Policy # 1
EMPLOYER ADMINISTRATIVE SERVICES AGREEMENT
This Employer Administrative Services and Group Rating Plan Participation Agreement is entered into this _____ day of
_______________ 201_, between (“Employer”) and V & A Risk Services, LLC., (“V&A”)
NOW, THEREFORE, in consideration of the mutual promises and agreements contained herein, the parties hereto agree as follows:
A. CLAIMS MANAGEMENT ADMINISTRATION:
V&A will through the use of generally accepted actuarial risk and claims
management procedures and policies assist in the control of the variable expense associated with workers’ compensation claims within the risk
experience of the Employer for the term of this agreement. V&A will act as the exclusive claim and risk representative for Employer in
connection to its Ohio workers’ compensation matters for the term of this agreement. In this regard, V&A will provide the following third-party
claims management administrative services:
1. Proper and efficient Claim administration
• Administration and management of workers’ compensation claims.
• Review BWC First Report of Illness/Injury (FROI) claim applications for completeness and compliance with BWC and IC
rules and regulations.
• Provide guidance on the certification and rejection of claims, motions for disability benefits, further allowance of claim,
medical treatment and related claim matters.
• Provide claims management, in conjunction with the Employer’s selected Managed Care Organization (“MCO”),
• Advise Employer when it would be actuarially beneficial to accommodate restricted duty requests or pay wage
continuation benefits in lieu of workers compensation benefits.
• Pursue handicap reimbursement, claims settlement and subrogation where appropriate.
• Coordinate representation of the Employer’s interests at Administrative hearings before the BWC and Industrial
Commission of Ohio.
This agreement shall not include representation of the Employer regarding application for an additional award of
compensation for alleged violations of specific safety requirements (V.S.S.R.), BWC payroll audit or any other matter that
would constitute the practice of law.
2. Risk Technical Services
• Annually review Employer’s risk experience history as provided by the BWC and current and projected premium rates.
• Prepare an analysis of estimated Employer’s potential savings through various BWC Employer discount programs.
• Analyze BWC claim data and history for consideration of settlement, wage continuation and other options to minimize
the financial/ actuarial impact of claims. Coordinate actuarial analysis with client and client’s retained legal counsel to
assist in the settlement of claims and other litigated matters.
• Prepare special studies and reports designed to aid in workers’ compensation cost control for Employer.
• Retroactively audit the Employer’s merit rating experience, verify the adjusted annual rates, review the accuracy of
reserves assigned to open and pending claims, verify the correct charging of awards, and file request for corrections
where indicated.
• Analyze the feasibility of alternative methods of financing the Employer’s worker’s compensation obligation and assist
in the processing of all information with the BWC necessary to obtain group-rating, retrospective-rating, self-insurance
or any other available BWC funding or payment alternative.
B. EMPLOYER OBLIGATION
Employer shall fully and promptly cooperate with V&A in its delivery of third-party administrative
services by:
Notifying V&A of any material changes in the operation of the Employer, including, but not limited to, mergers, acquisition or
significant adjustments to the employer’s payroll (such as an adjustment that results in changing the National Council on
Compensation Insurance (“NCCI”) classifications under which the Employer was originally contracted with by V&A.) For
purposes of this Agreement, “significant adjustments to the Employer’s payroll” shall be defined as a reduction or increase in
reported payroll in excess of 10% from the initial reported payroll or any change in the occupational classifications utilized by the
Employer over the term of this Agreement. Any change in payroll or reported classifications under this section shall be reported in
writing to V&A no later than the six month payroll report is mandated to be filed with the BWC.
Provide V&A notice and results of any BWC audit including copies of all documents provided to the BWC auditor.
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Provide V&A such other information in such form as is reasonably requested by V&A and otherwise reasonably cooperates
with V&A in furtherance of its administration under this agreement.
Study ID 101