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Sub. S. B. No. 213 As Passed by the SenateAs Passed by the Senate
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Senators Schaffer, Jones, Grendell, Hughes, Cates, Buehrer, Carey, Gibbs, Gillmor, Goodman, Harris, Niehaus, Patton
A BILL
To amend sections 4123.29 and 4123.321 of the Revised
Code to require the Administrator of Workers'
Compensation to make specified changes concerning
workers' compensation premium rates and to
prohibit the Bureau of Workers' Compensation Board
of Directors from issuing a refund or rebate to
subscribers to the State Insurance Fund without
approval of the General Assembly.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4123.29 and 4123.321 of the Revised
Code be amended to read as follows:
Sec. 4123.29. (A) The administrator of workers'
compensation, subject to the approval of the bureau of workers'
compensation board of directors, shall do all of the following:
(1) Classify occupations or industries with respect to their
degree of hazard and determine the risks of the different classes
according to the categories the national council on compensation
insurance establishes that are applicable to employers in this
state;
(2)(a) Fix the rates of premium of the risks of the classes
based upon the total payroll in each of the classes of occupation
or industry sufficiently large to provide a fund for the
compensation provided for in this chapter and to maintain a state
insurance fund from year to year. The administrator shall set the
rates at a level that assures the solvency of the fund. Where the
payroll cannot be obtained or, in the opinion of the
administrator, is not an adequate measure for determining the
premium to be paid for the degree of hazard, the administrator may
determine the rates of premium upon such other basis, consistent
with insurance principles, as is equitable in view of the degree
of hazard, and whenever in this chapter reference is made to
payroll or expenditure of wages with reference to fixing premiums,
the reference shall be construed to have been made also to such
other basis for fixing the rates of premium as the administrator
may determine under this section.
(b) If an employer elects to obtain other-states' coverage
pursuant to section 4123.292 of the Revised Code through either
the administrator, if the administrator elects to offer such
coverage, or an other-states' insurer, calculate the employer's
premium for the state insurance fund in the same manner as
otherwise required under division (A) of this section and section
4123.34 of the Revised Code, except that when the administrator
determines the expenditure of wages, payroll, or both upon which
to base the employer's premium, the administrator shall use only
the expenditure of wages, payroll, or both attributable to the
labor performed and services provided by that employer's employees
when those employees performed labor and provided services in this
state only and to which the other-states' coverage does not apply.
(c) The administrator in setting or revising rates shall
furnish to employers an adequate explanation of the basis for the
rates set.
(3) Develop and make available to employers who are paying
premiums to the state insurance fund alternative premium plans.
Alternative premium plans shall include retrospective rating
plans. The administrator may make available plans under which an
advanced deposit may be applied against a specified deductible
amount per claim.
(4)(a) Offer to insure the obligations of employers under
this chapter under a plan that groups, for rating purposes,
employers, and pools the risk of the employers within the group
provided that the employers meet all of the following conditions:
(i) All of the employers within the group are members of an
organization that has been in existence for at least two years
prior to the date of application for group coverage;
(ii) The organization was formed for purposes other than that
of obtaining group workers' compensation under this division;
(iii) The employers' business in the organization is
substantially similar such that the risks which are grouped are
substantially homogeneous;
(iv) The group of employers consists of at least one hundred
members or the aggregate workers' compensation premiums of the
members, as determined by the administrator, are expected to
exceed one hundred fifty thousand dollars during the coverage
period;
(v) The formation and operation of the group program in the
organization will substantially improve accident prevention and
claims handling for the employers in the group;
(vi) Each employer seeking to enroll in a group for workers'
compensation coverage has an industrial insurance account in good
standing with the bureau of workers' compensation such that at the
time the agreement is processed no outstanding premiums,
penalties, or assessments are due from any of the employers.
(b) If an organization sponsors more than one employer group
to participate in group plans established under this section, that
organization may submit a single application that supplies all of
the information necessary for each group of employers that the
organization wishes to sponsor.
(c) In providing employer group plans under division (A)(4)
of this section, the administrator shall consider an employer
group as a single employing entity for purposes of group rating.
No employer may be a member of more than one group for the purpose
of obtaining workers' compensation coverage under this division.
(d) At the time the administrator revises premium rates
pursuant to this section and section 4123.34 of the Revised Code,
if the premium rate of an employer who participates in a group
plan established under this section changes from the rate
established for the previous year, the administrator, in addition
to sending the invoice with the rate revision to that employer,
shall send a copy of that invoice to the third-party administrator
that administers the group plan for that employer's group.
(e) In providing employer group plans under division (A)(4)
of this section, the administrator shall establish a program
designed to mitigate the impact of a significant claim that would
come into the experience of a private, state fund group-rated
employer for the first time and be a contributing factor in that
employer being excluded from a group-rated plan. The administrator
shall establish eligibility criteria and requirements that such
employers must satisfy in order to participate in this program.
For purposes of this program, the administrator shall establish a
discount on premium rates applicable to employers who qualify for
the program.
(f) In no event shall division (A)(4) of this section be
construed as granting to an employer status as a self-insuring
employer.
(g) The administrator shall develop classifications of
occupations or industries that are sufficiently distinct so as not
to group employers in classifications that unfairly represent the
risks of employment with the employer.
(5) Generally promote employer participation in the state
insurance fund through the regular dissemination of information to
all classes of employers describing the advantages and benefits of
opting to make premium payments to the fund. To that end, the
administrator shall regularly make employers aware of the various
workers' compensation premium packages developed and offered
pursuant to this section.
