
the necessary forms for processing a workers' compensation claim.
The employer may retain a third party administrator or an individual to assist in handling workers' compensation
claims and to authorize settlements. However, the ultimate responsibility for the administration and
processing of workers' compensation claims resides with the self-insuring employer.
Workers' compensation claim files must be housed at an Ohio location of the self-insuring employer. Should the
employer wish to maintain claim files out of state, prior approval must be obtained from BWC's self-insured
department.
The employer must post a copy of its self-insured certification at each work site with the name, title and
department location of the company individual who is responsible for administering its workers' compensation program.
Also, the employer must furnish or make arrangments for reasonable medical services during working hours
in accordance with BWC rules.
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Self-insuring publications
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BWC's self-insured department has two publications to keep self-insuring employers up-to-date on workers'
compensation management.
- Self-Insuring Update - newsletter providing the latest news to self-insuring employers
- The Script - newsletter providing the latest information about provider treatment in the self-insuring community
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Requirements of Self-Insuring Employers
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As a self-insuring employer, you must participate in the Self-Insured Employers
Guaranty Fund. This fund guarantees that claims liabilities are satisfied if the
self-insured employer is unable to pay them. BWC bases the guaranty fund assessment
on the total of your last two paid state-fund payroll premiums at base rate; multiplied
by 6 percent, you are assessed once a year for three years. The minimum assessment
is $5,000 per year for the three years.
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In addition, you must reimburse disabled workers' relief fund payments on a semiannual
basis. This fund is for permanently and totally disabled employees whose workers'
compensation benefits have not kept up with inflation. BWC bills you dollar for dollar
regardless of the date of injury. The buy-out agreement does not relieve you of your
state-fund disabled workers' relief fund liability.
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Also, you must form a BWC-certified Qualified Health Plan (QHP), which is a managed
care program to deliver medical services to your employees. You can administer the
QHP yourself, contract with a BWC-certified managed care organization or select
services from medical management vendors. Prior to establishing a QHP you must attend
a training session.
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For more information
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Call BWC's self-insured department at (614) 466-6737 or 1-800-OHIOBWC and follow the options.
Check out a list of
forms available, along with step-by-step instructions for completing those forms.
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