# San Allen, Inc. v. Buehrer

> Ohio Court of Appeals · May 15, 2014 · 2014 Ohio 2071

URL: https://www.frixlaw.com/law-library/cases/2701677

## Case

- **Court:** Ohio Court of Appeals
- **Decided:** May 15, 2014
- **Citations:** 2014 Ohio 2071
- **Precedential status:** Published
- **Opinion:** Opinion
- **Judges:** Rocco
- **Cited by:** 34 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/2701677

## How later opinions describe it (automated extraction)

- noting that "Ohio courts have long recognized that persons from whom funds have been unlawfully collected and retained by the state may be entitled to equitable restitution"

## Opinion text

[Cite as San Allen, Inc. v. Buehrer, 2014-Ohio-2071.]

Court of Appeals of Ohio
EIGHTH APPELLATE DISTRICT
COUNTY OF CUYAHOGA

JOURNAL ENTRY AND OPINION
No. 99786

SAN ALLEN, INC., ET AL.
PLAINTIFFS-APPELLEES/
CROSS-APPELLANTS

vs.

STEPHEN BUEHRER, ADMINISTRATOR, OHIO
BUREAU OF WORKERS’ COMPENSATION
DEFENDANT-APPELLANT/
CROSS-APPELLEE

JUDGMENT:
AFFIRMED IN PART, REVERSED IN PART,
REMANDED

Civil Appeal from the
Cuyahoga County Court of Common Pleas
Case Nos. CV-07-644950 and CV-689611

BEFORE: Rocco, P.J., E.A. Gallagher, J., and Kilbane, J.

RELEASED AND JOURNALIZED: May 15, 2014
ATTORNEYS FOR APPELLANT

Michael DeWine
Attorney General of Ohio

BY: Mark E. Mastrangelo
Jeffrey B. Duber
Assistant Attorneys General
615 West Superior Ave., 11th Floor
Cleveland, Ohio 44113-1899

John N. Childs
Robert A. Hager
Adam D. Fuller
Brennan, Manna & Diamond, L.L.C.
75 E. Market St.
Akron, Ohio 44308

ATTORNEYS FOR APPELLEES

James A. DeRoche
Stuart I. Garson
David L. Meyerson
David H. Krause
Seaman Garson, L.L.C.
1600 Rockefeller Building
614 West Superior Ave.
Cleveland, Ohio 44113

Patrick J. Perotti
Jonathan T. Stender
Darrin R. Toney
Nicole T. Fiorelli
Dworken & Bernstein Co., L.P.A.
60 South Park Pl.
Painesville, Ohio 44077

AMICI CURIAE

Attorneys for Ohio AFL-CIO
Marc J. Jaffy
Stewart R. Jaffy
Stewart Jaffy & Assoc. Co., L.P.A.
306 East Gay St.
Columbus, Ohio 43215

Attorneys for Ohio Chamber of Commerce and National Federation of Independent
Business/Ohio

John W. Zeiger
Stuart G. Parsell
Zeiger, Tigges & Little L.L.P.
41 South High St., Suite 3500
Columbus, Ohio 43215

Attorney for Cleveland Teachers Union, AFT Local 279, AFL-CIO

Susannah Muskovitz
Muskovitz & Lemmerbrock, L.L.C.
1621 Euclid Ave., Suite 1750
Cleveland, Ohio 44115

Attorney for Teamsters Local Union No. 416

Susan L. Gragel
Goldstein Gragel, L.L.C.
1040 Leader Building
526 Superior Ave.
Cleveland, Ohio 44114

Attorney for International Association of Bridge, Structural, Ornamental and
Reinforcing Iron Workers Local No. 17

James A. Marniella
Demer & Marniella, L.L.C.
2 Berea Commons, Suite 200
Berea, Ohio 44017

Attorneys for City of Cleveland

Barbara A. Langhenry
Director of Law
City of Cleveland
By: Joseph F. Scott
Chief Assistant Director of Law
City of Cleveland - Law Department
601 Lakeside Ave., Room 106
Cleveland, Ohio 44114

Mitchell G. Blair
Maura L. Hughes
Calfee Halter & Griswold L.L.P.
1405 East 6th St.
Cleveland, Ohio 44114

Attorney for The Council for Economic Opportunities in Greater Cleveland

Terence E. Copeland
The Council for Economic Opportunities in Greater Cleveland
1228 Euclid Ave., Suite 700
Cleveland, Ohio 44115

KENNETH A. ROCCO, P.J.:
{¶1} Reduced to its irreducible essence, this appeal is about a cabal of Ohio

Bureau of Workers’ Compensation (“BWC”) bureaucrats and lobbyists for group

sponsors who rigged workers’ compensation insurance premium rates so that for

employers who participated in the BWC’s group rating plan (“group-rated employers”), it

was “heads we win,” and for employers who did not participate in the group rating plan

(“nongroup-rated employers”), it was “tails you lose.” For more than 15 years, the BWC

allowed nongroup-rated employers to subsidize excessive, undeserved premium discounts

to group-rated employers who were handpicked by group sponsors to participate in the

BWC’s group rating plan. The temerity of the group sponsors, untempered by any

notions of equity from or of the BWC, exacted a heavy price for nongroup-rated

employers — over $859 million.

{¶2} The trial court correctly determined that the BWC was responsible for

developing and maintaining an unlawful rating system under which excessive premium

discounts were given to group-rated employers at the expense of nongroup-rated

employers. The BWC first failed to follow a legislative mandate to establish a

retrospective group rating plan, then set up a prospective group rating plan without

sufficient controls to address the plan’s susceptibility to manipulation by group sponsors

and the potential for premium inequity as a result of the generous discounts provided to

group-rated employers under the plan.

{¶3} Defendant-appellant/cross-appellee Stephen Buehrer, Administrator, BWC,

appeals the judgment of the Cuyahoga County Court of Common Pleas that awarded over
$859 million in equitable restitution to a class of employers who alleged that they had

been unlawfully charged inflated workers’ compensation insurance premiums in order to

subsidize discounts given to other employers participating in the BWC’s group rating

plan. Plaintiffs alleged that until 2009, when the BWC modified its premium rating

system, the BWC “undercharged,” from an actuarial standpoint, group-rated employers

and “overcharged,” from an actuarial standpoint, nongroup-rated employers in setting

workers’ compensation premiums. The trial court held that the BWC’s implementation

of its group rating plan and the resulting inequity between the premiums charged

group-rated and nongroup-rated employers under its rating system violated former R.C.

4123.29 and 4123.34(C). The trial court further held that the BWC was unjustly

enriched by the excessive premiums it received from nongroup-rated employers, entitling

class members to equitable restitution of the unlawful premium overcharges.

{¶4} Plaintiffs-appellees/cross-appellants San Allen, Inc., d.b.a. Corky and

Lenny’s, Timely Advertising Specialty Co., d.b.a. S.E. Bennett Company, Linderme

Tube Co., Cambridge Manufacturing Jewelers, Ltd., D&J Structural Contracting, Inc.,

Lifecenter Plus, Inc., and David W. Steinbach, Inc. (“plaintiffs”) have filed a cross

appeal, challenging the trial court’s determination that the BWC’s premium rating system

did not violate the Equal Protection Clause of the Ohio Constitution and claiming that the

trial court abused its discretion in failing to award plaintiffs an additional $330 million (or

more) in investment returns the BWC allegedly earned on the excessive premiums

collected from the class.
{¶5} For the reasons that follow, we affirm the trial court’s judgment in part,

reverse the trial court’s judgment in part, and remand the matter for further proceedings

consistent with this opinion.1

I. Factual Background

A. This Action

1. Plaintiffs’ Allegations

{¶6} This action was commenced on December 18, 2007, when

plaintiffs-appellees San Allen, Inc., d.b.a. Corky and Lenny’s, Timely Advertising

Specialty Co., d.b.a. S.E. Bennett Company, and Linderme Tube Co. filed their original

“class action complaint for equitable relief” against the BWC. On January 31, 2008, an

amended complaint was filed, adding as additional named plaintiffs, Cambridge

Manufacturing Jewelers, Ltd., D&J Structural Contracting, Inc., Lifecenter Plus, Inc., and

David W. Steinbach, Inc.

{¶7} In their amended complaint, plaintiffs asserted “a claim in equity for unjust

enrichment” on behalf of themselves and similarly-situated employers who had paid

nongroup-rated premiums for workers’ compensation insurance coverage, raising

statutory and constitutional challenges to the BWC’s group rating plan. Plaintiffs alleged

that the BWC’s group rating plan granted group-rated employers excessive discounts off

their workers’ compensation premiums, which were subsidized by charging

1
We acknowledge that this opinion is lengthy. The trial court in this case authored a
thorough and comprehensive, if not masterful, opinion. As such, we believe it is deserving of an
equally thorough and comprehensive review on appeal.
nongroup-rated employers “inflated” base premium rates. Plaintiffs claimed the BWC’s

prospective group rating plan exceeded the BWC’s rule-making authority under former

R.C. 4123.29 (which plaintiffs contended authorized only a retrospective group rating

plan) and that it denied plaintiffs and other class members equal protection of the law, in

violation of Article I, Section 2 of the Ohio Constitution, because it imposed burdens on

nongroup-rated employers in the plaintiff class that were not borne by identically situated

group-rated employers.2 Plaintiffs also claimed that, as a result of its collection and

retention of excessive premiums from plaintiffs and other class members, the BWC had

been unjustly enriched. Plaintiffs sought (1) a declaration that the BWC’s group rating

program violated state law and was unconstitutional, (2) repayment of the excessive

premiums they alleged had been wrongfully collected and retained by the BWC, and (3)

an award of pre-judgment and post-judgment interest, costs, and attorney fees.

