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To amend section 4123.29 of the Revised Code to | 1 |
require the Administrator of Workers' Compensation | 2 |
to include in the notice of premium rate that is | 3 |
applicable to an employer for an upcoming policy | 4 |
year the mathematical equation used by the | 5 |
Administrator to determine the employer's premium | 6 |
rate. | 7 |
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)(a) 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 may | 26 |
determine the rates of premium upon such other basis, consistent | 27 |
with insurance principles, as is equitable in view of the degree | 28 |
of hazard, and whenever in this chapter reference is made to | 29 |
payroll or expenditure of wages with reference to fixing premiums, | 30 |
the reference shall be construed to have been made also to such | 31 |
other basis for fixing the rates of premium as the administrator | 32 |
may determine under this section. | 33 |
(b) If an employer elects to obtain other-states' coverage | 34 |
pursuant to section 4123.292 of the Revised Code through either | 35 |
the administrator, if the administrator elects to offer such | 36 |
coverage, or an other-states' insurer, calculate the employer's | 37 |
premium for the state insurance fund in the same manner as | 38 |
otherwise required under division (A) of this section and section | 39 |
4123.34 of the Revised Code, except that when the administrator | 40 |
determines the expenditure of wages, payroll, or both upon which | 41 |
to base the employer's premium, the administrator shall use only | 42 |
the expenditure of wages, payroll, or both attributable to the | 43 |
labor performed and services provided by that employer's employees | 44 |
when those employees performed labor and provided services in this | 45 |
state only and to which the other-states' coverage does not apply. | 46 |
(c) The administrator in setting or revising rates shall | 47 |
furnish to employers an adequate explanation of the basis for the | 48 |
rates set. | 49 |
(3) Develop and make available to employers who are paying | 50 |
premiums to the state insurance fund alternative premium plans. | 51 |
Alternative premium plans shall include retrospective rating | 52 |
plans. The administrator may make available plans under which an | 53 |
advanced deposit may be applied against a specified deductible | 54 |
amount per claim. | 55 |
(4)(a) Offer to insure the obligations of employers under | 56 |
this chapter under a plan that groups, for rating purposes, | 57 |
employers, and pools the risk of the employers within the group | 58 |
provided that the employers meet all of the following conditions: | 59 |
(i) All of the employers within the group are members of an | 60 |
organization that has been in existence for at least two years | 61 |
prior to the date of application for group coverage; | 62 |
(ii) The organization was formed for purposes other than that | 63 |
of obtaining group workers' compensation under this division; | 64 |
(iii) The employers' business in the organization is | 65 |
substantially similar such that the risks which are grouped are | 66 |
substantially homogeneous; | 67 |
(iv) The group of employers consists of at least one hundred | 68 |
members or the aggregate workers' compensation premiums of the | 69 |
members, as determined by the administrator, are expected to | 70 |
exceed one hundred fifty thousand dollars during the coverage | 71 |
period; | 72 |
(v) The formation and operation of the group program in the | 73 |
organization will substantially improve accident prevention and | 74 |
claims handling for the employers in the group; | 75 |
(vi) Each employer seeking to enroll in a group for workers' | 76 |
compensation coverage has an industrial insurance account in good | 77 |
standing with the bureau of workers' compensation such that at the | 78 |
time the agreement is processed no outstanding premiums, | 79 |
penalties, or assessments are due from any of the employers. | 80 |
(b) If an organization sponsors more than one employer group | 81 |
to participate in group plans established under this section, that | 82 |
organization may submit a single application that supplies all of | 83 |
the information necessary for each group of employers that the | 84 |
organization wishes to sponsor. | 85 |
(c) In providing employer group plans under division (A)(4) | 86 |
of this section, the administrator shall consider an employer | 87 |
group as a single employing entity for purposes of group rating. | 88 |
No employer may be a member of more than one group for the purpose | 89 |
of obtaining workers' compensation coverage under this division. | 90 |
(d) At the time the administrator revises premium rates | 91 |
pursuant to this section and section 4123.34 of the Revised Code, | 92 |
if the premium rate of an employer who participates in a group | 93 |
plan established under this section changes from the rate | 94 |
established for the previous year, the administrator, in addition | 95 |
to sending the invoice with the rate revision to that employer, | 96 |
shall send a copy of that invoice to the third-party administrator | 97 |
that administers the group plan for that employer's group. | 98 |
(e) In providing employer group plans under division (A)(4) | 99 |
of this section, the administrator shall establish a program | 100 |
designed to mitigate the impact of a significant claim that would | 101 |
come into the experience of a private, state fund group-rated | 102 |
employer for the first time and be a contributing factor in that | 103 |
employer being excluded from a group-rated plan. The administrator | 104 |
shall establish eligibility criteria and requirements that such | 105 |
employers must satisfy in order to participate in this program. | 106 |
