Third Party Administrator Services

 

Third Party Administrators (TPA) provide invaluable expertise for over 120,000 employers in Ohio alone.  This expertise includes injury prevention, risk management and claim cost containment strategies, information management, data trending and analysis and outcomes measurement.   Successful TPA’s integrate these and other value-added services to deliver customized workers’ compensation cost containment solutions to their clients.

Some important statistics on the impact of TPA’s include:

  • TPA’s currently represent approximately 82% of Ohio’s state-funded employers with claims, and approximately 90% of the state-funded claims.  On average, the state-funded cost per claim was $2,500 less when TPA’s managed the claims versus employer self-administration.  This translates into a savings of over $258 million to the Ohio Bureau of Workers’ Compensation (BWC) for the same year.
  • The average indemnity claim cost for employers with TPA representation is 39% less than the average for employers not represented by a TPA.

(Statistics from BWC Public Information Request (2008))


TPAs serve three distinct types of employers. Self Insured Employers, State Fund employers and Group Rated employers within the state of Ohio.  

Large Self Insured clients turn to TPAs to manage all aspects of their claims: first report of injury, investigation, compensability determination, medical bill payments, settlements, hearing representation. TPAs manage claims for most of the self insured employers in Ohio.

TPAs perform similar services for State Fund employers with the exception of medical bill payments, which is performed by Managed Care Organizations (MCO).  MCOs manage the medical aspects of the claim. TPAs work closely with MCOs while advising employers of the impact of overall costs on their future premiums.

For group rated employers, TPAs analyze their claims information to determine whether they qualify for group rating and at what savings level. TPAs administer groups up to the current maximum savings off premium established by BWC. TPAs also work with group rated employers to manage claims when they do occur.

While BWC has employer services specialists, they cannot serve as the employer’s advisor on workers’ compensation matters because BWC has to remain as an objective party.   Two specific areas are representation of employers at hearings before the Industrial Commission and assisting employers with preparation for an audit.  Additional expertise can be found in injury/illness trending, loss prevention/safety assessment services and feasibility studies for alternative rating programs.

In developing workers’ compensation programs that will result in maximum cost effectiveness for the employer and a safe and healthy return to work and/or productive lifestyle for their injured employee, TPAs pursue multiple strategies that include:

  • Accident Prevention and safety programs to reduce claim frequency and severity
  • Claims investigation to determine compensability
  • Evaluation of claims prior to reserves being set
  • Coordination of private investigation, case management and/or vocational rehabilitation experts to bring claims to resolution
  • Hearing attendance
  • Wage/Salary Continuation
  • Claim settlements
  • Handicap reimbursements
  • Underwriting and Rate review services including manual classifications, transfer/merger/acquisition consultation, premium/rate verifications
  • Evaluation Studies, Recommendation, and Administration of Alternative
  • Savings/Rate Programs, including:
  • Group Rating
  • Group Retrospective Rating
  • Individual Retrospective Rating
  • Large/Small Deductible
  • EM Cap
  • Safety Council
  • Drug Free Safety Program
  • One Claim Program
  • $15,000 Medical Program
  • Self Insurance

TPA services allow companies to receive the highest level of risk management expertise while working with the various entities that are involved in the workers’ compensation system.