2. The BWC’s Answer

{¶8} On February 28, 2008, the BWC filed its answer. The BWC denied most

of the allegations of plaintiffs’ amended complaint, but admitted that the group rating

plan affected the base rates of nongroup-rated employers and that studies had been

conducted that showed that the group discounts provided to group-rated employers did

not generate adequate premiums to cover the claims costs of group-rated employers. The

2
Plaintiffs also alleged in their amended complaint that the BWC’s group rating plan violated
Article II, Section 35 of the Ohio Constitution by apportioning workers’ compensation premiums
differently to identically-situated employers, based on their group membership or nongroup
membership, instead of their occupational classification. Plaintiffs appear to have abandoned this
argument.
BWC also asserted a variety of affirmative defenses, including lack of subject matter

jurisdiction, failure to exhaust administrative remedies, lack of ripeness, laches, and that

plaintiffs’ claims were barred by the applicable statute of limitations.

3. Preliminary Injunction

{¶9} On April 11, 2008, plaintiffs filed a motion for preliminary injunction,

seeking to enjoin the BWC from continuing its allegedly inequitable and unlawful group

rating plan. Concluding that plaintiffs had established a probability of success on the

merits that the group rating plan violated former R.C. 4123.29(A) and that plaintiffs

would suffer irreparable harm if preliminary relief was not granted, on November 18,

2008, the trial court granted plaintiffs’ motion, restraining the BWC from using its

prospective group rating plan for the policy year beginning July 1, 2009 and ordering the

BWC to enact a retrospective group rating plan for that year. San Allen, Inc. v. Ryan,

Cuyahoga C.P. No. CV-07-644950, 2008 Ohio Misc. LEXIS 333 (Nov. 18, 2008). Four

months later, after the General Assembly rewrote the statute to remove the language upon

which plaintiffs had relied for their argument that R.C. 4123.29(A) required a

retrospective group rating plan, rather than the prospective group rating plan implemented

by the BWC, the trial court vacated the preliminary injunction.3

3
Effective January 6, 2009, the General Assembly amended R.C. 4123.29(A)(4)(c),
substituting the word “group” for the word “retrospective” in the first sentence of R.C.
4123.29(A)(4)(c). As amended, the statute provided, in pertinent part: “In providing employer group
plans under division (A)(4) of this section, the administrator shall consider an employer group as a
single employing entity for purposes of group rating.” (Emphasis added.) Before the amendment,
this section of the statute stated: “In providing employer group plans under division (A)(4) of this
section, the administrator shall consider an employer group as a single employing entity for purposes
{¶10} On January 10, 2010, the trial court granted plaintiffs’ motion for class

certification, certifying the following plaintiff class:

Ohio private employers subscribing to the Ohio workers’ compensation
State Fund, for any policy year from July 1, 2001 through and including
policy year July 1, 2008, who in any of those policy years were rated on a
non-group basis and who reported payroll and paid premiums in a manual
classification for which the base rate was “inflated” due to experience
modifications under the group experience rating plan.

{¶11} The BWC appealed the class certification order. This court affirmed class

certification on April 7, 2011. San Allen, Inc. v. Buehrer, 8th Dist. Cuyahoga No. 94651,

2011-Ohio-1676.

B. The Trial

{¶12} A bench trial commenced on August 20, 2012. Prior to trial, the BWC

moved in limine to exclude the declarations and testimony of plaintiffs’ expert Allan

Schwartz under Evid.R. 702, Miller v. Bike Athletic Co., 80 Ohio St.3d 607, 687 N.E.2d

735 (1998), and Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.Ct.

2786, 125 L.E.2d 469 (1993). The BWC also moved to decertify the class on the

grounds that certain members of the plaintiff class had suffered no harm, that individual

issues predominated over common issues, and that the class was a “fail-safe class.” The

trial court denied both motions.

{¶13} During the trial, the trial court heard testimony from more than a dozen

witnesses, including current and former representatives of the BWC, several of the named

of retrospective rating.” (Emphasis added.)
plaintiffs, and various experts, and reviewed thousands of pages of exhibits. 4 The

following summary is based on the testimony and evidence presented.

1. Rate Setting by the BWC

a. The BWC’s Rate-Setting Authority

{¶14} The administrator of the BWC is charged, by statute, with managing Ohio’s

workers’ compensation system and, with the approval of its board of directors, setting the

premiums employers pay into the state insurance trust fund for workers’ compensation

coverage. The BWC is granted considerable discretion in setting premium rates,

provided it complies with statutory mandates and workers’ compensation insurance

principles.

{¶15} R.C. 4123.29 and 4123.34 set forth the BWC’s statutory rate-setting

obligations. These obligations include: “[c]lassify[ing] occupations or industries with

respect to their degree of hazard and determin[ing] the risks of the different classes,”

“[f]ix[ing] the rates of premium of the risks of the classes,” “set[ting] * * * rates at a level

that assures the solvency of the [state insurance] fund,” and the development of “fixed

and equitable rules controlling the rating system, which rules shall conserve to each risk

the basic principles of workers’ compensation insurance.”

4
This was in addition to the testimony and exhibits the parties previously offered into
evidence at the preliminary injunction hearing, held in August 2008. The evidence at the
preliminary injunction hearing included testimony from several of the named plaintiffs, several
representatives of the BWC, and various group sponsors and lobbyists.
b. The BWC’s Rate-Setting Process

{¶16} The BWC’s rate-setting process is complex. Numerous assumptions,

factors, and calculations go into setting annual premium rates. The final premium paid

by an employer typically involves a number of price adjustments and may also include

pre- or post-policy year discounts, rebates, or dividends that reduce the employer’s total

premium. Because we believe a general understanding of this process is helpful to our

review of the issues in this case, we provide a brief overview here.

{¶17} As Christopher Carlson (“Carlson”), the BWC’s chief actuarial officer, and

other BWC representatives testified, the BWC is designed to operate on a

“revenue-neutral” basis. This means that the BWC seeks to collect from employers

participating in Ohio’s workers’ compensation insurance program only the amount of

premiums necessary to cover the BWC’s projected claims costs and administrative

expenses and to maintain a reasonable surplus in the state insurance trust fund. Rates are

determined each year on a “top-down” basis. That is, each year the BWC estimates the

costs of claims and expenses expected to be incurred in the upcoming policy year. This

estimate considers all of the losses of employers insured through the workers’

compensation system over the last ten years and uses those losses to predict future costs.

Based on this estimate, the BWC’s current net asset position, and the general economic

climate (including investment income expected to be earned on premiums received), the

BWC determines its overall revenue needs for the year, and, with the assistance of
actuaries, sets a statewide rate. The BWC then allocates the total premiums it needs to

collect among the employers participating in the workers’ compensation system.

{¶18} Under Ohio’s workers’ compensation program, employers can be “base

rated” or “experience rated.” Employers are classified into one or more of more than 500

different occupational classifications (“manual classes”) based on the type of work in

which their employees are engaged, i.e., their “occupations or industries,” and the “degree

of hazard” associated with the work. For each manual class, the BWC performs

calculations based on historical data to come up with the projected value of losses for the

class in relation to payroll, which is then adjusted for catastrophic losses and certain other

items. The BWC assigns each manual class a base premium rate that is revised annually

based on the combined accident and occupational experience of the employers in each

manual class during the oldest four of the last five calendar years. This figure is then

adjusted by an “off-balance factor”5 assigned by the BWC to generate a base premium

rate for the class (“base rate”).

{¶19} After base rates are set, the BWC applies merit or “experience rating.” If

an employer has sufficient claims experience, the employer may qualify for individual

5
The off-balance factor is a factor that is applied at the manual class level in
determining base rates. The off-balance factor is used to offset a premium shortfall
or overage condition in the overall level of premiums collected from employers due
to experience rating (including both individual experience rating and group rating)
and discounts or rebates given to employers participating in the BWC’s discount
programs. Even if there had been no group rating, use of an off-balance factor
would still be necessary to account for discounts given as a result of individual
experience rating and the BWC’s other discount programs.
experience rating. Under experience rating, an employer’s past claims experience,

adjusted by a credibility factor based on the statistical reliability of the employer’s

experience, 6 is used to determine the employer’s premium. In the experience rating

process, the base rate may be adjusted up or down by applying an “experience

modification factor.” If an employer’s past claims experience is better than average, an

employer may be charged a lower premium rate; if an employer’s past claims experience

is worse than average, the employer may be charged a higher premium. Costs factors are

then added to the base rate or the experience-modified base rate, as applicable, to cover

administrative costs and the costs of paying cost-of-living increases to permanently and

totally disabled workers. The total of the premiums assessed for each manual class to

which the employer is assigned, less any rebates or discounts the employer receives based

on its participation in various programs offered by the BWC,7 is the employer’s total

workers’ compensation premium.

2. The BWC’s Group Rating Plan

6
Generally, the larger the employer (in terms of payroll and loss experience),
the greater the credibility accorded the employer’s past claims experience. Under
group experience rating, discussed in the following section, credibility is assigned based on the
combined payroll and expected losses of the members of the group. In most cases, the result is a
higher credibility factor (and larger premium discount) than if group members were individually rated
on their individual experiences.
7
During the class period, the BWC offered a number of programs under which qualifying
employers could receive post-policy period refunds of a portion of their premium payments if they
met certain performance measures, for example, a drug-free workplace program and a safety council
incentive program.
{¶20} In 1989, the General Assembly amended R.C. 4123.29 to require the BWC

to develop and implement a plan “that groups for rating purposes, employers, and pools

the risk of the employers within the group.” Am.Sub.H.B. No. 222.

{¶21} In response to this mandate, the BWC established a group rating plan for the

policy year beginning July 1, 1991. See Ohio Adm.Code 4123-17-61-4123-17-68.

