As Introduced

127th General Assembly Regular Session 2007-2008

H. B. No. 461

Representative Batchelder 

Cosponsors: Representatives Wachtmann, Huffman, Gardner, McGregor, J., Fessler, Combs, Wagner, Webster, Adams, Zehringer 

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A BILL

To amend section 4123.29 of the Revised Code to allow

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an employer to reimburse the Administrator of

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Workers' Compensation for the first fifteen

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thousand dollars of medical bills incurred in any

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type of workers' compensation claim rather than

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allow an employer to pay directly only those

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medical bills incurred in medical-only claims.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 4123.29 of the Revised Code be	8
amended to read as follows:	9

Sec. 4123.29.  (A) The administrator of workers'	10
compensation, subject to the approval of the bureau of workers'	11
compensation board of directors, shall do all of the following:	12

(1) Classify occupations or industries with respect to their	13
degree of hazard and determine the risks of the different classes	14
according to the categories the national council on compensation	15
insurance establishes that are applicable to employers in this	16
state;	17

(2) Fix the rates of premium of the risks of the classes	18
based upon the total payroll in each of the classes of occupation	19
or industry sufficiently large to provide a fund for the	20
compensation provided for in this chapter and to maintain a state	21
insurance fund from year to year. The administrator shall set the	22
rates at a level that assures the solvency of the fund. Where the	23
payroll cannot be obtained or, in the opinion of the	24
administrator, is not an adequate measure for determining the	25
premium to be paid for the degree of hazard, the administrator	26
may determine the rates of premium upon such other basis,	27
consistent with insurance principles, as is equitable in view of	28
the degree of hazard, and whenever in this chapter reference is	29
made to payroll or expenditure of wages with reference to fixing	30
premiums, the reference shall be construed to have been made also	31
to such other basis for fixing the rates of premium as the	32
administrator may determine under this section.	33

The administrator in setting or revising rates shall furnish	34
to employers an adequate explanation of the basis for the rates	35
set.	36

(3) Develop and make available to employers who are paying	37
premiums to the state insurance fund alternative premium plans.	38
Alternative premium plans shall include retrospective rating	39
plans. The administrator may make available plans under which an	40
advanced deposit may be applied against a specified deductible	41
amount per claim.	42

(4)(a) Offer to insure the obligations of employers under	43
this chapter under a plan that groups, for rating purposes,	44
employers, and pools the risk of the employers within the group	45
provided that the employers meet all of the following conditions:	46

(i) All of the employers within the group are members of an	47
organization that has been in existence for at least two years	48
prior to the date of application for group coverage;	49

(ii) The organization was formed for purposes other than that	50
of obtaining group workers' compensation under this division;	51

(iii) The employers' business in the organization is	52
substantially similar such that the risks which are grouped are	53
substantially homogeneous;	54

(iv) The group of employers consists of at least one hundred	55
members or the aggregate workers' compensation premiums of the	56
members, as determined by the administrator, are expected to	57
exceed one hundred fifty thousand dollars during the coverage	58
period;	59

(v) The formation and operation of the group program in the	60
organization will substantially improve accident prevention and	61
claims handling for the employers in the group;	62

(vi) Each employer seeking to enroll in a group for workers'	63
compensation coverage has an industrial insurance account in good	64
standing with the bureau of workers' compensation such that at the	65
time the agreement is processed no outstanding premiums,	66
penalties, or assessments are due from any of the employers.	67

(b) If an organization sponsors more than one employer group	68
to participate in group plans established under this section, that	69
organization may submit a single application that supplies all of	70
the information necessary for each group of employers that the	71
organization wishes to sponsor.	72

(c) In providing employer group plans under division (A)(4)	73
of this section, the administrator shall consider an employer	74
group as a single employing entity for purposes of retrospective	75
rating. No employer may be a member of more than one group for the	76
purpose of obtaining workers' compensation coverage under this	77
division.	78

(d) At the time the administrator revises premium rates	79
pursuant to this section and section 4123.34 of the Revised Code,	80
if the premium rate of an employer who participates in a group	81
plan established under this section changes from the rate	82
established for the previous year, the administrator, in addition	83
to sending the invoice with the rate revision to that employer,	84
shall send a copy of that invoice to the third-party administrator	85
that administers the group plan for that employer's group.	86

(e) In providing employer group plans under division (A)(4)	87
of this section, the administrator shall establish a program	88
designed to mitigate the impact of a significant claim that would	89
come into the experience of a private, state fund group-rated	90
employer for the first time and be a contributing factor in that	91
employer being excluded from a group-rated plan. The administrator	92
shall establish eligibility criteria and requirements that such	93
employers must satisfy in order to participate in this program.	94
For purposes of this program, the administrator shall establish a	95
discount on premium rates applicable to employers who qualify for	96
the program.	97