(6) Make available to every employer who is paying premiums
to the state insurance fund a program whereby the employer or the
employer's agent pays to the claimant or on behalf of the claimant
the first fifteen thousand dollars of a compensable workers'
compensation medical-only claim filed by that claimant that is
related to the same injury or occupational disease. No formal
application is required; however, an employer must elect to
participate by telephoning the bureau after July 1, 1995. Once an
employer has elected to participate in the program, the employer
will be responsible for all bills in all medical-only claims with
a date of injury the same or later than the election date, unless
the employer notifies the bureau within fourteen days of receipt
of the notification of a claim being filed that it does not wish
to pay the bills in that claim, or the employer notifies the
bureau that the fifteen thousand dollar maximum has been paid, or
the employer notifies the bureau of the last day of service on
which it will be responsible for the bills in a particular
medical-only claim. If an employer elects to enter the program,
the administrator shall not reimburse the employer for such
amounts paid and shall not charge the first fifteen thousand
dollars of any medical-only claim paid by an employer to the
employer's experience or otherwise use it in merit rating or
determining the risks of any employer for the purpose of payment
of premiums under this chapter. A certified health care provider
shall extend to an employer who participates in this program the
same rates for services rendered to an employee of that employer
as the provider bills the administrator for the same type of
medical claim processed by the bureau and shall not charge,
assess, or otherwise attempt to collect from an employee any
amount for covered services or supplies that is in excess of that
rate. If an employer elects to enter the program and the employer
fails to pay a bill for a medical-only claim included in the
program, the employer shall be liable for that bill and the
employee for whom the employer failed to pay the bill shall not be
liable for that bill. The administrator shall adopt rules to
implement and administer division (A)(6) of this section. Upon
written request from the bureau, the employer shall provide
documentation to the bureau of all medical-only bills that they
are paying directly. Such requests from the bureau may not be made
more frequently than on a semiannual basis. Failure to provide
such documentation to the bureau within thirty days of receipt of
the request may result in the employer's forfeiture of
participation in the program for such injury. The provisions of
this section shall not apply to claims in which an employer with
knowledge of a claimed compensable injury or occupational disease,
has paid wages in lieu of compensation or total disability.
(B) The administrator, with the advice and consent of the
board, by rule, may do both of the following:
(1) Grant an employer who makes the employer's semiannual
premium payment at least one month prior to the last day on which
the payment may be made without penalty, a discount as the
administrator fixes from time to time;
(2) Levy a minimum annual administrative charge upon risks
where semiannual premium reports develop a charge less than the
administrator considers adequate to offset administrative costs of
processing.
(C) The administrator shall adopt a rule that sets the
discount for programs or alternative premium plans not later than
the first day of September prior to the policy year in which the
discount for programs or alternative premium plans is to be in
effect.
Sec. 4123.321. (A) The bureau of workers' compensation board
of directors, based upon recommendations of the workers'
compensation actuarial committee, subject to division (B) of this
section, shall adopt a rule with respect to the collection,
maintenance, and disbursements of the state insurance fund
providing that in the event there is developed as of any given
rate revision date a surplus of earned premium over all losses
that, in the judgment of the board, is larger than is necessary
adequately to safeguard the solvency of the fund, the board may
return such excess surplus to the subscribers to the fund in
either the form of cash refunds or a reduction of premiums,
regardless of when the premium obligations have accrued.
(B) In any year in which a gubernatorial election occurs, the
board shall not return excess surplus to subscribers to the state
insurance fund in the form of a cash refund or rebate as described
in division (A) of this section without the approval of the
general assembly through the enactment of legislation.
Section 2. That existing sections 4123.29 and 4123.321 of
the Revised Code are hereby repealed.
Section 3. (A) As used in this section, "breakeven factor"
means an adjustment factor applied to the group rated experience
modification used to calculate the workers' compensation premium
rate of an employer that participates in the group rating program
created under division (A)(4) of section 4123.29 of the Revised
Code.
(B) Beginning on July 1, 2010, the Administrator of Workers'
Compensation shall suspend the use of a breakeven factor for a
period of two years. During that two-year period, the
Administrator shall not lower the maximum premium discount for
employers who participate in the group rating program created
under division (A)(4) of section 4123.29 of the Revised Code below
sixty-five per cent, and neither the Administrator nor the Bureau
of Workers' Compensation Board of Directors shall make or approve
any changes to the group rating program.
(C) During the first year of the two-year period described in
division (B) of this section, the Administrator shall study the
premium rating system. The study shall be a collaborative effort
with stakeholders in the workers' compensation system. The
Administrator shall submit a report summarizing the results of the
study by the end of that first year to the Governor, the President
and Minority Leader of the Senate, the Speaker and Minority Leader
of the House of Representatives, and the chairpersons of the
standing committees of the Senate and the House of Representatives
to which legislation concerning workers' compensation customarily
is referred. The Administrator shall include in that report a
determination of the direction of future premium rates and
supporting evidence of that determination and, if the
Administrator determines that changes to Chapter 4121., 4123.,
4127., or 4131. of the Revised Code are necessary to implement the
report, a list of those recommended changes.
(D) During the second year of the two-year period described
in division (B) of this section, the Administrator, subject to the
approval of the Bureau of Workers' Compensation Board of
Directors, may adopt rules in accordance with section 4123.29 of
the Revised Code, as amended by this act, and section 4123.34 of
the Revised Code to make changes to the rating system to implement
the results of the study required under division (C) of this
section.
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