Although, as amended, R.C. 4123.29(A)(4) stated that “[i]n providing employer group

plans * * * , the administrator shall consider an employer group as a single employing

entity for purposes of retrospective rating,”8 the BWC implemented only a prospective

group rating plan.9 Under a prospective rating plan, premium rates are based on past

8
According to Preston Garvin, a lobbyist for the Ohio Chamber of Commerce,
who was involved in the negotiation of H.B. 222 and who testified on behalf of the
BWC at the preliminary injunction hearing, H.B. 222 was an “agreed to workers’
compensation bill,” i.e., the result of negotiations between representatives of the
employer community (including the Ohio Chamber of Commerce, the Ohio
Self-Insured Association, and the Ohio Manufacturers’ Association) and
representatives of the labor community (including the AFL-CIO and other unions).
He testified that the legislation was intended to “get small employers in the game”
and to “provide them with [an] incentive” to become “involved and concerned about
their workers’ compensation claims.” He did not recall any discussions relating to
retrospective group rating during the negotiations and testified that he was
“surprised” when he later learned that, as enacted by the General Assembly, R.C.
4123.29(A)(4)(c) required that “in providing employer group plans * * * the administrator shall
consider an employer group as a single employing entity for purposes of retrospective rating.”
(Emphasis added.)
9
Following the 1989 amendments to R.C. 4123.29, the BWC adopted Ohio
Adm.Code 4123-17-61, setting forth the criteria for “group experience rating.” Ohio
Adm.Code 4123-17-61 was patterned after the language of R.C. 4123.29 with one
exception: it substituted the word “group” for the word “retrospective” used in R.C.
4123.29. Ohio Adm.Code 4123-17-61(C) stated, in relevant part: “In providing
employer group plans under section 4123.29 of the Revised Code, the bureau shall
consider an employer group as a single employing entity for purposes of group
rating.” (Emphasis added.)
claims experience, with premium discounts provided to those insureds with favorable past

claims experience. Under a retrospective rating plan, the employer (or, in the case of a

group plan, the group of employers) assumes some of the risk of actual losses during the

policy period, and the total premium is determined after the policy period has ended,

based on losses that have actually occurred during the policy period. In consideration for

sharing the risk of losses that may actually be incurred during the policy period, the

employer (or group) pays a lower up front premium. At the end of the policy period, the

premium is adjusted retrospectively, based on the actual losses incurred by the employer

(or group). If actual losses were higher than expected, the employer (or group) may pay

a surcharge; if actual losses were lower than expected, the employer (or group) may

receive a credit. During the class period, 2001-2008, the BWC offered only a

prospective group rating plan. The BWC did not offer a retrospective group rating plan

until 2009.

{¶22} Before group rating, employers could qualify for experience rating only on

an individual basis. Group experience rating allowed employers to group together their

claims history and receive experience-related premium discounts similar to larger

employers. Group rating thus enabled employers with good safety records, but who were

statistically too small to be individually experience-rated (i.e., too small qualify for

experience modification of their base premium rates based on their own claims

experience) and who would otherwise be base rated or experience rated with minimal

credibility, to group together with other employers to qualify for experience rating. By
combining the experience of all of the members of the group, totaling it up, and treating

the group as a single employer for rating purposes, the group could qualify for significant

premium discounts based on their combined claims experience.

{¶23} Group rating was believed to provide employers with an incentive to

improve safety and control claims costs because it was anticipated that group members

with good safety records would not allow employers with poor safety records to join or

remain in the group or would pressure those employers to improve their safety records to

avoid an adverse effect on the group’s rating. Because of the substantial discounts

employers received under the BWC’s group rating system, it was very popular.

Employers participating in the BWC’s group rating plan could qualify for discounts off

their base rates as high as 90%. A representative of one group sponsor, Phillip Parker,

president and CEO of the Dayton area Chamber of Commerce (“Parker”), testified that

800 of its member businesses saved $12 million annually from group rating. He testified

that the discounts from group rating were so significant that, in order to get into a group

or to retain their group status, certain members of his organization would just pay the

wages of an injured employee while he or she was off work rather than report a claim to

keep the claim off the employer’s experience for rating purposes.

{¶24} Because the BWC operates on a revenue-neutral basis, the loss in premiums

resulting from the significant discounts provided to employers under the BWC’s group

rating plan had to be redistributed. In other words, the premium obligations for

nongroup-rated employers needed to be increased in order to offset the substantial
discounts provided to employers participating in the group rating program. As Carlson

and Elizabeth Bravender (“Bravender”), director of the BWC’s actuarial department,

testified, this was achieved by increasing the off-balance factor used in calculating the

base rates for the manual classes. Increasing the off-balance factor increased the base

rate for all employers. Employers who were not part of a group (and did not receive the

significant discounts off base rates that group members received) thus, in effect, paid

“extra premiums” to make up for the discounts granted to group-rated employers under

the BWC’s group rating program.10

{¶25} A number of the employers in the plaintiff class, including several of the

named plaintiffs, “migrated” between group rating and nongroup rating during the class

period. For example, an employer in the plaintiff class might have been group rated

from 2001-2005, then nongroup rated from 2006-2008. Of the approximately 302,000

employers in the plaintiff class, 89,439 employers were, at times, group rated and, at other

times, nongroup rated during the class period. The remaining class members,

approximately 213,000 employers, were nongroup rated during the entire class period.

During the policy years in which class members were group rated, they, like other

group-rated employers, benefitted from the significant discounts group-rated employers

10
As an example of the disparity in premiums that resulted from the BWC’s group rating
plan, in a 2007 presentation, John Pedrick, who was then the BWC’s chief actuary, compared the
premiums paid by two carpenters under the BWC’s rating system, both of which had total payroll of
$500,000 and zero claims. Carpenter A, a new, nongroup-rated employer, paid $48,050 in annual
workers’ compensation premiums, and carpenter B, a group-rated employer receiving the maximum
group discount, paid $4,805 in annual workers’ compensation premiums.
received under the BWC’s rating system. During the policy years in which those class

members were not group rated, they, like other nongroup-rated employers, were charged

“extra premiums” in excess of the risk they presented to the workers’ compensation

system.

{¶26} The problem with the BWC’s group rating plan stemmed from the way in

which groups were formed and the manner in which employers’ experience was

accounted for under the plan. Group membership was determined on an annual basis,

and groups were permitted to change their member employers in each policy period. The

BWC gave group sponsors the right to control who was invited into a group and who was

kicked out of a group. Unlike individual experience rating, in which an individual

employer’s experience rating would be affected by a claim for five years,11 an employer’s

experience affected the experience rating of the group only so long as the employer was a

member of the group. See Ohio Adm.Code 4123-17-65 (“[I]f an individual employer is a

member of a group for group experience rating and leaves the group, the experience of

that individual employer shall be used in experience-rating calculations for the group to

impact only the rating years that the employer was a member of the group. * * * The

group shall not be liable for claims experience incurred by an individual employer for

claims occurring after the employer has left the group.”). In other words, there was no

shared risk among the employers in a group under the BWC’s group rating plan.

11
When experience rating an individual employer, the BWC considers the employer’s
individual loss experience during the oldest four of the latest five calendar years. See Ohio
Adm.Code 4123-17-03(A)(1).
{¶27} If an employer who was group rated had a claim during the policy period,

the group could avoid any adverse effect from that claim simply by excluding the

employer from the group the following policy year. If an employer was kicked out of a

group, its experience was no longer considered in rating the group. Because the

experience period used to determine the discounts granted group-rated employers under

the BWC’s group rating plan related to a time period before the group was even formed,

group sponsors could hand pick employers for groups to ensure the maximum discounts

for its group members each year. John Pedrick (“Pedrick”), the BWC’s former chief

actuary, testified that group sponsors would target an experience modifier, then design the

membership of the group to achieve that modifier. As one consultant described it, the

BWC’s group rating plan was like “having a fantasy league where the players are chosen

after the season has ended.”

{¶28} Pedrick testified that this “adverse selection” or “cherry picking” of

employers for group membership resulted in a significant understatement of the risk

presented by the employers remaining in the group. Group-rated employers did not have

the level of credibility that was being assigned to them under the BWC’s group rating

program. As a result, group-rated employers were being undercharged premiums

compared with the risk such employers presented to the workers’ compensation system,

and nongroup-rated employers were paying more than their fair share of premiums,

subsidizing the discounts provided to group-rated employers through inflated base rates.

3. Actuarial Consultants Evaluate the Group Rating Plan
{¶29} That nongroup-rated employers were subsidizing the large discounts the

BWC provided to group-rated employers under its group rating plan should have come as

no surprise to the BWC. The record reflects that even before the BWC’s prospective

group rating plan went into effect, concerns were raised by the BWC’s actuarial

consultants regarding the plan’s susceptibility to manipulation and the potential for

premium inequity between group-rated and nongroup-rated employers as a result of the

generous premium discounts provided to group-rated employers under the plan. In a

1990 report, actuary Robert Finger warned that the merit rating process and base rates

could be subject to manipulation by group rating and that this “would increase the

off-balance and the base rates; consequently, those employers not in the group would pay

more than they should.” A 1991 report similarly warned that the “potential for

manipulation” under the BWC’s proposed prospective group rating plan was

“considerable” and could cause “increases in base rates, which cause rate increases for

employers who are not members of a group.”

