Sheakley.com 513-326-8003 Phone One Sheakley Way 888-743-2559 Phone Cincinnati, Ohio 45246 Sheakley UniComp Employer Manual
Preface On March 1, 1997, the Ohio Bureau of Workers Compensation (BWC) changed how it manages state fund workers compensation claims. BWC is still responsible for the overall management of the claim file, and Managed Care Organizations are responsible for the medical management of the claim. The Health Partnership Program (HPP) ushered in a new era in health care for Ohio s injured workers. Through the combined efforts of BWC, businesses, organized labor and health-care providers, BWC created a workers compensation managed-care system that will meet your needs for years to come. HPP is truly a partnership where BWC and private-sector managed care organizations certified to participate in HPP must work together to provide comprehensive claims-management and medical-management services. Sheakley UniComp, Inc. is an Ohio workers compensation Managed Care Organization dedicated to providing high quality, cost effective medical care. We will facilitate a safe and early return to work or a functional life-style in the event a return to work is not medically feasible. Sheakley UniComp promotes continuous communication between the injured worker, the employer, the provider and BWC. Our goal is to offer exemplary service, assistance and education to all of our program participants. This manual is designed to anticipate our participants needs and questions. We encourage a thorough review of this material to ensure familiarization with the policies and procedures of Sheakley UniComp. We also encourage our clients to take full advantage of Sheakley UniComp s and BWC s premium cost savings programs. One Sheakley Way Cincinnati, OH 45242 513-326-8003 888-743-2559 Fax: 513-326-8005 888-626-2667 www.sheakley.com 1
Responsibilities Managed Care Organizations - MCOs Sheakley UniComp is responsible for: Medical management of claims; Obtaining initial claim data and medical records for BWC; Obtaining physical restrictions and assisting with light duty opportunities; Pre-approval of prolonged treatment; Providing network of BWC certified physicians; Provider network management; Determining reimbursement eligibility and paying medical providers for services; Utilization review; Processing of medical disputes/appeals; Educating employers, injured workers and providers Bureau of Workers Compensation-BWC The BWC is responsible for: Claim determinations/allowances; Authorizing compensation payments (Temporary Total TT/Wage Loss); Maintaining a current and accurate record of all BWC and IC actions and decisions; Communication to all parties on any BWC claims decisions; Recording periods of disability; Assisting employer with discount programs; NCCI/Manual Classifications; Determining employer premium payments; Educating employers, injured workers and providers Third Party Administrators - TPAs TPAs are responsible for: Control workers compensation costs; Evaluate alternative rating programs and discount programs (including Group Rating, Premium Discount Programs, Retrospective Rating, Self Insurance); Process appeals and file motions; Initiate claim settlements; Pursue handicap reimbursement for pre-existing conditions 2 www.sheakley.com
Medical management begins. Injured worker continues treatment from a BWC-certified healthcare provider. In contested compensation claims, the IC hears the dispute. In medical disputes, the MCO and BWC offers an alternative dispute resolution process before going to the IC. MCO and physician of record focus on quality health-care services geared to early and safe return to work. $1K, 5K, 15K Claims managed by employer. Employer contacts BWC to remove from program and have MCO begin Medical Management www.sheakley.com 3
Case Management Sheakley UniComp Case Managers are registered nurses that work closely with your injured worker, the medical provider, and you to coordinate a safe and timely return to work. The Case Manager reviews all medical documentation to determine the treatment necessary for the safest and quickest Return to Work. They also ensure that all approved medical treatment is appropriate for the allowed conditions in the claim. The Case Manager contacts the providers to expedite office visits, diagnostics, and any necessary treatments. Case Managers contacts the providers as often as necessary to obtain the Medco-14 (BWC workability form) for restrictions and a release to Return to Work. You should complete the job analysis to enable the Case Manager to assist in getting the Injured Worker back to work. You should also accommodate all restrictions when possible. The Case Manager attempts to place all appropriate injured workers in a Transitional Work Program so they can return to full duty work at the earliest possible time. The Case Manager