Allowed claim An Ohio workers’ compensation claim that has one or more physical or mental conditions recognized as resulting from an incident or condition at a particular employer.

Attorney An attorney is the only party who can be paid to represent a claimant. A company can hire an attorney to represent it at hearings. At ICO hearings, only attorneys can argue case law, interpret medical reports or question witnesses.

Base rates The basic rate attached to each manual classification that reflects the risk of injury to employees who perform that type of work. A new company with no history of injuries would be charged the base rate (modified by other factors such as the administrative fee) for each of the manual classifications assigned to it. A base rate traditionally changes no more than 30% from one year to the next.

BEF Break even factor: This was introduced in 2009 as the BWC response to complaints that non-group rated employers pay more premiums so that group rated employers can get big discounts. The first BEF was 31.1% applied to all group EMs, which eliminated groups with discounts less than 25%. Now the BWC has introduced stratified BEFs, which will maintain groups with the smallest discounts, and reduce the EMs for groups with the largest discounts.

BWC Bureau of Workers’ Compensation An agency of the State of Ohio that collects premiums from employers with employees in Ohio, and administers claims for benefits and compensation by injured workers.

Certify a claim There is no official definition of what it means to certify a claim. The BWC or MCO may ask if you agree that “something happened” at work. They may also imply that your employee will get medical care faster if you certify the claim. Certifying a claim is like buying a pig in a poke. Even if you saw an injury occur, DO NOT CERTIFY A CLAIM. You do not know what the employee told the doctor, you do not know what the medical records say, and you probably do not know whether the employee has a history of filing workers’ compensation claims.

Claim costs Medical costs paid, compensation costs paid, and reserves.

Claimant A person who claims an injury while working in Ohio. This term was changed to Injured Worker (IW) to be “politically correct”, but sooner or later, a person is not injured any more.

Compensation Monies paid directly to the claimant as opposed to medical benefits that are paid to the provider.

Contested The term for any part of a claim that either party disagrees with.

Court If an employer or claimant is not satisfied with the decisions of the Industrial Commission, it may file an appeal to the Court of Common Pleas or file a mandamus action to the Court of Appeals. The appealing party must use an attorney to file to court.

Due diligence. The process of investigating what you are thinking of buying. If it’s a car, you take it to a mechanic you trust for a second opinion. If it’s a house, you get an independent inspection of the property and a title search. If it’s a company, you call the names on the client list to find out how much business they really do with the seller, your accountant looks at the financial records, and your lawyer researches the intellectual property. You should also investigate its workers’ compensation experience because, after 9/7/2007, the BWC will transfer that experience to the new owner.

Expected losses The dollar amount of claim costs the BWC expects based on your company’s size, as reflected in four years of payroll, and the risk of injury, as indicated by the manual classifications assigned to your company.

Experience A term that reflects a company’s payroll for the oldest four of the last five years, and five years of claims costs for claims incurred during the oldest four of the last five years.

EM Experience modifier The newer way of expressing the ratio between the real claims costs and the expected losses. An EM of 100 or less is good. An EM of more than 105 will make it difficult for a company to be included in group rating.

Group rating This is similar to group health insurance. The experiences of a number of companies are combined so that the group EM is better than the EM of each individual company.

Hearing A meeting at the ICO to decide a contested issue. The Hearing Officer who makes the decision is an attorney who is a full time employee of the Industrial Commission.

ICO Industrial Commission of Ohio. An agency of the State of Ohio that decides contested issues in Ohio workers’ compensation claims.

Injury A negative impact on an employee’s body resulting from an incident at work or the environmental conditions at work.

IW Injured worker The “politically correct” term for an employee who has filed a claim for medical benefits and/or compensation for an injury that occurred while working.

Manual classification Manual number The four digit number that identifies the type of work an employee performs for the employer. For example, manual 8810 indicates a clerical worker with no or few duties outside the office. The risk of injury for a clerical worker is low, so the base rate is also low. There is a base rate associated with each manual classification.

Maximum value Max val The largest dollar amount charged to an employer’s experience for any one claim in one year. The max val can change each year based on the four years of payroll in that year’s experience. Companies with one or more max val claims in that year’s experience are never invited to enroll in group rating.

MCO Managed Care Organization A company that authorizes medical services and approves the medical bills for payment by the Ohio BWC. The more medical services and medical bills your MCO approves, the higher your company’s premiums. All companies that pay premiums to the Ohio State Fund are required to choose an MCO. A company can easily change its MCO every two years during open enrollment.

Medical benefits Medical costs Payments to providers for treatments, prescriptions and/or durable medical equipment such as crutches.

Open enrollment This is the period every other year when companies can easily change to a different MCO. Traditionally, open enrollment is in May during even-numbered years, and the newly chosen MCO starts working with your company’s claims on July 1.

Party An employer or claimant in a workers’ compensation claim.

Penalty rated A company is penalty rated when its EM is greater than 100, or its TM is greater than 1. Companies that are penalty rated are usually not invited to participate in group rating.

Pig in a poke Even though it squeals and squirms, you don’t know if it’s a healthy pig until you take it out of the bag (poke) and thoroughly examine it. If you don’t investigate a company’s workers’ compensation experience before buying it, you have purchased a pig in a poke.

Policy number The identification number assigned to each company covered by Ohio workers’ compensation. This was formerly called the risk number.

PPD. Permanent Partial Disability. This is compensation paid to an injured worker for residual effects after a work-related injury. This award has nothing to do with whether the employee can work. The claimant’s attorney usually takes one-third of this award as his fee.

Premiums Dollars paid to the BWC for Ohio workers’ compensation insurance.

Projected savings The amount a group TPA estimates your company will save by enrolling in its group. This is the most prominent number on a group rating offer, and the least reliable. Projected savings are as optimistic as possible, to entice you to enroll your company in that group.

Provider A medical professional or company that provides medical services or equipment to an injured worker.

Reserves A dollar amount that the BWC adds to a claim’s costs for the four years that the claim is included in a company’s premium rates.

Risk 1) The potential for injury while performing work as an employee. 2) A BWC shorthand term for a company, based on the BWC identifier called a risk number.

Risk number The old name for the identification number assigned to each company that has Ohio workers’ compensation coverage for its employees. See also policy number.

Sponsor An organization, such as a chamber of commerce or trade association, that hires a TPA to administer its group rating program.

State Fund A fund established by the Ohio Constitution to provide workers’ compensation insurance for companies and employees in Ohio. The Ohio State Fund is one of the largest “single-line” insurance companies in the world.

TM Total modified The old way of expressing the ratio between the claims costs and the expected losses. A TM that is less than zero is better than a TM that is positive. Group rating offers are expressed as TM, to make it easy to see that -75 is a bigger discount than -10.

TPA Third party administrator A company hired by an employer to manage its Ohio workers’ compensation claims and provide advice on controlling its premiums. Group sponsors also hire TPA firms to administer their group rating programs.

TPA fee The fee charged by the group TPA to represent a company that is included in its group. Fees are often calculated as a percentage of the projected savings. The TPA fee is charged and paid before the premium discount takes effect, and will not be altered even if the projected savings are substantially less (or more).

TT Temporary total disability compensation This is compensation paid to an injured worker for time missed from work due to an allowed condition in the claim.

Uncontested Any part of a claim that neither party disagrees with.

* highlighted terms may be found defined on this page