{¶30} Equity concerns continued to be raised once the group rating plan was

underway and throughout the class period. Beginning in October 1993 and continuing

through 2007, the BWC commissioned seven additional independent actuarial studies (in

1993, 1994, 1995, 2001, 2004, 2006, 2007) to evaluate the BWC’s rating program. Each

of these studies concluded that, as a result of the large discounts given to group-rated

employers, the BWC’s group rating plan was creating substantial premium inequity

between group-rated and nongroup-rated employers, i.e., group-rated employers were not
paying enough premiums to cover the risk they presented, and nongroup-rated employers

were paying too much in premiums, subsidizing the discounts given to the group-rated

employers. Each of these studies also recommended that changes be made to the group

rating plan to correct this inequity. In October 1993, for example, the BWC’s actuarial

consultant recommended that premiums for group-rated employers be increased and that

base rates and premiums for nongroup-rated employers be reduced “in order to restore

equity to the experience rating process.” In 1994, the BWC’s actuarial consultant

reported that nongroup-rated employers had at that time subsidized group-rated employers

by approximately $128 million and that similar subsidies were expected for subsequent

rating periods if the current group rating approach was continued. The BWC received

similar reports from its consultants in 1995 and 2001, each calling attention to the

premium overcharges of nongroup-rated employers resulting from the BWC’s group

rating plan and recommending that the plan be fixed or discontinued.

{¶31} In August 2004, the BWC asked its actuarial consultant to consider

whether its group rating plan was “fair.” The consultant advised the BWC that the loss

ratios (i.e., losses divided by premiums) for group-rated employers were “noticeably

higher” than for nongroup-rated employers under the BWC’s rating system and that “even

though group rating may have resulted in an overall reduction in losses for the fund,

group rated employers have enjoyed higher credits than can be supported by their actual

losses.” In a June 2007 report to the Ohio Workers’ Compensation Oversight

Commission, another actuarial consultant similarly reported that “group rating has had a
significant adverse effect on pricing equity — prices for various groups are not reflective

of underlying costs” and that “there exists substantial cross-subsidization,”12 resulting in

the payment of “exorbitantly high base rates” by nongroup-rated employers. The

consultant recommended that “[g]iven its current unfairness, the Group Rating Plan

should not continue in its current form.” As he explained:

While the general concept of group rating has merit, the program as

it currently exists does not produce rates that are actuarially sound

(reasonable and not excessive, inadequate, or unfairly discriminatory).

Group rated companies consistently produce loss ratios well in excess of

non-group rated companies, indicating that non-group rated companies are

subsidizing the group rated companies.

{¶32} In November 2006, a task force led by the Ohio Inspector General opened

an investigation into the methodology used by the BWC in calculating premium rates. In

its August 2007 report, the task force concluded that the BWC had committed an “act of

omission” in failing to follow the recommendations of its actuarial consultants with

regard to the “huge premium discounts” the BWC had given group-rated employers under

its group rating plan.

12
Cross-subsidies occur when rating classifications or processes result in premium levels for
one segment of insureds that are relatively greater than the insureds’ expected claims and expenses
and premiums for another segment of insureds that are relatively lower than their expected claims and
expenses.
{¶33} In 2007, the General Assembly enacted H.B. 100, which called for an

independent “comprehensive review” of the base premium rates paid by employers and

“all of the [BWC’s] rating programs.” 2007 Am.Sub.H.B. 100. In its 2009 report,

Deloitte Consulting L.L.P., the consultant engaged to perform this review, concluded that

the “pricing structure” under the BWC’s rating system “has created substantial inequity in

the premiums paid by different employers,” that the “primary driver of this inequity is the

[BWC’s] current approach to group rating,” and that the “performance results of the

group rating program indicate a substantial lack of actuarial soundness with respect to

equitable rating.” It further stated: “We are unaware of any other state that has a

program which functions as poorly as the existing group rating program does in Ohio.”

4. The BWC Acknowledges Problems with the Group Rating
Plan

{¶34} The record reflects that BWC representatives acknowledged the premium

inequity resulting from its group rating plan both publicly and privately, but, for many

years, did little or nothing to correct it. Base rates continued to rise, and nongroup-rated

employers continued to subsidize the excessive discounts given to group-rated employers

throughout the class period. In October 1993, then-BWC administrator Wes Trimble

reported in a memorandum to the BWC board of directors that for the rating year

beginning July 1, 1993, the “shift in premium payment caused by the group rating plan

increased the base rates by an average of 13.1%,” resulting in a $222,320,437 increase in

premiums to nongroup-rated employers “to offset the discounts given to group

employers.” Bravender testified that the BWC knew by at least 2001 that
nongroup-rated employers were paying more in premiums than they should have been

paying. Tracy Valentino, the BWC’s chief fiscal and planning officer, similarly

confirmed that from 2004 to 2008, the BWC knew that it was “shifting premium burden”

from group-rated employers to nongroup-rated employers under the rating system then in

effect.

{¶35} In a 2007 Powerpoint presentation, Pedrick, who was then the chief

actuarial officer of the BWC, expressly acknowledged that nongroup-rated employers

were “being hurt” by the BWC’s group rating system. He advised that nongroup-rated

employers were paying an average subsidy of $1,251, totalling over $200 million

annually, “to cover claims costs incurred by group-rated employers.” Employers who

were “eliminated from group rating” experienced an average premium increase of $8,600.

In a consumer advisory issued to employers in the fall of 2007, then-BWC administrator

Marsha Ryan reported that “[t]he premium inequity caused by the Ohio group-rating

program inflates base rates” and that actuarial “studies have determined that current group

discounts do not generate adequate premiums to cover claims costs for group employers.”

In February 2009, she acknowledged that under the BWC’s group rating plan,

“[s]imilarly situated employers were paying different premiums for the same product —

some far less than what their risk represents to the system, others more than their fair

share.” Later that year, she informed the Ohio Senate Insurance Committee that

“[a]ctuarial data indicates that group rated employers bring higher costs to the system
than they pay” and that “employers who were not in a group paid extra premium to make

up the shortfall left as an effect of the large group discount.”

{¶36} Efforts by the BWC to correct the premium inequity resulting from its group

rating program met with sharp resistance from the group sponsors. As a representative

from one group sponsor, Parker, testified, “we want the maximum discounts available * *

* to provide the lowest cost to our members.” “[A]nything reducing that”— even to

correct inequity in the rating system for nongroup-rated employers — “is incorrect, is a

flaw * * * head[ing] back to * * * that slippery slope we once were in in Ohio where

workers’ compensation was going to be * * * the silent killer of jobs in Ohio.” In other

words, the premium inequity resulting from the BWC’s group rating plan was simply not

a concern for many group sponsors:

Q. Now, do you believe that every employer in the State of Ohio has a
right to be charged a fair premium, a fair premium that’s based on
the risk that that employer brings to the system?

A. I believe that there are certain programs like group rating that allows
us to maximize the discounts. And that’s why I’m here. That’s the
opinion I have and that’s why I’m here.

Q. So I will take that as a no?

A. If you want to.

{¶37} Although at various points throughout the class period, the BWC

undertook certain steps to reduce premium costs, 13 it was not until the policy year

13
The BWC presented evidence that at various points throughout the class period, it took steps
to reduce overall premium rates (i.e., reducing premium costs for both group-rated and nongroup-rated
employers), including the issuance of dividends, lowering claims reserves, and the introduction of
beginning July 1, 2009, that the BWC began making significant changes to its rating

system to set more accurate (and equitable) premium rates for group-rated and

nongroup-rated employers. Instead of calculating separate off-balance factors for each

manual class, for the policy year beginning July 1, 2009, the BWC applied a constant

off-balance factor of 1.23 in setting rates for all manual classes, lowering the off-balance

factor for any class that had previously had an off-balance factor greater than 1.23 and

raising the off-balance factor for any class that had previously had an off-balance factor

less than 1.23. Pedrick testified that this method of calculating rates set “more accurate

rates” for nongroup-rated employers “than the prior system” and that if the 1.23

off-balance factor implemented in 2009 had been used to recalculate premium rates in

prior years, it would have resulted in a “more accurate rate” for nongroup-rated employers

then as well. The BWC made other changes to its rating system in 2009 as well,

including applying a “break-even factor” to group-rated employers that had the effect of

lowering the effective maximum discount received by nongroup employers. As a result

of these and other continuing changes to the BWC’s rating plans, the premium inequity

problems with the BWC’s group rating system were, by all accounts, slowly resolved.

new safety programs under which employers could qualify for premium discounts or rebates. The
BWC also presented evidence of several measures it implemented that were designed to provide
premium relief specifically to nongroup-rated employers. For example, from 2002-2006, the BWC
applied a nongroup discount factor to premium rates of nongroup-rated employers and, beginning in
2005, the BWC began reducing the maximum discount group-rated employers could receive under the
group rating program, thereby reducing the base rates and subsidy paid by nongroup-rated employers.
Even as a result of these efforts, however, the record reflects that substantial premium inequity
between group-rated and nongroup-rated employers continued.
5. The Experts

a. Plaintiffs’ Expert Allan Schwartz

{¶38} Plaintiffs retained actuarial expert Allan Schwartz (“Schwartz”) to support

their claim for equitable restitution. Schwartz opined that, based on actuarial principles of

rate-making, i.e., guidelines used by insurance companies to set actuarially sound rates,

the rates the BWC charged group-rated and nongroup-rated employers during the class

period “were not actuarially sound” and that the BWC’s rating system was “unfairly

discriminatory” and “actuarially inequitable” because nongroup-rated employers were

charged a rate that was higher than the expected value of future costs associated with the

risk they presented, and group-rated employers were charged a rate that was lower than

the expected value of future costs associated with the risk they presented.

{¶39} Schwartz developed a formula to determine the amount by which the BWC

had overcharged nongroup-rated employers during 2001-2008 (the “Schwartz formula”).

