Sheakley UniComp is a Managed Care Organization (MCO) in the State of Ohio and is a Nationally Accredited (URAC) Case Management Company. Tens of thousands of employers have placed their trust in us as their MCO of choice to help their injured workers get the care they need and return to work.
Certified by the Ohio Bureau of Workers’ Compensation (OBWC) since 1997, we’ve managed over 130,000 claims. This has created a vast knowledge base among our trained team and we rely upon that expertise each day to serve those employers that have placed their trust in us.
Sheakley UniComp is a Managed Care Organization (MCO) for Ohio workers’ compensation serving thousands of employers in the State of Ohio. As an MCO, Sheakley services employers’ workers’ compensation programs and the medical management of their workers’ compensation claims. This service includes proactive, comprehensive medical case management; assisting in the return to work of injured workers; utilizing return to work strategies and/or transitional work programs; remain at work services; on-site/job-site physical therapy; employee education; employer education and consultation; and a unique individualized reporting system.
Return to Work
Return to work is one of the most important tactics in the world of MCOs. Sheakley UniComp utilizes several strategies to assist employers and injured workers with return to work; such as onsite physical therapy, creating a direct provider contact for employers, and offering physician consultation.
First Report of Injury
Another important measure among the MCOs is initial claim reporting to the BWC. This measure is commonly referred to as FROI or First Report of Injury turnaround time. Quicker response to injuries saves time and time saved helps prevent claims from becoming lost time. This is especially important when you consider that the average lost time claim is $37,000. Sheakley focuses on return to work strategies and quicker reporting of injuries in order to prevent claims from becoming lost time. We are sensitive to the fact that claims costs have a direct impact to employers.
Sheakley has Client Relations Managers (CRMs) who act as your personal consultant to help manage workers’ compensation issues and ensure you receive all the information you need while being ever mindful of opportunities to keep your premiums as low as possible. We provide regularly scheduled meetings and quarterly reports showing trends of your claims/injury data.
Our integrated therapy programs include job-site therapy and transitional work which allow your injured workers to recover while remaining at the job site. By implementing these programs, we minimize the loss of productivity and maximize safe work tasks. Your CRM will also review, analyze, and assess the needs of your business and assist in building a relationship with experienced occupational medical providers in your area for optimal return to work results.
As an MCO, Sheakley UniComp provides injury prevention assessments and health and safety programs that assist in the return to work of injured workers’ utilizing return to work strategies and/or transitional work programs, remain at work services, on-site/job-site physical therapy, employer education and consultation and a unique individualized reporting system.
Your rights and responsibilities
As an injured worker, you have rights and responsibilities related to your worker’s compensation claim:
You have the right to:
- be active in the care of your injury and how to get the care you need
- be treated with courtesy and respect by the Sheakley UniComp, Inc staff
- understand and be active in your care and case management plan
- refuse care or case management services
- choose and/or change your BWC provider when you want
- be seen by a doctor in the case of an emergency
- privacy of information regarding your health
- file an appeal or grievance if you do not agree with a decision made about your care
- be informed of all choices you have when making a decision about your care
- be notified of changes in your case management plan, including when it is closed
- have end of life and advanced care directives honored, if given
You have the responsibility to:
- tell your doctors and other health care providers about your medical history
- follow what your doctor and case manager tell you to do to get better
- ask questions about your care and your worker’s compensation claim
- treat your providers and the Sheakley UniComp, Inc. staff with courtesy and respect
- be active in the care of your injury
What to do if an injury occurs
Once a work related injury occurs the employee must immediately notify their employer of the injury.
If the injury is an emergency, employer should direct the injured worker to nearest medical facility for treatment. If the injury is not an emergency, the employer should refer the injured worker to the provider directory to find a physician nearby.
For additional assistance locating a physician, please contact Sheakley UniComp at 1-888-743-2559 or 1-513-326-8003.
Within 24 hours of seeking medical treatment, the employer or injured worker must contact Sheakley UniComp to report an injury occurrence or complete the 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 representative will follow up with the employer to request any additional information needed to process claim.
If you receive any bills, please submit to:
Sheakley UniComp, Inc.
One Sheakley Way
Cincinnati, OH 45246
Attn: Billing Department
All pharmacy bills are processed by:
P.O. Box 968066
Bureau of Workers’ Compensation handles all compensation benefits. For additional assistance, the injured worker may contact the BWC at 1-800-OHIOBWC.
Commitment to Providers
Sheakley UniComp is committed to the providers who care for our clients’ injured workers. We understand that effective communication, medical management and early intervention are keys to returning an injured worker back to work as quickly and safely as possible
Sheakley utilizes the Official Disability Guidelines (ODG) to identify appropriate treatment guidelines and disability duration.
Frequently Asked Questions
1. How can your MCO help my business save money on my workers’ compensation premiums?
2. How quickly do you get an injured worker back to work?
3. What are the different strategies used to help facilitate return to work for an injured employee?
4. List three medical providers located in the area of my business.
5. Can your company customize injury packets?
6. Is there an on-line system to access my account?
7. Do you have a sample report I can review?
8. Can I get a few references?
The Ohio Bureau of Workers’ Compensation (BWC) is responsible for making initial claim and diagnoses determinations.
