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The Ohio Bureau of Workers' Compensation (BWC) is the state agency responsible for Ohio's workers' compensation system. The BWC is responsible for claim determinations and allowances (i.e. if the claim is allowed and what it is allowed for) and paying lost time compensation.
A Managed Care Organization (MCO) is a private company that an employer contracts with to medically manage the workers' compensation claims for injured employees. An MCO will work with the employer, injured worker and provider to ensure a safe and quick return to work and to minimize costs. All state-funded Ohio employers are required to select an MCO. MCOs are paid by the BWC and will not bill employers for the service.
A Third-Party Administrator (TPA) is a private company that an employer hires to represent its interests with the Bureau of Workers' Compensation. The TPA can contest claims and attend hearings on your behalf as well as recommend and implement premium saving programs like group rating. The TPA is paid by the employer for their services.
Early reporting is essential to reducing workers' compensation costs. An injured worker needs early, effective treatment before the injury becomes more serious or before more damage is done
When an employee is injured:
While a claim is enrolled in the $15K program, Spooner MAI as a MCO cannot medically manage the claim, authorize treatment or pay medical bills. While in the program, the employer is responsible for the following:
You have the ability to opt out of the $15K program for a specific claim or entirely at any time by notifying the BWC - if the claim because a Lost Time claim, it will automatically be opted out. Once a claim has been opted out, Spooner MAI will start to medically manage the claim and pay the medical bills.
Fraud is a hidden cost of workers' compensation insurance, with an impact on both employers and injured workers. National industry studies estimate 5 percent to 20 percent of all workers' compensation benefits paid are fraudulent. Some examples of workers' compensation fraud occur when:
If you suspect workers' compensation fraud you may submit an online Fraud Allegation Form on the BWC website or call the BWC at 1-800-OHIOBWC and follow the options. Whether you submit the Fraud Allegation Form or call the fraud hotline, you will be asked to confidentially provide all of the information you have pertaining to the suspected fraud, including the following: