Application For Claim Impact Reduction Program {BWC-4842}

BWC-4842 - APPLICATION FOR CLAIM IMPACT REDUCTION PROGRAM. The Bureau of Workers’ Compensation form is used by Ohio employers to apply for participation in the CIRP, a voluntary program designed to reduce the impact of significant workers’ compensation claims on an employer’s premium rates. The program is specifically targeted at employers currently in a group-rating program who will not be renewed in that group for the next rating year due to the presence of significant claims in their experience. Through CIRP, eligible employers can receive a gradually decreasing discount on their base premium rate over four years—starting at 20% in the first year and reducing to 5% by the fourth year—as long as they continue to meet program requirements. To qualify, employers must have no more than one significant claim and no more than three non-significant, medical-only claims during the upcoming experience period. They must also maintain active coverage without lapses exceeding 40 days within a 12-month period and be current on all BWC obligations by the application deadline. A significant claim is defined as one whose cost exceeds the employer’s Total Limited Losses (TLL), and once a claim is designated as significant, it cannot be changed. Participation also requires safety training—specifically, a half-day classroom session in the first year and three hours of online training in subsequent years. The form requires submission by a specified deadline—either the last business day in January for private employers or the last business day in July for public employers—and must be signed by an authorized company representative to be valid. Employers are encouraged to review Ohio Administrative Code 4123-17-71 for full program requirements and to determine compatibility with other BWC discount programs. Failure to comply with the program’s criteria may result in the revocation of the discount. CIRP-1 (Formerly OCP-1). www.FormsWorkflow.com