Under his formula, restitution was calculated on annual basis, based on whether, during a

given year or policy period, a class member was nongroup-rated in any manual classes

that included both group-rated and nongroup-rated employers and to which an off-balance

factor of 1.23 or greater had been applied in calculating base premium rates. Schwartz

opined that this formula produced “[a] reasonable value for the premium overcharge to a

reasonable degree of actuarial certainty.”

i. The Schwartz Formula
{¶40} Schwartz used a five-step process to calculate the restitution plaintiffs

claimed was owed the plaintiff class. First, an overcharge factor was calculated for each

of the “inflated” manual classes by comparing the base rate the BWC actually charged

nongroup-rated employers to a “corrected base rate” calculated by Schwartz, i.e., the rate

that should have been charged. To calculate the corrected base rate, the off-balance

factors the BWC had actually used in calculating rates for the relevant manual classes

during the class period were replaced with a “corrected” off-balance factor of 1.23 — the

uniform off-balance factor the BWC applied in policy year 2009 when attempting to

charge more accurate rates to nongroup-rated employers.14

{¶41} Second, the overcharge factors calculated in step one were applied to the

premiums charged nongroup-rated employers, by manual class, to determine the amount

of the overcharge. Schwartz excluded from his restitution calculation (1) manual classes

in which there were no group-rated employers 15 and (2) manual classes in which the

off-balance factor applied by the BWC during the class period was less than 1.23.16 The

14
The BWC criticizes Schwartz’s use of a single, constant off-balance factor in calculating
his “corrected” base rates, in part because the BWC used different off-balance factors for each manual
class during the class period. Schwartz claimed that if he applied different off-balance factors to
each manual class, it “would shift the amount of damages between classes, but it wouldn’t make a
difference in the overall issue that there were damages[.] * * * [T]he difference would be in terms of
different classes, how much you would say one was inflated relative to the other.”
15
Schwartz excluded manual classes in which there were no group-rated
employers from his restitution calculation, reasoning that if a manual class did not
have any group-rated employers, the base rate for that class could not have been
inflated by the BWC’s group rating plan.
16
Whereas the BWC applied a 1.23 off-balance factor to all manual classes,
overcharge factor was applied to the net premium charged the employer after deducting

dividends and other upfront discounts. Also included in Schwartz’s restitution

calculation were the amounts the BWC charged employers for administrative costs and

certain contributions to the disabled workers relief fund, which were also affected by the

inflated base rates.

{¶42} Third, the premium overcharges in each manual class were totaled by policy

number. In step four, adjustments were made to the restitution amount calculated for

each employer to account for any post-policy period discounts or rebates the employer

received. Finally, in step five, investment returns allegedly earned by the BWC on the

premium overcharges were calculated to determine the total restitution allegedly owed to

the plaintiff class.

{¶43} Because the BWC calculated and collected premiums on an annual basis,

Schwartz likewise calculated restitution on an annual basis. If, in a given policy year,

an employer was nongroup rated in a manual class that included both group-rated and

nongroup-rated employers and had an off-balance factor of 1.23 or higher, he included

lowering the off-balance factor for any class that was above 1.23 and raising the
off-balance factor for any class that had an off-balance factor less than 1.23, when it
modified its rating program in 2009, Schwartz used a zero restitution value for
manual classes in which the off-balance factor was less than 1.23. According to
Schwartz, because it had been established, based on testimony by Carlson and
others, that the manual classes that included group-rated employers had inflated
base rates during the class period, the fact that application of a uniform 1.23
off-balance factor resulted in negative numbers for some classes did not mean those
employers had been “undercharged” during the class period; it simply meant that
his formula did not capture all of the premium overcharges of nongroup-rated
employers in the plaintiff class.
the premium overcharge for that employer for that policy year in his restitution
17
calculation. No offset was provided under the Schwartz formula for any

cross-subsidies class members received during the years they were group rated; Schwartz

testified that he had no opinion regarding the migration of class members in and out of

groups. b. The BWC’s Expert

Richard Conger

{¶44} Robert Conger, an actuarial consultant with Towers Watson, testified on

behalf of the BWC. Both Conger’s methodology and conclusions differed significantly

from those of Schwartz. Conger proposed an alternative means of evaluating the equity

of the BWC’s group rating plan using a “net income analysis.” Under his net income

analysis, Conger compared the premiums class members paid to the BWC against the

claim costs, expenses, mandatory assessments, and “benefits,” i.e., dividends and

“cross-subsidy benefits,” received by the class in the aggregate. The two most

significant differences between Conger’s and Schwartz’s methodologies involved (1)

Conger’s recognition of cross-subsidy benefits and (2) the treatment of dividends class

members received from the BWC in 2001-2004.

{¶45} Conger, as part of his analysis, included a deduction from the restitution

amount for a “cross-subsidy benefit” class members who were group rated during part of

the class period received during the years in which they were group rated. Conger

described this “cross-subsidy benefit” as follows:

17
The trial court did not adopt step five of the Schwartz formula. See infra at ¶ 48.
If their premiums [i.e., the premiums of class members during the years in
which they were group rated] had been adequate to cover their claims and
their expenses at the same relative level as everybody else, * * * their
calculated premiums would have been higher by $1.8 billion. That’s what
we mean by a cross-subsidy benefit. * * * They paid less by this much than
they would have [paid] if there had been no cross subsidies in the system.

{¶46} Conger also treated dividends differently than Schwartz. Whereas

Schwartz, under his formula, deducted dividends upfront along with other premium

discounts in calculating the amount of premium overcharges, Conger deducted

dividends, in the aggregate, after applying his cross-subsidy modifier. Conger testified,

that based on his analysis, the class as a whole did not pay “inflated” premiums and was

not overcharged during the class period. Instead, Conger claimed that the class as a

whole benefitted from the BWC’s group rating program. Specifically, Conger testified

that when taking into account the $1.87 billion in dividends the BWC paid class members

in 2001-2004 and the “cross-subsidy benefits” those class members who migrated

between group and nongroup rating received during the class period, the BWC actually

experienced a net loss of $861 million from the class.

C. The Trial Court’s Ruling

{¶47} On December 28, 2012, the trial court issued its partial order and opinion,

holding that plaintiffs were entitled to restitution as a result of the BWC’s violation of

former R.C. 4123.29 and 4123.34(C). The trial court’s opinion is detailed, provides a

well-reasoned analysis of the applicable facts and law, and clearly identifies the testimony

and other evidence supporting its findings. With respect to the procedural challenges

raised by the BWC, the trial court held that because plaintiffs sought “the return of a
specific amount which they claim has been wrongfully collected by the BWC,” their

claim was “an equitable one for restitution” over which the common pleas court could

properly exercise jurisdiction pursuant to R.C. 2743.03(A)(2). The trial court further

determined that compliance with the administrative review process would have been

futile and that the plaintiff class, therefore, was not required to exhaust administrative

remedies before filing suit. With respect to the merits of plaintiffs’ claim, the trial court

determined that the BWC had “received and retained excess premiums charged to the

Plaintiff Class” during the class period and, in doing so, violated R.C. 4123.29 and

4123.34(C). The trial court further found that the BWC “must disgorge the excess

premiums” it had unlawfully collected and that the plaintiff class was entitled to

restitution of the amounts by which they were overcharged.

{¶48} As to the amount of restitution to be awarded, the trial court held that the

formula offered by plaintiffs’ actuarial expert, the Schwartz formula, was a “sufficiently

reliable method * * * based on actuarial [principles]” to determine the amount by which

the plaintiff class had been overcharged. The trial court, however, denied plaintiffs’

request to recover investment income the BWC had allegedly earned on the premium

overcharges, concluding that plaintiffs had failed to establish the value of the investment

income, if any, the BWC had earned on the overcharges. The trial court also rejected

plaintiffs’ claim that the BWC’s group rating plan violated the Ohio Constitution’s Equal

Protection Clause, concluding that the BWC’s classifications and differential treatment

were rationally related to promoting workplace safety, a legitimate state interest.
{¶49} Due to issues with the data that had been produced, the trial court held that

the specific amount of restitution owed the plaintiff class could not be determined based

on the evidence presented at trial. The trial court, therefore, reserved its determination of

the restitution amount and ordered the parties to use the Schwartz formula to calculate “a

final restitution figure.” On March 20, 2013, following a hearing on the final restitution

amount, the trial court issued its final judgment, awarding plaintiffs $859,440,258.79 in

restitution on their unjust enrichment claim. Although the trial court made no explicit

finding in its partial order and opinion that the BWC was unjustly enriched as a result of

its unlawful premium overcharges, in its final order and opinion, the trial court states:

“The Court issued a Partial Order and Opinion on December 28, 2012, which found the

Defendant collected premiums in violation of Ohio statute and, as a result, the Defendant

was unjustly enriched.”

{¶50} The BWC appealed, presenting the following nine assignments of error:

Assignment of Error 1

The trial court erred as a matter of law by holding that BWC abused its
rate-setting discretion and violated R.C. 4123.29 and R.C. 4123.34.

Assignment of Error 2

The trial court erred as a matter of law by holding that Plaintiffs were not
obligated to exhaust statutorily specified administrative remedies applicable
to Plaintiffs’ premium protest.

Assignment of Error 3

The trial court erred as a matter of law by holding that BWC was unjustly
enriched through an alleged violation of R.C. 4123.29 and an unalleged
violation of R.C. 4123.34.
Assignment of Error 4

The trial court abused its discretion by overruling BWC’s Motion for Leave
to File an Amended Answer to assert the additional affirmative defense of
set-off — a motion made over a year before trial and before any discovery
cut-off had been established.

Assignment of Error 5

The trial court erred as a matter of law by holding that Plaintiffs are entitled
to “equitable restitution” for unjust enrichment without taking into account
important equitable considerations relating to the totality of the
circumstances — including the undisputed fact that, far from benefitting
from policies provided to Plaintiffs, BWC incurred $861 million more in
claims costs than Plaintiffs paid in premiums on policies provided to
Plaintiffs over the Class Period.

Assignment of Error 6

The trial court abused its discretion by failing to decertify the Plaintiff Class
in light of new facts and circumstances not present at the time of class
certification.

