(2)(a) Fix the rates of premium of the risks of the classes | 19 |
based upon the total payroll in each of the classes of occupation | 20 |
or industry sufficiently large to provide a fund for the | 21 |
compensation provided for in this chapter and to maintain a state | 22 |
insurance fund from year to year. The administrator shall set the | 23 |
rates at a level that assures the solvency of the fund. Where the | 24 |
payroll cannot be obtained or, in the opinion of the | 25 |
administrator, is not an adequate measure for determining the | 26 |
premium to be paid for the degree of hazard, the administrator may | 27 |
determine the rates of premium upon such other basis, consistent | 28 |
with insurance principles, as is equitable in view of the degree | 29 |
of hazard, and whenever in this chapter reference is made to | 30 |
payroll or expenditure of wages with reference to fixing premiums, | 31 |
the reference shall be construed to have been made also to such | 32 |
other basis for fixing the rates of premium as the administrator | 33 |
may determine under this section. | 34 |
(b) If an employer elects to obtain other-states' coverage | 35 |
pursuant to section 4123.292 of the Revised Code through either | 36 |
the administrator, if the administrator elects to offer such | 37 |
coverage, or an other-states' insurer, calculate the employer's | 38 |
premium for the state insurance fund in the same manner as | 39 |
otherwise required under division (A) of this section and section | 40 |
4123.34 of the Revised Code, except that when the administrator | 41 |
determines the expenditure of wages, payroll, or both upon which | 42 |
to base the employer's premium, the administrator shall use only | 43 |
the expenditure of wages, payroll, or both attributable to the | 44 |
labor performed and services provided by that employer's employees | 45 |
when those employees performed labor and provided services in this | 46 |
state only and to which the other-states' coverage does not apply. | 47 |
(e) In providing employer group plans under division (A)(4) | 100 |
of this section, the administrator shall establish a program | 101 |
designed to mitigate the impact of a significant claim that would | 102 |
come into the experience of a private, state fund group-rated | 103 |
employer for the first time and be a contributing factor in that | 104 |
employer being excluded from a group-rated plan. The administrator | 105 |
shall establish eligibility criteria and requirements that such | 106 |
employers must satisfy in order to participate in this program. | 107 |
For purposes of this program, the administrator shall establish a | 108 |
discount on premium rates applicable to employers who qualify for | 109 |
the program. | 110 |
(6) Make available to every employer who is paying premiums | 125 |
to the state insurance fund a program whereby the employer or the | 126 |
employer's agent pays to the claimant or on behalf of the claimant | 127 |
the first fifteen thousand dollars of a compensable workers' | 128 |
compensation medical-only claim filed by that claimant that is | 129 |
related to the same injury or occupational disease. No formal | 130 |
application is required; however, an employer must elect to | 131 |
participate by telephoning the bureau after July 1, 1995. Once an | 132 |
employer has elected to participate in the program, the employer | 133 |
will be responsible for all bills in all medical-only claims with | 134 |
a date of injury the same or later than the election date, unless | 135 |
the employer notifies the bureau within fourteen days of receipt | 136 |
of the notification of a claim being filed that it does not wish | 137 |
to pay the bills in that claim, or the employer notifies the | 138 |
bureau that the fifteen thousand dollar maximum has been paid, or | 139 |
the employer notifies the bureau of the last day of service on | 140 |
which it will be responsible for the bills in a particular | 141 |
medical-only claim. If an employer elects to enter the program, | 142 |
the administrator shall not reimburse the employer for such | 143 |
amounts paid and shall not charge the first fifteen thousand | 144 |
dollars of any medical-only claim paid by an employer to the | 145 |
employer's experience or otherwise use it in merit rating or | 146 |
determining the risks of any employer for the purpose of payment | 147 |
of premiums under this chapter. A certified health care provider | 148 |
shall extend to an employer who participates in this program the | 149 |
same rates for services rendered to an employee of that employer | 150 |
as the provider bills the administrator for the same type of | 151 |
medical claim processed by the bureau and shall not charge, | 152 |
assess, or otherwise attempt to collect from an employee any | 153 |
amount for covered services or supplies that is in excess of that | 154 |
rate. If an employer elects to enter the program and the employer | 155 |
fails to pay a bill for a medical-only claim included in the | 156 |
program, the employer shall be liable for that bill and the | 157 |
employee for whom the employer failed to pay the bill shall not be | 158 |
liable for that bill. The administrator shall adopt rules to | 159 |
implement and administer division (A)(6) of this section. Upon | 160 |
written request from the bureau, the employer shall provide | 161 |
documentation to the bureau of all medical-only bills that they | 162 |
are paying directly. Such requests from the bureau may not be made | 163 |
more frequently than on a semiannual basis. Failure to provide | 164 |
such documentation to the bureau within thirty days of receipt of | 165 |
the request may result in the employer's forfeiture of | 166 |
participation in the program for such injury. The provisions of | 167 |
this section shall not apply to claims in which an employer with | 168 |
knowledge of a claimed compensable injury or occupational disease, | 169 |
has paid wages in lieu of compensation or total disability. | 170 |
Sec. 4123.321. (A) The bureau of workers' compensation board | 186 |
of directors, based upon recommendations of the workers' | 187 |
compensation actuarial committee, subject to division (B) of this | 188 |
section, shall adopt a rule with respect to the collection, | 189 |
maintenance, and disbursements of the state insurance fund | 190 |
providing that in the event there is developed as of any given | 191 |
rate revision date a surplus of earned premium over all losses | 192 |
that, in the judgment of the board, is larger than is necessary | 193 |
adequately to safeguard the solvency of the fund, the board may | 194 |
return such excess surplus to the subscribers to the fund in | 195 |
either the form of cash refunds or a reduction of premiums, | 196 |
regardless of when the premium obligations have accrued. | 197 |
(B) Beginning on July 1, 2010, the Administrator of Workers' | 211 |
Compensation shall suspend the use of a breakeven factor for a | 212 |
period of two years. During that two-year period, the | 213 |
Administrator shall not lower the maximum premium discount for | 214 |
employers who participate in the group rating program created | 215 |
under division (A)(4) of section 4123.29 of the Revised Code below | 216 |
sixty-five per cent, and neither the Administrator nor the Bureau | 217 |
of Workers' Compensation Board of Directors shall make or approve | 218 |
any changes to the group rating program. | 219 |
(C) During the first year of the two-year period described in | 220 |
division (B) of this section, the Administrator shall study the | 221 |
premium rating system. The study shall be a collaborative effort | 222 |
with stakeholders in the workers' compensation system. The | 223 |
Administrator shall submit a report summarizing the results of the | 224 |
study by the end of that first year to the Governor, the President | 225 |
and Minority Leader of the Senate, the Speaker and Minority Leader | 226 |
of the House of Representatives, and the chairpersons of the | 227 |
standing committees of the Senate and the House of Representatives | 228 |
to which legislation concerning workers' compensation customarily | 229 |
is referred. The Administrator shall include in that report a | 230 |
determination of the direction of future premium rates and | 231 |
supporting evidence of that determination and, if the | 232 |
Administrator determines that changes to Chapter 4121., 4123., | 233 |
4127., or 4131. of the Revised Code are necessary to implement the | 234 |
report, a list of those recommended changes. | 235 |