For purposes of this program, the administrator shall establish a | 107 |
discount on premium rates applicable to employers who qualify for | 108 |
the program. | 109 |
(f) In no event shall division (A)(4) of this section be | 110 |
construed as granting to an employer status as a self-insuring | 111 |
employer. | 112 |
(g) The administrator shall develop classifications of | 113 |
occupations or industries that are sufficiently distinct so as not | 114 |
to group employers in classifications that unfairly represent the | 115 |
risks of employment with the employer. | 116 |
(5) Generally promote employer participation in the state | 117 |
insurance fund through the regular dissemination of information to | 118 |
all classes of employers describing the advantages and benefits of | 119 |
opting to make premium payments to the fund. To that end, the | 120 |
administrator shall regularly make employers aware of the various | 121 |
workers' compensation premium packages developed and offered | 122 |
pursuant to this section. | 123 |
(6) Make available to every employer who is paying premiums | 124 |
to the state insurance fund a program whereby the employer or the | 125 |
employer's agent pays to the claimant or on behalf of the claimant | 126 |
the first fifteen thousand dollars of a compensable workers' | 127 |
compensation medical-only claim filed by that claimant that is | 128 |
related to the same injury or occupational disease. No formal | 129 |
application is required; however, an employer must elect to | 130 |
participate by telephoning the bureau after July 1, 1995. Once an | 131 |
employer has elected to participate in the program, the employer | 132 |
will be responsible for all bills in all medical-only claims with | 133 |
a date of injury the same or later than the election date, unless | 134 |
the employer notifies the bureau within fourteen days of receipt | 135 |
of the notification of a claim being filed that it does not wish | 136 |
to pay the bills in that claim, or the employer notifies the | 137 |
bureau that the fifteen thousand dollar maximum has been paid, or | 138 |
the employer notifies the bureau of the last day of service on | 139 |
which it will be responsible for the bills in a particular | 140 |
medical-only claim. If an employer elects to enter the program, | 141 |
the administrator shall not reimburse the employer for such | 142 |
amounts paid and shall not charge the first fifteen thousand | 143 |
dollars of any medical-only claim paid by an employer to the | 144 |
employer's experience or otherwise use it in merit rating or | 145 |
determining the risks of any employer for the purpose of payment | 146 |
of premiums under this chapter. A certified health care provider | 147 |
shall extend to an employer who participates in this program the | 148 |
same rates for services rendered to an employee of that employer | 149 |
as the provider bills the administrator for the same type of | 150 |
medical claim processed by the bureau and shall not charge, | 151 |
assess, or otherwise attempt to collect from an employee any | 152 |
amount for covered services or supplies that is in excess of that | 153 |
rate. If an employer elects to enter the program and the employer | 154 |
fails to pay a bill for a medical-only claim included in the | 155 |
program, the employer shall be liable for that bill and the | 156 |
employee for whom the employer failed to pay the bill shall not be | 157 |
liable for that bill. The administrator shall adopt rules to | 158 |
implement and administer division (A)(6) of this section. Upon | 159 |
written request from the bureau, the employer shall provide | 160 |
documentation to the bureau of all medical-only bills that they | 161 |
are paying directly. Such requests from the bureau may not be made | 162 |
more frequently than on a semiannual basis. Failure to provide | 163 |
such documentation to the bureau within thirty days of receipt of | 164 |
the request may result in the employer's forfeiture of | 165 |
participation in the program for such injury. The provisions of | 166 |
this section shall not apply to claims in which an employer with | 167 |
knowledge of a claimed compensable injury or occupational disease, | 168 |
has paid wages in lieu of compensation or total disability. | 169 |
(B) The administrator, with the advice and consent of the | 170 |
board, by rule, may do both of the following: | 171 |
(1) Grant an employer who makes the employer's semiannual | 172 |
premium payment at least one month prior to the last day on which | 173 |
the payment may be made without penalty, a discount as the | 174 |
administrator fixes from time to time; | 175 |
(2) Levy a minimum annual administrative charge upon risks | 176 |
where semiannual premium reports develop a charge less than the | 177 |
administrator considers adequate to offset administrative costs of | 178 |
processing. | 179 |
(C)(1) The administrator shall include all of the following | 180 |
information in the notice of premium rate that is applicable to an | 181 |
employer for the upcoming policy year: | 182 |
(a) The mathematical equation, expressed algebraically, used | 183 |
by the administrator to determine the employer's premium rate; | 184 |
(b) A definition of each variable used in the mathematical | 185 |
equation described in division (C)(1)(a) of this section; | 186 |
(c) The mathematical equation described in division (C)(1)(a) | 187 |
of this section with the specific numbers applicable to the | 188 |
employer included in the equation. | 189 |
(2) With respect to the mathematical equation described in | 190 |
division (C)(1)(c) of this section, the administrator shall | 191 |
highlight those numbers over which the employer has direct | 192 |
control. | 193 |
Section 2. That existing section 4123.29 of the Revised Code | 194 |
is hereby repealed. | 195 |