4123-17-13 Employer application for workers' compensation coverage.

(A) To institute workers' compensation coverage under this rule, the employer shall submit an application for coverage that completely provides all the information required for the bureau of workers' compensation to establish coverage for the employer.

(1) The application for coverage shall be submitted on a form designated by the bureau, and shall include, at a minimum, the following information:

(a) The legal name and business entity type (corporation, L.L.C., sole proprietorship, partnership, etc.);

(b) Address of the employer;

(c) The federal tax identification number or social security number of the employer;

(d) Information related to the description of the employer's operations, including:

(i) A description of the work done or industry conducted by the employer, and

(ii) The estimated average number of employees in each kind of work; and

(iii) The estimated wages of employees in each kind of work over the next twelve months.

(e) Information related to whether the applicant for coverage has purchased an existing business or has another associated policy;

(f) Name of the owners or corporate officers, and, where applicable for elective coverage, the name and necessary identifying information of the sole proprietor, partners, or ministers;

(g) Signature of the person completing the application for coverage; and

(h) A non-refundable application fee equal to the minimum administrative annual charge set forth in rule 4123-17-26 of the Administrative Code.

(2) If the bureau receives an application for coverage that does not contain all of the information required by paragraph (A)(1) of this rule, the bureau will attempt to contact the employer to obtain the required information. If the applicant does not provide the required information, the bureau shall deny the employer's application for coverage based upon the employer's failure to provide all the information required by paragraph (A)(1) of this rule.

(3) When an applicant fails to provide the information required by paragraph (A)(1) of this rule and has employed one or more persons, the employer may be considered a non-complying employer under rule 4123-14-01 of the Administrative Code, and the bureau may recover premium and penalties from the employer under rule 4123-14-02 of the Administrative Code.

(B) Upon receipt of the application, the bureau shall assign payroll to the classification applicable to the duties performed. The bureau shall send the employer notice of its determination regarding the employer's manual classifications and division of the employer's payroll within those classifications, the manual rates for those classifications, and estimated premium due for the remainder of the policy year in which the employer applies for initial coverage.

(C) If the bureau determines, after reviewing the information submitted with the application provided for in paragraph (A) of this rule, that the employer was subject to division (B)(2) of section 4123.01 of the Revised Code but failed to comply with the law in matters of workers' compensation coverage, the bureau shall notify the employer in writing of such a finding and request any additional information required to make a determination of the period for which the employer was not in compliance with the law. Upon such determination, the bureau shall notify the employer of the premium and assessments due for the period of noncompliance.

(D) If the bureau determines, after reviewing the information submitted with the application provided for in paragraph (A) of this rule, that the employer is essentially the same employer regardless of entity type for which risk coverage previously had been provided, the bureau may transfer the prior risk coverage to the employer pursuant to rule 4123-17-02 of the Administrative Code and the employer shall assume any outstanding obligations under the prior risk coverage. The bureau may reactivate a previously cancelled policy in order to complete this transfer.

(E) Upon receipt of the application fee, the bureau shall issue a notice of workers' compensation coverage pursuant to section 4123.82 of the Revised Code. The notice shall indicate that coverage is contingent on payment of estimated premium and assessments due.

(F) Upon receipt of the first estimated premium payment, the employer's coverage shall begin.

(1) Such coverage shall be effective from the date of receipt of the application for coverage required by paragraph (A) of this rule.

(2) A credit in an amount equal to the application fee shall be applied to the employer's account upon receipt of the first estimated premium payment.

Replaces: Replaces 4123-17-13; and in Part 4123-19-02

Effective: 7/1/2015
Five Year Review (FYR) Dates: 07/01/2020
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.13, 4121.30
Rule Amplifies: 4123.29, 4123.32, 4123.34
Prior Effective Dates:
4123-17-13: 7/1/62, 10/1/79, 9/1/93, 7/27/06, 12/20/07
4123-19-02: 6/30/74, 12/11/78,11/26/79, 5/9/90