refers to Vocational Rehabilitation all injured workers who are eligible and feasible to assist in Return to Work. Case Managers utilize nationally recognized guidelines for return to work plans and the authorization of medical treatment. Vocational Rehabilitation The vocational needs of the injured worker will be assessed by the Sheakley UniComp RN Case Manager throughout the case management process. The Sheakley UniComp Case Manager works with the physician, BWC, injured worker and you to help facilitate a timely return to work either in transitional or full duty employment. If specific vocational intervention is required to fulfill the goal of return to work, the case will be referred to a certified vocational rehabilitation specialist. Services supplied through Vocational Rehabilitation are most often charged out of the surplus fund. Charges out of the surplus fund do not typically have an impact on your workers compensation experience and therefore will not impact your premiums. 4 www.sheakley.com
Provider Network Sheakley UniComp partners with HealthSmart, who has contracts with its panel providers at an approximate 10% discount below the BWC fee schedule. Our extensive network of panel physicians, hospitals, durable medical equipment companies, home health care agencies, urgent care centers, and occupational health centers provide wide accessibility to our client base. The network will continue to expand as the need arises. Providers are geographically situated in relation to our clients and their employees residences. Injured workers do have the right to treat with providers outside the network as long as they are enrolled with BWC. Availability and Extent of Services Providers will be required to treat an injured worker within 24 hours of his/her request and additional treatments within a reasonable time frame. Providers will recognize the need to treat injured workers so that they may obtain optimal improvement. Providers agree to follow Sheakley UniComp s practice standards which include a prompt response regarding treatment plans and a 72 hour turnaround time on completion of forms. Providers are required to follow BWC s standardized prior authorization procedures. Credentialing and Education Providers must meet HealthSmart s credentialing criteria. All information submitted by an applicant will be verified through four sources: the American Board of Medical Specialties, the Federation of State Medical Boards, the National Practitioner Data Bank and the State Medical Board of Ohio. Re-credentialing occurs every 2 years upon the anniversary date of the contract. Providers will be knowledgeable in the treatment of occupational injuries and illnesses. Sheakley UniComp will assist network physicians, who are not currently BWC certified, apply for certification with the Bureau. www.sheakley.com 5
MCO PROCESS Filing an Injured Worker s Claim Work related injury occurs. Employee IMMEDIATELY notifies you of the injury. If an emergency, you direct injured worker to nearest medical facility for treatment. If not an emergency, employer refers to the online provider directory for physician location nearby. You can locate the HealthSmart Provider Directory by going to www.healthsmart. com. For additional assistance in locating a physician, employer or injured worker may contact Sheakley UniComp, Inc. at 1-888-743-2559 or 1-513-326-8003. Within 24 hours of seeking medical treatment, the employer or injured worker calls Sheakley UniComp, Inc. to report injury occurrence or completes a BWC First Report of Injury form (FROI). Please fax the FROI, with the injured worker s signature and any medical documentation to 1-888-626-2667 or 1-513-326-8005. A FROI can also be completed online at www.ohiobwc.com A Sheakley UniComp, Inc. representative will follow up with employer to request any additional information needed to process claim (i.e.: Injured worker s return to work date, claim certification/rejection, etc.) If you receive any bills, please submit to: Sheakley UniComp, Inc. Attention: MCO Department One Sheakley Way Cincinnati, OH 45246 Fax: 888-743-2559 All pharmacy bills are processed by: SXC Health Solutions P.O. Box 5226 Lisle, IL 60532-5226 Bureau of Workers Compensation handles all compensation benefits. For additional assistance, the injured worker may phone BWC at 1-800-OHIOBWC. 6 www.sheakley.com
Medical Bill Payment Process Medical providers have two years from the date of service to submit their medical fee bills on BWC approved forms. Sheakley UniComp will process the bill within 7 business days of receipt from the provider. The bill will either be processed for payment/denial and transmitted to BWC. If the bill contains insufficient information for accurate processing, the bill will be returned to the provider with the appropriate explanation. BWC will process the bill and will forward funds to Sheakley UniComp within 7 business days from receipt. Within 7 business days of receipt from BWC, Sheakley UniComp will issue a check and/or an explanation of benefits to the provider. Prescription Bill Payment (Pharmacies) Bills for medications are processed and paid for by BWC s designated Pharmacy Benefits information is as follows: SXC Health Solutions P.O. Box 5226 Lisle, IL 60532-5226 or call 1-800-ohiobwc and listen to the options www.sheakley.com 7