Assignment of Error 7

The trial court abused its discretion by denying BWC’s Miller Bike/Daubert
Motion to exclude the “expert testimony” of Allan I. Schwartz, by adopting
the “Schwartz formula” to calculate restitution, and then by misapplying
that formula.

Assignment of Error 8

The trial court erred as a matter of law by holding that it had subject matter
jurisdiction over this case where the damages sought are a legal remedy
over which the Court of Claims has exclusive jurisdiction.

Assignment of Error 9
The trial court erred as a matter of law by failing to apply the statute of

limitations applicable to claims against the State of Ohio.

{¶51} Plaintiffs filed a cross-appeal, raising the following two cross-assignments

of error:

Cross-Assignment of Error 1

The Trial Court erred in holding that Defendant did not violate Plaintiffs’
right to equal protection guaranteed by Section 2, Article I of the Ohio
Constitution.

Cross-Assignment of Error 2

The Trial Court erred in holding that Defendant is not required to disgorge
the investment returns earned by Defendant on Plaintiffs’ funds that
Defendant wrongfully collected and retained.

II. Analysis

{¶52} For judicial clarity and ease of discussion, we consider the parties’

assignments of error out of order and together where appropriate. We address the

BWC’s eighth assignment of error first.

A. Subject Matter Jurisdiction

{¶53} In its eighth assignment of error, the BWC challenges the trial court’s

determination of subject matter jurisdiction. The BWC argues that the restitution sought

by plaintiffs is actually a claim for money damages, i.e., a legal remedy over which the

court of claims has exclusive jurisdiction, and that the trial court, therefore, erred as a

matter of law in determining that it had subject matter jurisdiction over the case.

“‘Subject-matter jurisdiction is the power conferred on a court to decide a particular
matter on its merits and render an enforceable judgment over the action.’” ABN AMRO

Mtge. Group, Inc. v. Evans, 8th Dist. Cuyahoga No. 96120, 2011-Ohio-5654, ¶ 5, quoting

Udelson v. Udelson, 8th Dist. Cuyahoga No. 92717, 2009-Ohio-6462. In evaluating

subject matter jurisdiction, we apply a de novo standard of review. Id.

{¶54} The law is clear that the court of claims “has exclusive jurisdiction over civil

actions against the state for money damages that sound in law.” Measles v. Indus.

Comm. of Ohio, 128 Ohio St.3d 458, 2011-Ohio-1523, 946 N.E.2d 204, ¶ 7, citing R.C.

2743.02 and 2743.03. R.C. 2743.03 established the court of claims, granting it

“exclusive, original jurisdiction of all civil actions against the state permitted by the

waiver of immunity contained in section 2743.02 of the Revised Code.” However, R.C.

Chapter 2743 does not divest other courts of jurisdiction “to hear and determine a civil

action in which the sole relief that the claimant seeks against the state is a declaratory

judgment, injunctive relief, or other equitable relief.” Santos v. Ohio Bur. of Workers’

Comp., 101 Ohio St.3d 74, 2004-Ohio-28, 801 N.E.2d 441, ¶ 9; R.C. 2743.03(A)(2). A

suit that seeks only equitable relief may be brought against the state in the court of

common pleas. Thus, whether the trial court had subject matter jurisdiction over

plaintiffs’ claim turns on whether plaintiffs’ claim for restitution sounds in equity or in

law. To determine whether a claim for restitution seeks equitable or legal relief, we must

“look to the basis for the plaintiffs’ claim and the nature of the underlying remedies

sought.” Cristino v. Ohio Bur. of Workers’ Comp., 118 Ohio St.3d 151,

2008-Ohio-2013, 886 N.E.2d 857, ¶ 7.
{¶55} The BWC argues that plaintiffs seek the recovery of “unliquidated sums,”

rather than the return of specific, traceable funds, and that their restitution claim,

therefore, seeks “purely legal relief.” In Santos, supra, the Ohio Supreme Court

explained the difference between restitution claims sounding in law and those sounding in

equity as follows:

Restitution is available as a legal remedy when a plaintiff cannot “‘assert
title or right to possession of particular property, but in which nevertheless
he might be able to show just grounds for recovering money to pay for
some benefit the defendant had received from him.’” Great-West Life &
Annuity Ins. Co. v. Knudson, 534 U.S. 204, 213, 122 S.Ct. 708, 151 L.Ed.2d
635 (2002), quoting Dobbs, Law of Remedies Section 4.2(1), 571 (2d
Ed.1993). Restitution is available as an equitable remedy “where money or
property identified as belonging in good conscience to the plaintiff could
clearly be traced to particular funds or property in the defendant’s
possession.” Id. “Thus, for restitution to lie in equity, the action generally
must seek not to impose personal liability on the defendant, but to restore to
the plaintiff particular funds or property in the defendant’s possession.” Id.
at 214, 122 S.Ct. 708, 151 L.Ed.2d 635.

Santos, 101 Ohio St.3d 74, 2004-Ohio-28, 801 N.E.2d 441, at ¶ 13; see also Measles at ¶

9.

{¶56} Thus, not every claim for monetary relief constitutes a legal claim for money

damages. Interim HealthCare of Columbus, Inc. v. State Dept. of Admin. Servs., 10th

Dist. Franklin No. 07AP-747, 2008-Ohio-2286, ¶ 15. “Even when the relief sought

consists of the state’s ultimately paying money, a cause of action will sound in equity if

‘money damages’ is not the essence of the claim.” Id., citing Ohio Academy of Nursing

Homes v. Ohio Dept. of Job & Family Servs., 114 Ohio St.3d 14, 2007-Ohio-2620, 867

N.E.2d 400, ¶ 15. “Unlike a claim for money damages where a plaintiff recovers
damages to compensate, or substitute, for a suffered loss, equitable remedies are not

substitute remedies, but an attempt to give the plaintiff the very thing to which it was

entitled.” Interim HealthCare at ¶ 15, citing Santos, supra. “If the essence of a claim is

* * * restitution for the state’s unjust enrichment by withholding funds to which a worker

had a statutory right, then the ultimate relief sought is equitable restitution.” Measles at ¶

9, citing Ohio Academy of Nursing Homes at ¶ 15-19.

{¶57} In Santos, the Ohio Supreme Court considered whether the common pleas

court had subject matter jurisdiction over a restitution claim brought by injured workers

who sought to recover funds the BWC had collected pursuant to a subrogation statute that

was later declared unconstitutional. Santos, 101 Ohio St.3d 74, 2004-Ohio-28, 801

N.E.2d 441, at ¶ 3-8. Because the plaintiffs sought repayment of specific funds

wrongfully collected and held by the state, the court held that their claim sounded in

equity and could be addressed by the courts of common pleas. Id. at ¶ 17. As the court

explained:

This court held in [Holeton v. Crouse Cartage Co.], 92 Ohio St.3d 115,
2001-Ohio-109, 748 N.E.2d 1111, that the workers’ compensation
subrogation statute was unconstitutional. Accordingly, any collection or
retention of moneys collected under the statute by the BWC was wrongful.
The action * * * is not a civil suit for money damages but rather an action to
correct the unjust enrichment of the BWC. A suit that seeks the return of
specific funds wrongfully collected or held by the state is brought in equity.
Thus, a court of common pleas may properly exercise jurisdiction over the
matter as provided in R.C. 2743.03(A)(2).

Santos at ¶ 17.
{¶58} Other cases have similarly recognized that where, as here, a state agency

collects money to which it is not entitled, an action to recover those funds is generally

considered a claim for equitable restitution. See, e.g., Ohio Hosp. Assn. v. Ohio Dept. of

Human Servs., 62 Ohio St.3d 97, 104-105, 579 N.E.2d 695 (1991) (order to reimburse

Medicaid providers for amounts unlawfully withheld pursuant to administrative rules

improperly promulgated by the Ohio Department of Human Services was “not an award

of money damages, but equitable relief”); Interim HealthCare, 2008-Ohio-2286 at ¶ 17

(“Cases in which a plaintiff claims a state agency has wrongfully collected certain funds

are characterized generally as claims for equitable restitution.”), citing Morning View

Care Center-Fulton v. Ohio Dept. of Job & Family Servs., 10th Dist. Franklin No.

04AP-57, 2004-Ohio-6073, ¶ 19; Dunlop v. Ohio Dept. of Job & Family Servs., 10th Dist.

Franklin No. 11AP-929, 2012-Ohio-1378, ¶13-16 (claim for reimbursement of child

support payments that child support agency allegedly wrongly collected in excess of child

support payments ordered by the common pleas court was a claim for equitable

restitution).

{¶59} Plaintiffs’ claim in this case is not a claim for general money damages to
compensate the plaintiff class for the losses they sustained as a result of the BWC’s
alleged unlawful premium overcharges. Rather, plaintiffs seek to recover a specific
amount of money they claim has been wrongfully collected from the class due to the
BWC’s alleged violation of R.C. 4123.29 and 4123.34(C). In other words, plaintiffs
have asserted a claim for the return of the very thing to which the class was allegedly
entitled in the first place — the amount of workers’ compensation insurance premiums
collected by the BWC in excess of the premiums the class allegedly should have been
charged. The fact that plaintiffs seek to recover only a portion of the premiums paid, i.e.,
the portion of premiums paid that exceeded the amount they should have been charged, or
that a calculation must be made to determine the amount by which class members were
overcharged, does not change the nature of the relief sought nor does it transform
plaintiffs’ claim from a claim seeking equitable relief into one seeking money damages.

