In order to maximize claims & disability management efforts, the following suggestions are being made. The desired result is to reduce your chargeable claim costs by reducing the amount of compensation paid in claims and, therefore, reducing the number and amount of the BWC established MIRA reserves.
The Bureau created a universal claim form which covers all initial filing situations. It is the “First Report of an Injury, Occupational Disease, or Death” (FROI) application. If lost time is seven calendar days or less (last day worked and return date not included), the claim is considered to be “medical only”. If lost time is more than seven calendar days or the injury results in amputation, the claim is considered to be “lost time”. Wage information will be requested by the Bureau and should be obtained from your Payroll Department as soon as possible.
Be sure to have your employee fill out a medical release form and an accident report for any injury that results in a workers’ compensation claim. Send the original to your claims manger and keep a copy for your records.
Is it a valid claim? You should contact your claims manager to discuss certification/rejection and alternative claims management options. You should also contact your claims manager on all lost time claims to:
a. Determine an estimated return to work date
b. Determine if an independent medical exam (IME) is necessary
c. Determine if claim needs to be contested
d. Determine future loss liability
If the disability in any lost time claim seems to be headed for 90 days or more
a. Contact your claims manager immediately
b. Discuss the need to schedule a 90 day exam with the BWC
c. Determine if an employer’s exam is needed
Report to your claims manager immediately
a. Any adverse developments on a return to work date
b. An actual return to work date
c. Any difficulty getting information from an attending physician
d. If the employer is able to accommodate modified duty to meet any restrictions
Other factors to consider:
Copies of all hearing notices should be forwarded to ProComp upon receipt. If a hearing is scheduled within five (5) working days of receipt, you should call and fax notice to our office. All Record of Proceedings (hearing results) should also be forwarded to your claims manager.
Group rating allows Ohio employers of similar industry groups to pool together and achieve discounts off their workers' compensation premiums.