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Information Guide for Transitional Work Transitional Work Program Transitional work is proving to be one of the most effective steps in successfully returning an injured worker back to work before they are totally recovered. Transitional work helps the injured worker return to a job that adheres to the medical restrictions placed on the worker by the doctor, and allows the employee to resume their work functions and life-style with minimal time off. The ultimate goal of this process is returning (or transitioning) your injured worker to his/her original position. Both, the job description and restrictions, are reevaluated frequently based on medical necessity. Transitional work allows the injured worker to be productive and gradually transition into performing their original job duties while recovering from an injury. Employers accommodating on-site therapy through their transitional work program find that it eliminates travel time to and from therapy, resulting in reduced worker down time and diminished loss of productivity. Having the physical/occupational therapist at the job site helps tailor treatment specifically to an injured worker s job duties ensuring safe adherence to restrictions and improved transition back to regular duty. These services are easily accommodated by having a small area or room the therapist can utilize while working on-site with the injured worker. Additionally, the Licensed Therapist will keep you informed of your injured worker s progress throughout their transition back to full duty. Any charges related to these services will be reimbursed in the same manner as therapy conducted at the provider s office. The Benefits of a Transitional Work Program Reduces taking time off work for physical therapy visits Physicians are aware of work conditions Lower workers compensation costs Increased productivity Increased employee morale Decreased lost time Decreased employee replacement expenses Increased employee retention Enhanced worker and employer satisfaction Decreased personal and financial impact on the employee Sheakley UniComp, Inc. can facilitate in the development and/or enhancement of your Transitional Work Program. If interested, please call your Client Relations Manager at 888-743-2559 The goal is to lower costs while keeping employees productive and on the job. www.sheakley.com 9
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OPTIONS FOR REDUCING YOUR WORKERS COMPENSATION COSTS Drug-Free Safety Program The Drug-Free Safety Program (DFSP) is a BWC rate program which offers a premium discount to eligible employers for implementing a program addressing workplace use and misuse of alcohol and other drugs, including prescription, over-the-counter, and illegal drug abuse. The Drug-Free Safety Program (DFSP) replaces the Drug-Free Workplace Program/Drug-Free EZ Programs and has: Wider reaching with expanded benefits Benefits not limited to five years Previous participants eligible to join Simpler and easier to implement than DFWP/DF-EZ; one program with two levels, basic & advanced Streamlined application process Proven effective with measurable results Streamlined safety components Better reporting data Continuous measurement & evaluation Group Rating Plan The group-rating plan allows employers who operate similar businesses to group together to potentially achieve lower premium rates than they could individually. While every employer s situation is unique, group rating could save an employer in premiums. Each group is sponsored by an organization, such as a trade association or chamber of commerce. Each sponsoring organization may require members to pay a membership fee. Off-Site Return to Work Program An option for controlling your workers compensation premiums is to loan your injured employee to a charitable entity. The benefit of this type of duty is quite obvious. The employee is returned to gainful employment with the hope of returning to his/her original position while compensation payments are not accumulating. Several factors must be taken into consideration before this type of program is implemented: You must pay the full wage of the employee; A job description must be obtained and be approved by the physician of record; You assume all liability for the welfare of the loaned employee; There may be a tax benefit for charitable contribution/work performed (please consult your tax advisor). To find a non-profit organization in your area, please use the following website, www.melissadata. com/lookups/np.asp One Claim Program Designed for employers recently removed from a group experience rating program, this program can earn them up to a 40-percent discount in premiums www.sheakley.com 11
