An MCO manages the medical aspects of a claim, while a TPA manages the employer’s administrative, financial, and strategic claim responsibilities.

For Ohio employers, an MCO and TPA often work together. The MCO manages medical care and return-to-work outcomes, while the TPA helps control costs, identify savings opportunities, and protects the employer’s interests.

Each plays a different role in Ohio workers’ compensation:

• BWC administers Ohio’s workers’ compensation system.
• MCO manages the medical portion of workplace injury claims and helps facilitate the injured workers’ safe return to work.
• TPA helps employers manage claims, control costs, and maximize workers’ compensation savings opportunities.

While most Ohio employers must have a BWC policy and an MCO, partnering with a TPA is optional.

No. A TPA is not required in Ohio.

However, many employers choose to partner with a TPA for assistance with claims management, hearing representation, cost-control strategies, premium reduction programs, and workers’ compensation administration.

An MCO only manages medical care and treatment coordination, while a TPA helps employers manage the administrative, financial, and strategic aspects of workers’ compensation, including claim strategy, program selection, hearings and cost-control opportunities.

Yes. Employers can change TPAs if they feel another provider is a better fit for their service, claims management, or savings needs.

Employers should evaluate a TPA’s experience, customer service, claims expertise, hearing support, savings results, return-to-work resources, and overall approach to workers’ compensation management.

A TPA can help employers:

• Reduce workers’ compensation costs
• Manage claims more effectively
• Identify savings opportunities
• Participate in discount and rating programs
• Navigate hearings and appeals
• Improve claim outcomes and return-to-work efforts

TPAs help control costs by monitoring claims, advocating for appropriate claim management, identifying savings opportunities, such as disability relief, settlement and non-at-fault; providing program recommendations, assisting with hearings, and supporting return-to-work initiatives.

A TPA helps employers identify savings opportunities, manage claim costs, evaluate rating programs, and implement strategies that can positively impact future premium calculations.

Yes. Through thorough reviews, proactive claim monitoring, return-to-work coordination, and early intervention strategies, TPAs help employers address potential issues before costs increase.

Disability Relief is an Ohio BWC program that may reduce the impact of certain lost time claim costs on an employer’s experience rating when a pre-existing condition significantly contributes to an injured worker’s disability. If approved, a portion of the claim costs may be charged to the BWC surplus fund rather than the employer’s experience, potentially reducing premium impact. A TPA can review claims for eligibility and submit the necessary application on the employer’s behalf.

Non-At-Fault refers to a workers’ compensation claim resulting from a work-related motor vehicle accident in which a third party—not the injured employee or employer—was responsible for the accident. If specific Ohio BWC requirements are met, the employer may apply to have the claim costs charged to the BWC surplus fund instead of impacting their experience rating. A TPA can help identify eligible claims, gather the required documentation, and submit the application to BWC.

A TPA can analyze your claims history, payroll, and risk profile to determine which workers’ compensation program may provide the greatest financial benefit for your organization.

Group Rating allows employers with better-than-average claims experience to combine with similar employers to earn workers’ compensation premium discounts.

Group Retro allows eligible employers to join together in a retrospective rating program, with the potential to receive premium refunds when the group’s claim costs remain below established thresholds.

Group Rating provides upfront premium discounts, while Group Retro provides refunds based on claim performance after the policy period.

Yes. TPAs often attend Industrial Commission hearings to support employers and help manage workers’ compensation claims. Their role may include preparing documentation, reviewing claim issues, coordinating hearing strategy, and providing guidance throughout the claims process. When legal representation is necessary, TPAs work in partnership with qualified legal counsel.

Yes. A TPA can help employers understand claim decisions, review documentation, identify concerns, and assist with the appeals process when appropriate.

Yes. A Third-Party Administrator (TPA) can help evaluate settlement opportunities, analyze claim exposure, gather supporting documentation, coordinate communication among involved parties, and provide guidance throughout the settlement process. While the final decision to settle rests with the employer and injured worker, a TPA can help determine whether settlement may be a cost-effective strategy and support negotiations through resolution.

