Policies & Procedures
Employers Q & A
How to file a Claim
Reporting Lost Time
Return to Work Programs
Injury Packets/ Educational Materials
Frequently Asked Questions
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.Back to Top
What to do if an employee is injured?
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.
What are my responsibilities for claims in the $15K program?
While a claim is enrolled in the $15K program, SMAI 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, SMAI will start to medically manage the claim and pay the medical bills.Back to Top
How do I report a fraudulent claim?
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 on-line 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:
Spooner Medical Administrators, Inc. | 28301 Ranney Parkway | Westlake, Oh 44145 | Main: 440.899.2400 | Toll-Free: 800.542.9479 | Fax: 440.899.2411