Deductible Program BWC s Deductible Program helps employers lower their premiums by offering an upfront premium discount in the form of a per claim deductible. It also encourages employers to focus on workplace health and safety to reduce injuries and illness. Employers who effectively manage their workers compensation claims and related costs will see a financial benefit. However, if an employer does not manage claim costs, the deductible can exceed premium savings. Group-Retrospective Rating Join a group within your industry to combine your experience and claims with other group members to receive a premium discount. Retrospective Rating Plan The retrospective rating plan allows an employer to assume a portion of the risk in return for a possible reduction in premiums. The greater the assumed risk, the greater the potential reduction in premiums. Employers who have a consistent claims history and proven safety practices will benefit the most from retrospective rating. The employer can customize the retrospective rating plan to control the amount of risk assumed and the potential savings by selecting the maximum premium and maximum claims costs he or she is willing to pay. Employers may benefit from retrospective rating because of lower initial premiums and realized cash flow advantages, which increase as premiums are saved. SafetyGRANT$ The purpose of the Safety Intervention Grant$ Program is to gather information about the effectiveness of safety interventions so that BWC may share the results with Ohio employers. The program is available to any Ohio state-fund or public employer who wishes to purchase equipment to substantially reduce or eliminate injuries and illnesses associated with a particular task or operation. The program is designed to work and partner with Ohio employers to establish safety intervention best practices for accident and injury prevention. To participate in the program an employer must pay into the Ohio State Insurance Fund, maintain active coverage, be current on all monies owed BWC and demonstrate the need for a safety intervention. With the safety intervention grant, private and public employers are eligible for a 2-to-1 matching grant, up to a maximum of $40,000, meaning a total of $60,000 $20,000 from the employer and $40,000 from BWC. The employer will benefit through a substantial reduction or elimination of workplace injuries and illnesses, and their related costs. In return, the employer will submit to BWC quarterly data reports and a case study one year after the date of the intervention. BWC will use this information to determine the effectiveness of the intervention and share successes with other employers. Salary Continuation Salary continuation allows an employer to pay an employee his or her regular wages after a workplace injury or illness occurs. The injured worker has the option to elect workers compensations benefits if he or she so chooses unless there is a collective bargaining contract that states otherwise. The employer pays salary continuation to the injured worker until either party terminates payment. At that time, workers compensation benefits may take effect, if appropriate. 12 www.sheakley.com
Your injured worker must receive a full check at the next scheduled time after the injury or illness occurs. You cannot wait until BWC or the IC makes a determination. If you miss paying an injured worker at a scheduled time, you forfeit salary continuations rights on the claim and temporary total will begin. You cannot pay salary continuation once BWC has ordered temporary total compensation, unless required by a collective bargaining contract. If you wish to pay salary continuation, you must notify BWC before the initial determination decision is issued. You must submit a Salary continuation Agreement (C-55) signed by a representative of your company and the injured worker, for each period of salary continuation to be paid. This does not mean for each pay period but for each period of disability as identified on the C-55. You should base the end date on the expected period of disability as supported by medical documentation, not to exceed 45 days. Do not list until return to work or a vague future date on the form. You cannot force your injured worker to use sick time, unless there is a collective bargaining contract that states otherwise. You must notify the BWC, within 72 hours when you discontinue salary continuation and/or the injured worker returns to