The Option allows employers who meet certain financial conditions to exit the administrative system and administer its work-related injuries under an employer sponsored benefit plan, similar in concept to that of a private group healthcare plan. While the employer has some discretion with respect to how the plan functions, e.g., medical management, it must provide the same forms of benefits as required under the administrative system, with at least the same dollar, percentage, and duration limits. In addition, the plan must provide that an aggrieved employee can appeal to the Workers’ Compensation Commission and the Oklahoma Supreme Court, if necessary.
Private and public employers are eligible to participate in the Option.
The benefit plan must provide for payment of the same forms of benefits included in the administrative system for temporary total disability, temporary partial disability, permanent partial disability, vocational rehabilitation, permanent total disability, disfigurement, amputation or permanent total loss of use of a scheduled member, death and medical benefits as a result of an occupational injury, on a no-fault basis, with dollar, percentage, and duration limits that are at least equal to or greater than the dollar, percentage, and duration limits contained in the Administrative Act.
A qualified employer must secure compensation to its employees in one of the following ways:
- Obtaining accidental insurance coverage in an amount equal to the compensation obligation;
- Furnishing satisfactory proof to the Commissioner of the employer’s financial ability to pay the compensation, i.e., self-insure; or
- Provide other security as may be approved by the Commissioner.
- In addition, the Option creates an insured and self-insured guaranty fund for the purpose of continuation of benefits for covered claims that are interrupted due to the inability of the insurer or employer, as applicable, to meet its compensation obligations.
If an employer denies an employee’s claim for benefits, the employer must notify him/her in writing within 15 days of receipt of the claim. The notice must contain an explanation of why the claim was denied and how to appeal.
A qualified employer’s liability under the benefit plan is exclusive and in place of all other liability. This exclusive remedy is as broad as the exclusive remedy protections under the Administrative Act.