{¶60} The BWC argues that because Schwartz’s restitution calculation is based

upon a “reasonable value for the premium overcharge,” plaintiffs’ claim is necessarily

one for money damages, i.e., a claim for legal restitution, rather than a claim for the return

of specific funds in equity. We disagree. Simply because the amount of an overcharge

may be difficult to calculate or there may be a disagreement as to the specific amount by

which a plaintiff was overcharged, does not mean the plaintiff loses his or her right to

equitable restitution of the overcharge (assuming other requirements for equitable

restitution have been met). The amount of the overcharge is simply a factual issue to be

resolved by the trier of fact.18 It was, therefore, sufficient that plaintiffs’ expert’s

calculations generated a “reasonable valuation” of the amount of the BWC’s premium

overcharges during the class period.

18
The amount of the overcharge, i.e., the difference between the premium payments the BWC
actually received from each class member during the class period under the BWC’s allegedly
inequitable rating system and the premium payments the BWC would have received from that class
member if the BWC had implemented a lawful rating system, cannot be calculated with absolute
certainty because there is a range of rating systems that the BWC, in its discretion, could have
implemented during the class period that would have complied with R.C. 4123.29 and 4123.34(C).
Under each such rating system, nongroup-rated employers would have likely paid slightly different
premium rates. Indeed, Schwartz expressly acknowledged that his formula failed to capture all of
the premium overcharges to class members in the class period. See supra at ¶ 41, fn. 16. Because
the restitution calculation generated under his formula was less than the total subsidies calculated by
the actuarial experts the BWC had previously retained to evaluate its group rating plan, Schwartz
opined that his formula resulted in a “conservative” approximation of the amount by which
nongroup-rated employers were overcharged during the class period.
{¶61} Nor, as the BWC contends, does the fact that the BWC distributed the

funds after the excessive premiums were allegedly wrongfully collected from the class —

such that the specific funds constituting plaintiffs’ overpayments may no longer be readily

traceable — transform plaintiffs’ claim from one sounding in equity into one in law. See

Dunlop, 2012-Ohio-1378 at ¶13-16 (merely because child support agency might have

eventually distributed the allegedly improperly collected child support to the child support

obligee, the state government, or the federal government did not transform plaintiff’s

claim seeking restitution of those funds from one sounding in equity to one sounding in

law; what child support agency “might have subsequently done with the funds is not

relevant to the determination of subject-matter jurisdiction”). Because plaintiffs seek the

return of the specific premiums they claim were unlawfully collected by the BWC, their

claim is one for equitable restitution. Santos, 101 Ohio St.3d 74, 2004-Ohio-28, 801

N.E.2d 441, at ¶ 14, 17. Accordingly, the trial court did not err in determining that it had

subject matter jurisdiction in this case. 19 The BWC’s eighth assignment of error is

overruled.

19
The BWC also argues that plaintiffs’ claim should be regarded as a claim
for legal restitution because the plaintiff class was certified under Civ.R. 23(B)(3) as
a Civ.R. 23(B)(3) “damages” class. Civ.R. 23(B)(3) is the broadest provision under
which classes may be certified under Civ.R. 23 and often includes classes in which
the class seeks the recovery of money damages. However, nothing in Civ.R.
23(B)(3) limits classes certified under that provision to classes seeking the recovery
of money damages or otherwise precludes the certification of classes seeking
equitable relief under Civ.R. 23(B)(3). See, e.g., In re Cordis Corp. Pacemaker Prod.
Liab. Litigation v. Cordis Corp., S.D.Ohio No. C-3-86-543, 1992 U.S. Dist. LEXIS
22612, *34, fn. 21 (Dec. 23, 1992) (“When appropriate, a court can grant equitable
relief in a class action certified under Rule 23(b)(3).”), citing In re Asbestos School
B. Exhaustion of Administrative Remedies

{¶62} In its second assignment of error, the BWC contends that the trial court

erred as a matter of law in failing to dismiss plaintiffs’ complaint for failure to exhaust

administrative remedies. The BWC claims that plaintiffs were required to comply with

the administrative review process set forth in R.C. 4123.291 and Ohio Adm.Code

4123-14-06 for challenges to risk premium matters before seeking relief in the court of

common pleas. The BWC maintains that because plaintiffs did not protest their premium

rates through the administrative process, they are not entitled to judicial relief.

{¶63} The determination of whether a complaint should be dismissed for failure to

exhaust administrative remedies presents a question of law that we review de novo.

Martin v. Ohio Dept. of Rehab. & Corr., 140 Ohio App.3d 831, 835, 749 N.E.2d 787 (4th

Dist.2001). “It is a ‘long settled rule of judicial administration that no one is entitled to

judicial relief for a supposed * * * injury until the prescribed administrative remedy has

been exhausted.’” State ex rel. Teamster Local Union No. 436, 132 Ohio St.3d 47,

2012-Ohio-1861, 969 N.E.2d 224, ¶ 19, quoting Myers v. Bethlehem Shipbuilding Corp.,

303 U.S. 41, 50-51, 58 S.Ct. 459, 82 L.Ed. 638 (1938). Thus, a party must generally

“exhaust any administrative remedy that could provide him with the relief he seeks”

before seeking judicial intervention. Driscoll v. Austintown Assocs., 42 Ohio St.2d 263,

Litigation, 104 F.R.D. 422, 439 (E.D. Pa. 1984) (“It is * * *well settled that
certification under 23(b)(3) does not preclude the granting of appropriate equitable
relief.”), citing 7A C. Wright and A. Miller, Federal Practice and Procedure, Section
1784, 127 (1972).
273, 328 N.E.2d 395 (1975). Exhaustion of remedies is required to avoid “‘premature

interference with agency processes, so that the agency may function efficiently and so that

it may have an opportunity to correct its own errors, to afford the parties and the courts

the benefit of its experience and expertise, and to compile a record which is adequate for

judicial review.’” State ex rel. Teamster Local Union No. 436 at ¶ 19, quoting

Weinberger v. Salfi, 422 U.S. 749, 765, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975).

Exhaustion of administrative remedies is an affirmative defense, which the BWC bore the

burden of proving. AMM Property Invest., Inc. v. Cleveland, 8th Dist. Cuyahoga No.

99848, 2014-Ohio-821, ¶ 3; Cleveland Constr., Inc. v. Kent State Univ., 10th Dist.

Franklin No. 09AP-822, 2010-Ohio-2906, ¶ 48.

{¶64} Where an administrative agency has no power to afford the relief sought or

an administrative appeal would otherwise be futile, exhaustion of administrative remedies

is not a prerequisite to seeking judicial relief. State ex rel. Teamsters Local Union No.

436 at ¶ 23-24; see also Kaufman v. Newburgh Hts., 26 Ohio St.2d 217, 219, 271 N.E.2d

280 (1971) (“‘failure to exhaust administrative remedies available’ may be a defense * *

* only if interposed * * *, and if a remedy exists which is effectual to afford the relief

sought”). In determining futility for exhaustion of remedies purposes, it does not matter

that it may be improbable that the claimant will receive the requested relief. “‘The focus

is on the power of the administrative body to afford the requested relief, and not on the

happenstance of the relief being granted.’” (Emphasis omitted.) State ex rel. Teamsters

Local Union No. 435 at ¶ 24, quoting Nemazee v. Mt. Sinai Med. Ctr., 56 Ohio St.3d 109,
115, 564 N.E.2d 477 (1990); see also McNally v. Cleveland, 8th Dist. Cuyahoga No.

92697, 2010-Ohio-512, ¶ 12 (“‘[a] vain act is defined in the context of lack of authority to

grant administrative relief and not in the sense of lack of probability that the application

for administrative relief will be granted’”), quoting Gates Mills Invest. Co. v. Pepper

Pike, 59 Ohio App.2d 155, 167, 392 N.E.2d 1316 (8th Dist.1978). A plaintiff cannot

escape the exhaustion of remedies requirement by bringing claims as a class action. See,

e.g., State ex rel. Davis v. Pub. Emps. Retirement Bd., 10th Dist. Franklin No.

04AP-1293, 2005-Ohio-6612, ¶ 45, 53.

{¶65} The trial court held that plaintiffs’ challenges to the “lawfulness and

constitutionality” of the BWC’s rules and regulations were “outside the scope of the

Adjudicating Committee’s power,” as set forth in Ohio Adm.Code 4123-14-06(F).

Because the adjudicating committee “lacked the jurisdictional authority to address the

[p]laintiffs’ claims,” the trial court held that plaintiffs were not obligated to exhaust any

administrative remedies prior to filing suit because “administrative remedies would have

been futile.”

{¶66} The BWC contends that the premium rate dispute in this case falls squarely

within the types of decisions employers can — and must — pursue through the

administrative review process and that the trial court erred in concluding otherwise. The

BWC’s exhaustion of administrative remedies defense thus turns on whether the

adjudicating committee had the authority to address plaintiffs’ claim and whether the
wrongs alleged by the plaintiff class could have been corrected by the administrative

review process.

{¶67} Under R.C. 4123.291(A), any employer “desiring to file a request, protest,

or petition” regarding certain categories of matters specified in the statute must file the

request, protest or petition with the adjudicating committee within 24 months after the

administrator sends notice of the determination that is the subject of the request, protest,

petition. Relevant to this case, the specified matters that the adjudicating committee has

the authority to address includes “[a]ny decision relating to any other risk premium

matter under Chapters 4121., 4123., 4131. of the Revised Code.” R.C. 4123.291(B)(6).

Similarly, Ohio Adm.Code 4123-14-06(F) provides, in relevant part:

The administrator may authorize the adjudicating committee to consider the
following matters:

(6) Any other risk or premium matters as authorized and delegated by the
administrator under Chapters 4121., 4123., and 4131. of the Revised Code.

{¶68} If an employer does not prevail before the adjudicating committee, the

employer may appeal the decision of the committee to the administrator or the

administrator’s designee. R.C. 4123.291(B); Ohio Adm.Code 4123-14-06(E).