work. $15,000 Medical-Only Program BWC s $15,000 Medical-Only Program offers employers the opportunity to pay the first $15,000 of medical bills in medical-only claims (claims with seven or fewer lost days from work). The program automatically covers medical-only claims with a date of injury after the enrollment date. The employer can decide not to have a specific claim in the program by calling BWC and speaking to the claims service specialist. The employer must inform the provider and MCO of the removal of the claim, and BWC will pay the medical bills. While the program covers a claim, the MCO cannot manage the claim, authorize treatment or pay medical bills. If a claim changes to lost time, indicating eight or more days lost from work, BWC will automatically remove it from the program, and the MCO begins managing the claim. The employer may enroll in the program by calling BWC at 1-800-OHIOBWC and choosing option 2. Self Insurance Self Insured employers are those employers who have applied for and been granted the authority to administer their own workers compensation claims. Self Insured employers agree to abide by BWC and the Industrial Commission s rules and regulations and to provide accurate and timely payments of compensation and benefits subject to the provisions of those rules. Settlements A settlement is an agreement between you, the injured worker and BWC for a specific amount to settle one or more claims. When a claim is settled, the injured worker will receive a lump sum payment. The injured worker will receive no additional compensation and/or benefits for the settled claim. Settlements also may reduce claims costs, which impact premiums. A settlement fixes the claim cost, which then allows the premium to reflect the settlement amount and possibly reduce your premium. The claims costs used in the experience following a settlement will be the actual payments made to date, both medical and indemnity (compensation), and will include the settlement amount. Once settled, BWC will no longer include a reserve in your experience. www.sheakley.com 13
Injured Worker Rights and Responsibilities Injured workers should be given an ID card as well as an injured worker brochure ( Introducing Sheakley UniComp, Inc. ). The ID card should be taken to each doctor s appointment. The injured worker brochure assists the injured worker in better understanding the managed care process for workers compensation. It also notifies them of their rights and responsibilities. UniComp Your policy number here 14 www.sheakley.com
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Physician s Report of Work Ability Instructions Physician must complete this form when the injured worker is under work restrictions or is temporarily totally disabled. You must send or fax a copy of the completed form to the managed care organization (MCO) and a copy given to the injured worker at time of exam. You may use any other physician-generated document provided that the substitute document contains, at a minimum, the data elements on the MEDCO-14. If injured worker is employed by a self-insuring employer complete this form and mail or fax it to the self-insuring employer. Fax Note: To Toll-free phone number Toll-free fax number From Phone number Fax number Injured worker name Claim number SSN if claim number unknown Date of injury / / Injured worker occupation Employer name WORk ACTIvITY May return to work (RTW) with no restrictions on May RTW with restrictions due to work-related injury/disease from to (complete work/non-work capabilities on the right). Work restrictions apply to work and non-work activity. If restrictions cannot be met at work, then injured worker is recommended to be off work. The restrictions are permanent temporary? If temporary, how long? Is totally disabled from work from to. Please explain in the space provided below why the injured worker is unable to work, due to work-related injury/disease. List ICD-9 codes for the allowed conditions being treated which prevent return to work. Estimated RTW date Work/Non-Work Capabilities None at all Occasional Frequent % of Workday (8 hr) 0% 1-33% 34-66% Repetitions per hr 4-6 6-12 Lift/Carry Up to 10 lbs.... 11-20 lbs.... 21-50 lbs.... 51-100 lbs.... Bending... Twist/turn... Reach below knee... Push/pull... Squat/kneel... Stand/walk... Sit... No lifting above shoulders.. Hand restrictions Left Right Must wear splint No lifting greater than lbs No repetitive activities No work with hot or cold substances Continuous 67-100% >12 Change positions every Work activity as splint/bandage permits Avoid driving Keep wound clean/dry Limit working to Hrs./Day Physician s further explanation of work abilities or why the injured worker is unable to perform any work: No use of Left Right Arm Hand Finger Other REHAB MMI Has the work-related injury(s) or occupational disease