02/29/2024

Workers' Comp & Safety

News from Sedgwick

The following information is provided by Sedgwick, the administrator of OWMA's Workers' Compensation Group Rating Program. 

2024 Safety Series

Sedgwick is offering a comprehensive, webinar-based free educational safety series safety to current clients, which includes OWMA members enrolled in the association's workers comp. group rating program. The first webinar is March 18th and covers OSHA Safety Emphasis Programs. Click HERE for details and registration for each of the Safety Series sessions. 

Identifying and reporting suspected claim fraud

The word “fraud” carries a heavy connotation with it and making a fraud referral to the Bureau of Workers’ Compensation can feel a bit overwhelming. What should you do if you suspect that a fraudulent claim has been filed against you? The Bureau of Workers’ Compensation has an entire division devoted to analyzing and investigating fraud concerns. The Special Investigations Department was created in 1994 with the sole purpose of reviewing potential fraud in the workers’ compensation system.

According to the Bureau’s Special Investigations Department Annual Report from 2022, they received 2,661 fraud allegations and ultimately closed 1,431 cases with 69 resulting in convictions for an identified savings of $90 million dollars.

It is important to understand the activities that are most associated with potential workers’ compensation claim fraud:

• Collecting disability benefits while receiving compensation
• Receiving cash payment for work performed “under the table”
• Claiming to be injured while at work when the injury happened elsewhere
• Exaggeration of disability complaints to extend disability
• Falsifying documents related to a claim application

Employers are often notified of potential fraud either from co-workers who witnessed or heard about the suspected incident or through personal observation, such as seeing a post on social media. Should you suspect one or more of the above activities you should contact the BWC Fraud unit to report a concern. You can do this either through the Bureau of Workers’ Compensation’s website or by contacting the BWC Fraud department directly at 1.800.644.6292.

If you have any questions, contact our Sedgwick program manager, Julia Bowling, at julia.bowling@sedgwick.com or phone 513-218-4062.

Employer Handicap Reimbursement Program name change

The Bureau of Workers’ Compensation (BWC) Employer Handicap Reimbursement Program is designed to encourage employers to hire and retain employees with pre-existing medical conditions. In some circumstances the employer may be eligible for reimbursement of a percentage of claim charges if an employee with a preexisting condition suffers a lost time industrial injury or occupational disease and documentation supports that the pre-existing condition delayed the employee’s recovery.

The BWC has recently proposed terminology changes related to this program. Effective April 6, 2023, Ohio Revised Code 4123.343 was revised, and the term “handicapped employee” was replaced with “employee with a disability”. To align with the 2023 change, the BWC is updating references from “handicap reimbursement” to “disability relief”. These updates affect code terminology only and do not change program eligibly criteria.

To prepare for this upcoming terminology change, Sedgwick has begun updating correspondence materials to reflect the change from “handicap reimbursement” to “disability relief” and expect those updates to be completed soon. Although the program name is changing, Sedgwick cost containment services will continue to be best-in-class. Our dedicated team of experienced disability relief colleagues will continue to review eligible claims for relief opportunity, file disability relief applications, and achieve favorable outcomes on behalf of our clients.

If you have any questions, contact our Sedgwick program manager, Julia Bowling, at julia.bowling@sedgwick.com or phone 513-218-4062.