(f) In no event shall division (A)(4) of this section be	98
construed as granting to an employer status as a self-insuring	99
employer.	100

(g) The administrator shall develop classifications of	101
occupations or industries that are sufficiently distinct so as not	102
to group employers in classifications that unfairly represent the	103
risks of employment with the employer.	104

(5) Generally promote employer participation in the state	105
insurance fund through the regular dissemination of information to	106
all classes of employers describing the advantages and benefits of	107
opting to make premium payments to the fund. To that end, the	108
administrator shall regularly make employers aware of the various	109
workers' compensation premium packages developed and offered	110
pursuant to this section.	111

(6) Make available to every employer who is paying premiums	112
to the state insurance fund a program whereby the employer or the	113
employer's agent pays to the claimant or on behalf of the claimant	114
the first fifteen thousand dollars of athe medical bills incurred	115
in any compensable workers' compensation medical-only claim filed	116
by that claimant that is related to the same injury or	117
occupational disease. No formal application is required; however,	118
an employer must electwho wishes to participate by telephoning	119
the bureauin the program shall notify the administrator of that	120
election on or after July 1, 1995the effective date of this	121
amendment. Once anAn employer who has elected to participate in	122
the program, the employer will beis responsible for all medical	123
bills in all medical-only claimsincurred for each compensable	124
claim of that employer's employees with a date of injury or a	125
date of occupational disease diagnosis that is the same or later	126
than the election date, unless the. The administrator shall	127
process a compensable claim incurred by an employee of an employer	128
notifieswho participates in the bureau within fourteen days of	129
receipt ofprogram in the notification of asame manner as all	130
other claims under this chapter, including medically managing the	131
claim being filedthrough the health partnership program, except	132
that it does not wish to pay the administrator shall bill the	133
amount the administrator pays for those medical bills to the	134
participating employer, in that claim, or theemployer notifies	135
the bureau that thean amount not to exceed fifteen thousand	136
dollar maximum has been paid, or the employer notifies the	137
bureau of the last day of service on which it will be	138
responsible for the bills in a particular medical-only claim	139
dollars, rather than charging the amount paid to the employer's	140
experience. The administrator shall adopt rules to establish	141
billing procedures and specify payment requirements for the	142
program. If	143

If an employer elects to enter the program and the employer	144
pays the amounts billed by the administrator in accordance with	145
the payment requirements the administrator specifies in rule, the	146
administrator shall not reimburse the employer for such amounts	147
paidthe employer pays for medical bills while participating in	148
the program and shall not charge the first fifteen thousand	149
dollars of any medical-onlymedical bills incurred in a claim	150
paid by an employer to the employer's experience or otherwise	151
use itthose amounts in merit rating or determining the risks of	152
any employer for the purpose of payment of premiums under this	153
chapter. If an employer elects to enter the program and the	154
employer fails to pay a billthe amount billed by the	155
administrator for a medical-onlycompensable claim included in	156
the program in accordance with the payment requirements the	157
administrator specifies in rule, the administrator shall remove	158
the claim for which the employer shall be liable for that bill	159
and the employee for whom the employer failed to pay the bill	160
shall not be liable for that billmake the payment from the	161
program and shall charge the amounts the administrator pays for	162
medical bills incurred in that claim to the employer's experience	163
or otherwise shall use those amounts in merit rating or	164
determining the risks of any employer for the purpose of payment	165
of premiums under this chapter. The administrator shall adopt any	166
additional rules the administrator considers necessary to	167
implement and administer division (A)(6) of this section. Upon	168
written request from the bureau, the employer shall provide	169
documentation to the bureau of all medical-only bills that they	170
are paying directly. Such requests from the bureau may not be	171
made more frequently than on a semiannual basis. Failure to	172
provide such documentation to the bureau within thirty days of	173
receipt of the request may result in the employer's forfeiture of	174
participation in the program for such injury. The provisions of	175
this section shall not apply to claims in which an employer	176
with knowledge of a claimed compensable injury or occupational	177
disease, has paid wages in lieu of compensation or total	178
disability.	179

(B) The administrator, with the advice and consent of the	180
board, by rule, may do both of the following:	181

(1) Grant an employer who makes the employer's semiannual	182
premium payment at least one month prior to the last day on which	183
the payment may be made without penalty, a discount as the	184
administrator fixes from time to time;	185

(2) Levy a minimum annual administrative charge upon risks	186
where semiannual premium reports develop a charge less than the	187
administrator considers adequate to offset administrative costs of	188
processing.	189

Section 2. That existing section 4123.29 of the Revised Code	190
is hereby repealed.	191