BWC: New Reserving System Coming
Now that the Ohio BWC has moved away from using ICD-9 Codes to using ICD-10 Codes for categorizing injuries and illnesses, they will be changing from the MIRA II Reserving System to the new ACES Reserving System. The ACES (Actuarial Claims Estimating System) process will be implemented on 7/1/2020. ACES uses very similar cost drivers (input variables) as MIRA II. Reserves are a key component in determining what your company’s EMR (Experience Modification Rate) will be for the upcoming policy year. Simply put, Reserves are estimated future costs of a claim. If Reserves are present on a claim when the BWC takes their annual EMR “snapshot” on September 30th, then there is a possibility that your EMR will be higher than anticipated for the upcoming policy year. The BWC’s calculation for how they arrive at a claim’s Reserve is proprietary, but they do look at such variables as claimant’s age, type of injury and expected recovery time.
Injured Worker Vocational Rehabilitation Participation Streamlined
Effective Oct. 7, 2019, the Ohio BWC made changes to vocational rehabilitation rules, policies, and procedures to simplify how an injured worker enters in to a voc rehab program. The rules impacted are OAC 4123-18-03 and OAC 4123-18-04. The BWC and the managed care organizations (MCOs) will no longer complete multiple decisions about eligibility, feasibility, and living maintenance (LM).
The MCO still makes the initial determination about feasibility and sends this recommendation to the BWC. The BWC will then review the eligibility criteria. Based on their review and the MCO decision, the BWC will issue a single participation order either approving or denying an injured worker’s participation in voc rehab. Employers are to send appeals of the voc rehab participation order directly to the Ohio Industrial Commission (IC) for adjudication. Any party to the claim may submit an appeal within 14 days of receipt of the order through the IC’s online network or the Notice of Appeal (IC-12) form.
Eligibility criteria changes
The BWC also made changes to simplify the eligibility criteria for voc rehab. These changes remove the requirements that the injured worker:
● Has received or been awarded a permanent partial award under Ohio Revised Code 4123.57(A).
● Must have been determined to have reached maximum medical improvement (MMI). The MMI criteria was changed that the injured worker is not currently receiving compensation and has job restrictions dated not more than 180 days from the date of referral.
● Was receiving LM wage loss not more than 90 days prior to the date of referral and has continuing job restrictions documented by the physician of record.
● All other eligibility criteria still apply.
An injured worker will no longer be eligible for voc rehab services if they:
● Successfully complete a comprehensive voc rehab plan and subsequently resign from employment.
● Are terminated for cause and the resignation or termination is not due to the allowed conditions in the claim.
There are four circumstances when a BWC order addresses Living Maintenance (LM). They are:
● Initial voc rehab participation decision.
● Suspension of LM for more than 30 days for medical interruption.
● Resuming LM.
● Deductions from LM.
Top 10 Most Frequently Cited Workplace Safety Violations Named for 2019
The National Safety Council and OSHA announced the top 10 most frequently cited workplace safety violations for 2019. While the rankings for OSHA’s Top 10 most cited violations typically vary little from year to year, it is important to refresh on this critical information:
Fall Protection--General Requirements
Powered Industrial Trucks
Fall Protection--Training Requirements
Eye and Face Protection
Ohio BWC Free Informational Webinars
Each month, BWC hosts two monthly webinars to help educate and keep the employer community informed on several items. The same topics are covered twice a month; webinars are held on the second Tuesday and fourth Thursday. Registration links as well past and current webinar information can be found at the following link: Monthly Employer Update Webinars The webinars last about 20-25 minutes. Any employer may attend and they are FREE!