OHIO Becomes First Self-Insured Public University

Hoping to avoid unnecessary bureaucracy and long delays in compensating injured Ohio University employees for medical bills, OU recently became the first self-insured public university in Ohio.When an OU employee submits a claim for a work-related injury, before the self-insurance initative, both the university and the Ohio Bureau of Workers’ Compensation (BWC) must approve the claim. Before an injured employee can receive compensation for medical bills or for lost hours on the clock, the university must send the paperwork to the BWC, which then reviews it and sometimes sends it to independent entities, such as doctors or nurses, for additional review.For a claim to be approved, the injury must be compensable; and to be considered compensable, the injury must “arise in the course and scope of employment.”“Those are the magic words when you look at the workers’ compensation law,” said Larry Wines, manager of workers’ compensation. “So if someone has a seizure or they have a preexisting medical condition that happens to manifest itself while they’re on the job, that doesn’t arise in the course and scope of employment.”Beginning January 1, 2013, solely OU, as a self-insured entity, will decide whether an injured worker’s claim has any merit.Some university employees may worry that, under the new process, the university would be more likely to deny their claim than an outsider like the BWC.“If the injured worker disagrees with the decision, then they can appeal it,” said Wines. “So you still have that protection there for the injured worker who feels their claim has been wrongly handled.”Wines also pointed out that over the past four years, the university has approved 90 to 94 percent of all work-related injury claims. By breaking ties with the BWC, the university also hopes to cut down on costs.“Over the last few years, we’ve been averaging between $1.2 and $1.4 million in claims being paid out … but the university pays that … In addition, we also pay an administrative fee to BWC—hundreds of thousands of dollars—for them to process the paperwork,” said Wines.Overall, Wines is optimistic about the new process, which he foresees will better serve university employees and in a timely manner.“We’re hoping to process claims faster, make decisions faster. By avoiding those administrative bureaucratic fees… we’re hoping to save some money,” said Wines.