reached a treatment plateau at which no fundamental functional or physiological change can be expected despite continuing medical or rehabilitative intervention (maximum medical improvement): Yes No Note: Periodic medical treatment may still be requested and provided. IF YES, give date IF NO, please explain (attach additional sheet if necessary) Physician name and address (please print, type or stamp) Check if vocational rehabilitation return to work services are indicated. Date of this exam Follow-up appointment Date / / / / Time I certify the above information is correct to the best of my knowledge. I am aware that any person who knowingly makes a false statement, misrepresentation, concealment of fact or any other act of fraud to obtain payment as provided by BWC or who knowingly accepts payment to which that person is not entitled, is subject to felony criminal prosecution and may, under appropriate criminal provisions, be punished by a fine, imprisonment, or both. Physician signature Date (mandatory) / / BWC-3914 (Rev. 7/30/2008) MEDCO-14 Distribution: White-Physician Fax a copy to MCO Yellow-Injured worker www.sheakley.com 17
Request for Injured Worker Outpatient Medication Reimbursement The pharmacy can process a point of sale transaction to avoid the need to submit the C-17. The attachment of prescription labels with pricing information or a pharmacy printout with pricing information is required. Photocopies are acceptable. Cash register receipts are not sufficient. Pharmacist s signature and date are required. Injured workers only use this form for reimbursement of outpatient medication. There is a two-year statute of limitations for reimbursement. If the injured worker uses more than one pharmacy to fill prescriptions, he or she must submit a separate C-17 for each pharmacy. Bill medical supplies, durable medical equipment and other non-drug items on a separate invoice to the managed care organization (MCO). To identify the correct MCO, please log on to ohiobwc.com, or call 1-800-OHIOBWC, and listen to the options. The amount paid will be pursuant to the approved BWC fee schedule for drugs. For drugs that are available generically, BWC will reimburse the maximum allowable cost amount assigned to that drug. If you or your physician requested the brand-name version of a drug when a generic drug was available, BWC will reimburse at the maximum allowable cost for the drug, which is based on the cost of the generic drug. Medications, including over-the-counter items, must be prescribed by a medical professional licensed to prescribe drugs and dispensed by a pharmacy provider enrolled with BWC. Drugs purchased from a physician s office for at-home use are not reimbursable. Compounded drugs are not reimbursable. Mail completed form to: SXC Health Solutions P.O. Box 5226 Lisle, IL 60532-5226 For additional information, or if you need help to complete this form, please contact an SXC customer service representative by calling 1-800-OHIOBWC and listening to the options. Check List Is the C-17 filled out completely for processing? Have you completed the Injured Worker Information section? Has the Injured Worker signed and dated the form? Has the pharmacy completed the Pharmacy Information and Prescription Detail sections? Has the pharmacist signed and dated the form? Have you included pharmacy labels with pricing information or a pharmacy printout with pricing information as required? Cash register receipts are not sufficient. 18 www.sheakley.com
Request for Injured Worker Outpatient Medication Reimbursement Injured Worker Information Date or request Date of injury BWC claim number (Required) Injured worker name (last, first, middle initial) Injured worker address (street or PO Box, city, state, and nine-digit ZIP code) Pharmacy Information Pharmacy (name and store number) NABP/NCPDP number (Required) Pharmacy phone Pharmacy address (street or P.O. Box, city, state, and nine-digit ZIP code) Prescription Detail Date Rx written Prescriber's name Prescriber NPI number Prescription number Date dispensed National drug code Drug name, strength, and dosage form Metric quantity Estimated days supply Refill YES NO Total charge Date Rx written Prescriber's name Prescriber NPI number Prescription number Date dispensed National drug code Drug name, strength, and dosage form Metric quantity Estimated days supply Refill YES NO Total charge Date Rx written Prescriber's name Prescriber NPI number Prescription number Date dispensed National drug code Drug name, strength, and dosage form Metric quantity Estimated days supply Refill YES NO Total charge Date Rx written Prescriber's name Prescriber NPI number Prescription number Date dispensed National drug code Drug name, strength, and dosage form Metric quantity Estimated days supply Refill YES NO Total charge Any person who obtains compensation, medical