A workers’ compensation claim can be filed by the injured worker, employer or medical provider. Once the injury is reported through a First Report of Injury (FROI), BWC reviews the claim and the MCO begins coordinating medical care.

A new workplace injury is reported by filing a First Report of Injury (FROI) with the Ohio Bureau of Workers’ Compensation, or reporting the injury to the MCO. Prompt reporting helps ensure timely medical care and allows the claim process to begin as quickly as possible.

Workplace injuries should be reported immediately. Prompt reporting helps ensure timely medical treatment, faster claim processing, and better return-to-work outcomes.

Once a claim is allowed, approved medical bills related to the workplace injury are paid through the Ohio workers’ compensation system. The MCO coordinates care and manages medical billing, while BWC pays for covered medical services.

Employers play an important role by maintaining communication with injured workers, evaluating work restrictions, identifying modified-duty opportunities, and collaborating with medical providers, MCOs, and TPAs throughout the recovery process.

Review the restrictions, compare them to the employee’s job duties, determine whether modified duty or transitional work is available and communicate with the employee, MCO, and TPA.

The sooner an injured employee returns to productive work, the more likely the claim is to have a positive outcome. Effective return-to-work programs can help reduce lost-time costs and improve claim outcomes.

The employee may be eligible for additional workers’ compensation benefits depending on the circumstances of the claim.

Employers should maintain records related to the injury, claim, medical treatment, payroll, return-to-work activities, and communications concerning the claim.

Most Ohio employees are covered, including full-time, part-time, temporary, and seasonal workers. However, some individuals, such as independent contractors and certain business owners, may not be covered.

Yes. Ohio employers are required to post proof of workers’ compensation coverage where employees can easily see it or access it electronically.

Unlike State Fund employers, self-insured employers are responsible for administering and paying workers’ compensation benefits directly. Many self-insured employers partner with a TPA to manage claims, coordinate medical care, monitor costs, maintain compliance, and support return-to-work efforts.

While a TPA is not required, many self-insured employers choose to partner with one because workers’ compensation administration can be complex and time-consuming. A TPA provides claim expertise, regulatory knowledge, cost-control strategies, hearing support, and administrative resources that help employers effectively manage their workers’ compensation program.

Self-insurance can provide employers with greater control over claim management, faster decision-making, improved cash flow, customized return-to-work programs, and opportunities to reduce long-term workers’ compensation costs through proactive claim management.

To become self-insured, an employer must apply through the Ohio Bureau of Workers’ Compensation and demonstrate the financial strength and administrative capability to directly pay and manage workers’ compensation claims. Eligibility requirements are established by Ohio law and reviewed by the BWC during the application process.

In Ohio, State Fund employers pay workers’ compensation premiums to the Ohio Bureau of Workers’ Compensation (BWC), while self-insured employers assume direct responsibility for paying workers’ compensation benefits and managing claim costs. Self-insured employers typically have greater control over claims administration, return-to-work strategies, and claim-related decisions, while State Fund employers rely on the BWC system for claim funding. Many self-insured employers work with a TPA to help manage claims, control costs, maintain compliance, and improve claim outcomes.

Self-insured employers are responsible for paying approved workers’ compensation benefits directly rather than through the Ohio State Insurance Fund. This may include medical expenses, compensation benefits, settlements, and other claim-related costs as required under Ohio law.

Yes. Self-insured employers have the right to challenge claim allowances, compensation requests, treatment requests, and other claim-related issues when appropriate. A TPA can assist with claim evaluation, documentation, hearing preparation, and overall claim strategy throughout the process.

Self-insured employers can help control costs through proactive claim management, early injury reporting, effective return-to-work programs, ongoing claim reviews, reserve management, timely claim resolution, and employee safety initiatives. A TPA can help identify opportunities to improve claim outcomes and reduce overall program costs.

Excess insurance helps protect self-insured employers from catastrophic workers’ compensation losses by providing coverage when claim costs exceed predetermined limits. This additional layer of protection can help reduce the financial impact of severe or high-cost claims.