Self-Insured Employer Control

[Georgedroy]

(01-07-2011 04:28 PM)Georgedroy Wrote:  [quote='1171' pid='130443' dateline='1294418750']
there is no law limiting the employer's involvement with their contracted administrator.

So the representative of the employer (HR, supervisor) can literally be in complete control of the claim ?
From the approval of medical treatment to paying replacement wages, and everything in between ?

[jayne]

Kinda they really must stay within guide lines suggest you check out the urls 1171 gave ya

[Georgedroy]

Thanks, jayne and 1171,

I've looked over the form 1171 posted. Is that something I have to fill out myself, or do I funnnel it through my attorney ?

Thanks

[alexcidp]

I will make this reply even though my user name identifies me in the State of Ohio and I am well aware that there are some lawyers with a lot of free time on their hands trolling these threads.
My case is a very old case and a very complicated case against a powerful self-insured employer in Ohio. Needless to say, it has been along and bitter battle. The TPA has changed hands during the course of the seven and 1/2 years, but the actions are much the same. Currently the TPA is _________. WOW is all that I can say. I have gone through all of the so-called systems set up within the BWC and filed complaints against my self-insured employer, yet they were dismissed without investigation. My complaints are valid complaints. I know this because I requested the supporting documents of their investigation and all records surrounding my complaints. All I received were my complaints and letters and a copy of some meeting minutes. I requested a hearing and received a notice indicating that I would get a hearing and then suddenly, months later I was sent a second notice telling me that my complaint had been dismissed and I would not be granted a hearing.

I have been told that there is no entity that investigates a self-insured employer for wrong-doing, only injured workers that commit wrong acts.
This system is very broken and I am ashamed for my employer, the very hospital where I graduated from nursing school and for the State of Ohio, for what they allow to occur in a program that is supposed to facilitate injured workers in returning to work or to take care of them for injuries that occurr[/size][/font]ed to them while on the job.
Thank you.

[1171]

should not believe everything you are told.
better to do your own research.
start here:
http://www.insurance.ohio.gov/Agent/Page...ement.aspx

[alexcidp]

[quote='1171' pid='131872' dateline='1298395733']
should not believe everything you are told.
better to do your own research.

Yes. Trust me. I believe most nothing that I am told. I am aware of the Department of Insurance and have spoken to someone there over a year ago briefly. Again, when fighting Goliath..you must have the right rock and know where you are aiming, in order to take down the mighty "Giant".
I have been in this fight for quite some time and the longer we go on the more info I gain to my advantage.
A complaint to this organization or even higher up might be in order very soon.
If you have any other thoughts please let me know. Thank you.[/size][/font]

[1171]

then you should know that there are entities that are empowered to investigate self-insured employers for wrong doing:

"Injured workers who feel their self-insuring employer is not operating in compliance with the rules governing self-insurance are eligible to file a complaint which BWC's self-insured department will investigate. "

http://www.ohiobwc.com/basics//guidedtou...info17.asp

see chapter 19 of Ohio Administrative Code
http://www.ohiobwc.com/basics//guidedtou...andoac.asp
specifically:
http://www.ohiobwc.com/downloads/blankpd...-19-06.pdf
http://www.ohiobwc.com/downloads/blankpd...-19-09.pdf

[alexcidp]

[quote='1171' pid='131872' dateline='1298395733']
should not believe everything you are told.
better to do your own research.
start here:

Are you suggesting to me that the TPA, ***edited by moderator. no names please***** is registered with the Ohio Department of Insurance? The way the game is played it is hard to pin down who exactly is commiting the deeds, which therefore makes it difficult to report. Their actions are also planned carefully to cause delays and much frustration without actually breaking the rules, however I think there are rules being broken. I am working on proving it.

[1171]

it's not your job to decide which is at fault.
go after them both.