or pharmaceutical benefits from BWC or self-insuring employers by knowingly misrepresenting or concealing facts, making false statements or accepting compensation, medical or pharmaceutical benefits to which he/she is not entitled, is subject to felony criminal prosecution for fraud. By signing below, I certify I have read and understand the statements above and agree with these conditions. Injured Worker I certify below the information on this form is true and correct to the best of my knowledge and belief. Injured Worker's signature (Required) Date Pharmacist I certify below the information on this form is true and correct to the best of my knowledge and belief. Pharmacist's signature (Required) Date BWC-1122 (Rev. 9/02/2009) C-17 www.sheakley.com 19
Salary Continuation Agreement You can obtain this online form at ohiobwc.com Instructions This form is used to acknowledge an agreement to pay salary/wage continuation in lieu of temporary total or living maintenance compensation. Regular (full) salary/wages includes any benefits, which the employee would normally be entitled to if he or she was working. The employee and the employer must sign this form. Fax or mail this completed agreement to your local BWC customer service office. Employee name Claim number Employer name Policy number Employer telephone number On the day of,,, the employer and Employer name the employee named above executed the following terms and conditions pertaining to the payment of salary continuation. The employer, since the inception of the employee s disability resulting from an accident/occupational disease suffered by the employee on / / while in course of his or her employment, has been or is paying regular (full) salary/wages in lieu of temporary total or living maintenance compensation to the employee during the period of disability as indicated below: Continuation of regular (full) salary/wages and any benefits the injured worker would otherwise have been entitled to has been/will be paid. Salary continuation will be paid at the rate of $ per (week, two weeks, etc.) for the period of time from / / to / / (a period of time not to exceed 45 days per C-55 submission). Does the amount paid include salary/wages from other employment? Yes No Should salary continuation payment continue, you must submit a new C-55 within five days of the end date of this agreement. The employer must notify BWC immediately if he or she will discontinue salary continuation and/or if the injured worker returns to work. Employee signature Date Employer signature and title Date BWC-1174 (6/30/2008) C-55 20 www.sheakley.com
Worker s Compensation Internet Resource Guide We have compiled a list of websites which can assist you on your journey to controlling Worker s Compensation costs. We recommend placing these websites in the favorites section on your internet web browser so they will only be a couple of mouse clicks away. Sheakley UniComp, Inc. www.sheakley.com ( access WebView; a free service, you can view your company claim information 24hrs a day) HealthSmart Provider Directory www.healthsmart.com ( query the closest medical providers to you within a 5, 15 or 30 mile radius then print them out) ( query under provider search, workers compensation on the closest) Non-Profit Organization Look Up..by Zip Code www.melissadata.com/lookups/np.asp ( loan your injured workers to a non-profit organization if you can t meet their medical restrictions) Ohio Bureau of Workers Compensation www.ohiobwc.com ( view recent news releases, gain access to the BWC system, view claim payments) OHIOLINK (Includes BWC s Div. of Safety & Hygiene library collection) www.ohiolink.edu ( gain access to the Div. of Safety & Hygiene s statewide library collection and information network) OSHA (Occupational Safety & Health Administration) www.osha.gov ( access updated OSHA media releases, publications, statistics and other valuable information) NIOSH (National Institute for Occupational Safety & Health) www.cdc.gov/niosh/homepage.html ( access current information on services and activities, including NIOSH publications and research info) www.sheakley.com 21
Supply Request Form Requested by: Quantity Identification Cards Employee Brochures 4-Step Poster Employer Manual (electronic copy) FROI (First Report of Injury) * Copy from page 15 BWC Medco-14 Form * Copy from page 17 Spanish Forms Available Employee Brochures FROI (First Report of Injury) Send Supplies To (Please Print): Company Name Risk/Policy # Mailing Address Phone Number Company Contact Name E-mail Address: Please fax Supply Request Form to 513-326-8005 or 888-626-2667. Revised 2/10 22 www.sheakley.com
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Sheakley UniComp, Inc. One Sheakley Way Cincinnati, 45246 (888) 743-2559 (513) 326-8003 Fax: (888) 626-2667 (513) 326-8005 Email: mco@sheakley.com