4 Huge Benefits of an Ohio TPA for Manufacturer Workers' Comp Claims

Ohio manufacturers experience the highest workplace injury and illness rates among private industries in the state. The heavy equipment and hazardous materials used in manufacturing inherently present risks, and accidents and injuries can happen even with vigorous safety programs in place.

Unfortunately, the claims processing can be complex. Employers need to staff their HR departments with personnel trained in BWC procedures, and this training isn’t a one-and-done; it must be ongoing because the BWC regularly updates policies in response to new initiatives and legislation.

The work and training necessary to process claims and ensure that your business complies with state regulations can overwhelm even the best-staffed HR and EHS departments. Fortunately, there is a solution.

A third-party administrator (TPA) can bring expertise to your claims management and advocate for your business when dealing with the BWC. Here are four benefits of working with an Ohio TPA.

1. Streamlined Claims Processing

When a worker is injured on the job, the employer’s first responsibility is to see that their immediate medical needs are met. This includes first aid and perhaps a trip to an urgent care facility. Having accident response protocols in place will facilitate a quick response.

The injury or illness is the start of the claim process, and the employer is responsible for overseeing the steps that lead to resolution. They must collect witness statements, produce an incident report, and then conduct an accident analysis to determine what caused the injury and the actions that must be taken to prevent future injuries.

Once a claim is filed by the employer, injured worker, or medical provider, the employer must determine if it meets all elements of compensability. If yes, it can be certified; if not, it must be rejected.

To process and investigate a claim, the BWC needs a copy of the incident report, medical reports, job descriptions, and wage information. If the employer or worker disagrees with the determination, they will have two weeks to file an appeal. This process can lead to hearings and thus, involve attorneys.

All this is a great deal of work, and the process can bog down an HR department. Bringing in a TPA shifts this burden to a professional who can ensure that all BWC requirements and deadlines are met so the injured worker can get the necessary care and return to work as soon as possible.

2. Identification of Exaggerated and Fraudulent Claims

Fraud in workers’ comp is a serious problem. In 2024, the Ohio BWC detected and deterred $72.3 million in fraud. This drives up employers’ premiums and adds to payroll costs related to processing these claims.

The system is “cheated” when a worker exaggerates the extent of their injury or claims that the injury that they’ve suffered is related when it actually happened elsewhere. Another example is when the employee is collecting disability but working under the table somewhere else. Medical providers can exploit the system by billing for procedures that they did not provide, overstating the units of medicine supplied, or providing services that are not medically necessary.

Identifying fraud can strain a business's finances, as doing so requires dedicated resources and experience in the field. A TPA knows the red flags and can reduce incidents of fraud, thereby reducing the employer’s incident rates.

3. Compliance with BWC Regulations

Workers’ comp claims are filed using specific forms, and employers must follow set procedures and adhere to timelines. While the veteran members of your HR department may have developed deep knowledge of these policies, keeping up to date can still be a full-time job. The Ohio BWC regularly updates policies and procedures to reflect new legislation and programs. While the agency produces monthly webinars to keep employers abreast of changes, tuning in each month takes time away from HR personnel’s regular tasks.

This is a vital area where a TPA can save you time and money and prevent possible errors that can affect your injured employee’s benefits and ability to recover and return to work. A reputable Ohio TPA will have a thorough knowledge of BWC policies and will be on top of any changes or new programs that might affect your business.

4. Lower Premiums

The Ohio BWC offers rebates and incentives to lower premiums. A TPA can advise you if your company qualifies for a Group Experience Rating Program, the Substance Use Prevention and Recovery Program, the Risk Management program, or other programs that offer premium reductions or bonuses.

Additionally, the TPA can review the employee classification, payroll, and claim experience data that is used to calculate premiums to ensure that all information accurately reflects your company’s risk exposure. Note that approximately 10,000 Ohio businesses are audited by the BWC each year, which sounds intimidating. If your business receives an audit notification letter, you will be asked to provide wage reports, federal tax returns, true-up worksheets, and other documents. Fortunately, TPA will be on your side throughout the process.

What to Look For in an Ohio TPA

A TPA is more than an outside contractor; the company that you choose becomes part of your team. Therefore, you should be confident that they have the experience and industry knowledge to efficiently manage claims, identify discount programs and rebates, and provide audit support.

Use the same care that you use when hiring and promoting employees. Pick a partner that is well-established in the industry and has a solid reputation and a good working relationship with the Ohio BWC. Ask for references, and consult your peers about their experiences with Ohio TPAs. Look for a company that will assign a dedicated consultant to your business so you will always have a contact person who knows your business and the status of ongoing claims.

Compensation Solutions, Inc. (CSI) meets all these needs. It’s well known and respected in the industry, and its team offers personalized service, giving you direct access to your own claims management consultant. With decades of combined experience, the CSI staff can ease the stress of managing claims and ensure that your business is taking advantage of all available incentives and rebates to lower your workers’ compensation costs.

Managing workers' compensation claims in Ohio shouldn’t be a headache. Partner with CSI to take the hassle out of claims, lower costs, and stay compliant with Ohio BWC regulations. Focus on your business and employees, and let our seasoned experts guide you through the complexities of workers' comp. Contact us today to streamline the process and experience stress-free claims management!