A Managed Care Organization (MCO) is a private company that an employer selects to medically manage the workers’ compensation claims for injured employees.
MCOs are responsible for filing a first report of injury with BWC, medically managing claims, and coordinating medical bill payment. MCOs help coordinate a safe and timely return to work for injured workers.
A Third Party Administrator (TPA) is a private company that an employer contracts with to represent the employer’s interests on issues relating to matters regarding workers’ compensation and alternative rating programs.
When a work-related injury occurs, the injured worker should make his or her employer aware of the injury, and then contact the MCO to report the injury information. The injured worker, employer, or provider may report the claim to their MCO by phone, fax, mail, or online. Sheakley UniComp will gather the necessary information for claim filing through conferring with all parties of the claim (injured worker, employer, and provider), and report the information to the Ohio Bureau of Workers’ Compensation. For injury reporting, call Sheakley UniComp at 1-888-743-2559, or fax First Report of Injury form to 1-888-626-2667. Claims may also be reported online via the Ohio Bureau of Workers’ Compensation web site at www.ohiobwc.com.
In emergency situations, the injured worker may seek treatment from any medical treatment facility or medical provider. After the initial treatment, injured workers must seek treatment from a BWC certified medical provider. Sheakley UniComp can assist you with locating a medical provider by calling 1-888-743-2559 or visit Sheakley’s extensive provider list at: HealthSmart.
The following information is needed to begin the process: employer name and address, injured worker name, address, date of birth, and social security number, date of injury, provider name and address (if treatment sought), detailed accident description, and nature of injury. Injured workers, employers, or providers reporting work related injuries are encouraged to use and/or refer to the Ohio Bureau of Workers Compensation First Report of Injury form which includes the necessary information to file a claim.
The BWC is responsible for making a determination as to whether a work related injury will be allowed as a claim. Prompt notification of injury and cooperation by all parties of the claim in information gathering by the MCO, including date of injury, accident description, and treating provider information, all assist the BWC in making appropriate and timely claim allowance decisions. The BWC will contact the parties of the claim to inform of claim allowance decisions via letter.
All injured workers who have a claim filed with BWC will receive a claim number within five to ten days of filing a claim. This unique claim number is extremely important in the workers’ compensation process. Please have this number available when visiting a medical provider, or when speaking to a BWC or Sheakley UniComp representative.
The BWC is responsible for wage compensation determination and mailing compensation checks. Please refer all questions relating to wage compensation payments to BWC at 1-800-OHIOBWC.
A lost time claim occurs when an injured worker is off work for eight days or longer due to an allowed injury or occupational disease.
Coordination for the payment of medical bills on allowed claims is the responsibility of Sheakley UniComp. Medical providers should send appropriate billing format directly to Sheakley UniComp for reimbursement of medical bills.
Yes. On the Ohio BWC’s website (www.ohiobwc.com) employers, injured workers, and their representatives will be able to enter a BWC claim number and view the claims associated with that number.
Sheakley clients have similar access on the Sheakley website. You can view treatment plan requests, case management plans, medical billing info (including check number and amount) and activity notes. You can also view reports relating to your claims.
“Union Township made a decision in 2002 to change our [MCO] to Sheakley UniComp. Since then we have realized that our only regret is that we did not make this move sooner. We now have a much greater appreciation for Sheakley’s knowledge and expertise. Union Township highly recommends the service that Sheakley provides and they will definitely be an asset to your organization.”
“Thank you Sheakley for exceeding my expectations. So many times customer service falls by the wayside. They are always professional, prepared and able to answer any questions or assist me in any way. We are not a number…they know us by name.”
“The MCO team at Sheakley provides us with timely and efficient service day in and day out. [They’ve] helped negotiate preferred rates with these providers as well as managing our claims and keeping our medical cost down, which can have an impact on our experience rating and premium. I greatly appreciate all that Sheakley UniComp has done for us.”
“Sheakley UniComp has earned our trust and, therefore, our business; which is why we have maintained our relationship with them year after year. As much as their outstanding service, it’s the quality of our relationship with Sheakley that makes the difference. Isn’t that what good business is all about?”
“Our company has had great customer service and experienced and aggressive Claims Managers. They are my backbone, and having such competent professionals handling claims for us has made my work much easier. Low medical bill payment is an important part of reducing the cost of the overall claim, which helps us stay in the large premium-reducing programs that contribute to a stable financial bottom line for our company. I highly recommend Sheakley to anyone looking for an MCO.”
“Sheakley always provides valuable input and technical assistance in a variety of work related injury prevention means, which helps us to maintain a successful return to work program. I work with several key personnel at Sheakley, whom have always been professional, responsive to our needs, and supportive at providing crucial injury management and prevention assistance. Sheakley has always been at the forefront of the latest ideas and suggestions to get our employees back to work. We value our relationship and would highly recommend their services to others.”