{¶69} Amici curiae urge us to reverse the trial court’s ruling that plaintiffs were

not required to exhaust administrative remedies based on Brown v. Levin, 10th Dist.

Franklin No. 11AP-349, 2012-Ohio-5768. In Brown, the plaintiff brought a class action

against the Ohio Tax Commissioner seeking equitable restitution of sales tax he

contended was improperly collected on the value of vehicles traded-in as part of the
“Cash for Clunkers” program. Id. at ¶ 2. Brown had been charged (and paid) Ohio

sales tax on the total purchase price of a new vehicle he had purchased, which included

the $3,500 value of his trade-in vehicle. Id. at ¶ 4. Brown alleged that, under R.C.

5739.01(H)(2), the trade-in value should have reduced the purchase price of the vehicle

for sales tax purposes and that he and other members were, therefore, unlawfully charged

Ohio sales tax on their vehicles’ trade-in values. Id. at ¶ 11, fn. 1. The tax commissioner

moved to dismiss Brown’s complaint on, among other grounds, that Brown and the class

failed to exhaust administrative remedies prior to seeking judicial intervention. Id. at ¶ 7.

Brown argued that because the tax commissioner had previously issued an “information

release,” “an ‘official statement’ declaring the policy of the Tax Commissioner,” which

was adverse to the claims of Brown and the putative class, it was “certain that any

application filed under R.C. 5739.07 would be rejected” and that, therefore, an

application for refund under R.C. 5739.07 would be “futile.” Id. at ¶ 20, 37-38. He

further argued that, based on the information release, filing an application for refund

would necessarily require an appeal to the BTA, which was not cost-effective, and that

the administrative remedy was therefore inadequate. Id. at ¶ 37. Citing its prior decision

in Telsat, Inc. v. Micro Ctr., Inc., 10th Dist. Franklin No. 10AP-229, 2010-Ohio-5628, the

Tenth District rejected Brown’s arguments and held that Brown was required to exhaust

the administrative remedies set forth in R.C. 5739.07 prior to pursuing an action in

common pleas court:

In Telsat, we rejected the assertion the statutory remedy in R.C.
5739.07 is inadequate simply based upon speculation that the Tax
Commissioner would deny all refunds requested under the statute. We noted
that if the Tax Commissioner denied a refund, the applicant could still
appeal the decision to the BTA and eventually to the Supreme Court of
Ohio. Thus, even if the Tax Commissioner denied the requested refund,
the plaintiff still had additional avenues for relief pursuant to the
administrative process.

We also rejected Telsat, Inc.’s argument that the potential lack of
cost-effectiveness made the remedy inadequate. Despite acknowledging
that the costs of pursuing a small sales tax claim to the BTA and the
Supreme Court of Ohio may substantially exceed the amount of the refund,
we nevertheless found the administrative remedy to be adequate in Telsat.
“The General Assembly * * * was aware that sales tax issues typically
involve small amounts but nonetheless prescribed the process set forth in
R.C. 5739.07, presumably because the initial cost of seeking a refund
through the administrative process is less than if litigation were to be
initiated to collect the illegal or erroneous tax.” Id. at ¶ 27. We further
found that, should the appeal of an adverse decision rendered by the Tax
Commissioner result in a decision that is favorable to the applicant, that
decision would likely resolve the claims of all of the remaining class
members when the Tax Commissioner implemented the appellate court’s
determination. Id. at ¶ 27. This provided further support for the adequacy
of the statutory remedy.

Brown, 2012-Ohio-5768 at ¶ 33-34.

{¶70} Brown is, however, distinguishable from this case. Under the

administrative review process at issue in Brown, the tax commissioner had express

authority to refund funds to a taxpayer who has paid “illegal or erroneous taxes.” R.C.

5739.07. A taxpayer who believed sales tax had been “illegally or erroneously” collected

could file an application for a refund. R.C. 5739.07(A) and (D). The tax commissioner

would then have to determine the amount of refund to which the applicant is entitled, if

any. R.C. 5739.07(E). If the taxpayer was dissatisfied with the commissioner’s final
determination, he or she could appeal the decision to the Ohio Board of Tax Appeals and

then to the court of appeals or the Ohio Supreme Court. R.C. 5717.02, 5717.04.

{¶71} In this case, however, there is nothing to suggest that the adjudicating

committee (or, upon further review, the administrator or his designee) had the authority to

address plaintiffs’ claim that the BWC’s group rating plan, the method by which the

BWC set premiums as a result of that rating plan, and the excessive premiums

nongroup-rated employers were allegedly charged as a result of the group rating plan,

were unlawful and unconstitutional. Tracy Valentino, the BWC’s chief fiscal and

planning officer, testified that in deciding matters brought before it, the adjudicating

committee follows the administrative rules that have been adopted by the BWC and

determines whether the BWC followed those rules, not whether those rules are lawful.

She further testified that the adjudicating committee had no authority to invalidate an

administrative regulation adopted by the BWC or to determine that an administrative

regulation violated the Ohio Constitution or the Ohio Revised Code.

{¶72} Since constitutional challenges are not within an administrative agency’s

jurisdiction, courts have long held that failure to exhaust administrative remedies is not a

prerequisite to an action raising a constitutional challenge to agency action. See, e.g.,

Roosevelt Properties Co. v. Kinney, 12 Ohio St.3d 7, 8, 465 N.E.2d 421 (1984); Herrick

v. Kosydar, 44 Ohio St.2d 128, 130, 339 N.E.2d 626 (1975); Driscoll, 42 Ohio St.2d 263,

328 N.E.2d 395, at paragraph two of the syllabus. “Because administrative bodies have

no authority to interpret the Constitution, requiring litigants to assert constitutional
arguments administratively would be a waste of time and effort for all involved.” Jones

v. Chagrin Falls, 77 Ohio St.3d 456, 460-461, 674 N.E.2d 1388 (1997).

{¶73} Although exhaustion of administrative remedies is not generally required

before a constitutional challenge may be raised, a party raising a constitutional challenge

must still exhaust any applicable administrative remedies for any non-constitutional

claims. Silverberg v. State Bd. of Pharmacy, 8th Dist. Cuyahoga No. 51777, 1987 Ohio

App. LEXIS 6905, *6-8 (Apr. 2, 1987) (failure to exhaust administrative remedies

applied to bar non-constitutional arguments that could have been considered through

administrative review process). With respect to plaintiffs’ non-constitutional arguments,

this case is materially different from a case such as Brown, in which a taxpayer challenges

a particular application of a tax provision, or one in which an individual employer

challenges a premium it has been assessed, based on a particular application of the

BWC’s rules, classifications, or calculations. Compare Arth Brass & Aluminum

Castings, Inc. v. Conrad, 104 Ohio St.3d 547, 2004-Ohio-6888, 820 N.E.2d 900; State ex

rel. Cafaro Mgt. Co. v. Kielmeyer, 113 Ohio St.3d 1, 2007-Ohio-968, 862 N.E.2d 474;

State ex rel. RMS of Ohio, Inc. v. Ohio Bur. of Workers’ Comp., 113 Ohio St.3d 154,

2007-Ohio-1252, 863 N.E.2d 160. In such cases, any “errors” impacting an individual

employer (or even multiple employers) are fully correctable in the normal course upon

administrative review. Because of the BWC’s expertise in administering its own rules

and regulations, it ordinarily should be given the opportunity to review the application of

those rules and regulations to a particular factual context.
{¶74} Plaintiffs’ challenges to their rates, however, do not involve individualized

decisions concerning particular employers’ risk accounts, but rather, a system-wide

challenge to the manner in which premium rates were set by the BWC and a request for

system-wide relief. Although the adjudicating committee (or, upon further review, the

administrator or his designee) may have had the authority to make individual, manual

premium rate adjustments under certain circumstances, nothing in the record (or the

applicable rule and statute) suggests that the plaintiff class had an administrative remedy

pursuant to which it could have required the BWC to change the manner in which it set

premium rates. See, e.g., AMM Peric Property Invest., Inc. v. Cleveland, 8th Dist.

Cuyahoga No. 99848, 2014-Ohio-821, ¶ 4, 6, 12 (where administrative agency lacks

power to grant relief sought, administrative remedy may be inadequate); Bowen v. New

York, 476 U.S. 467, 484-485, 106 S.Ct. 2022, 90 L. Ed.2d 462 (1986) (exhaustion of

administrative remedies would have been futile and, therefore, was not required where

challenged agency action involved a “systemwide, unrevealed policy” that was

inconsistent with established regulations and did not “depend on the particular facts of the

case before it”); New Mexico Assn. for Retarded Citizens v. New Mexico, 678 F.2d 847,

851 (10th Cir.1982) (plaintiff class was not required to exhaust administrative remedies

before filing lawsuit where the “gravamen” of the lawsuit was that “the entire special

education service system offered by the State is infirm” and the remedies offered at the

administrative level did not include “a restructuring of the State’s system” as sought by

the class); see also Espinoza-Gutierrez v. Smith, 94 F.3d 1270, 1273 (9th Cir.1996)
(exhaustion of administrative remedies doctrine did not bar review of a question

concerning the validity of an INS regulation due to conflict with a statute).

{¶75} Because adjudication of the lawfulness and constitutionality of the BWC’s

rating system and the relief sought by the plaintiff class were outside the scope of the

administrative review process set forth in R.C. 4123.291, the trial court committed no

error in concluding that plaintiffs were not obligated to exhaust administrative remedies

prior to filing their complaint. The BWC’s second assignment of error is overruled.

C. The Trial Court’s Determination that the BWC’s Violations of
Former R.C. 4123.29 and 4123.34(C) Warrant Equitable
Restitution

{¶76} We now turn to the merits of plaintiffs’ claim. In its first assignment of

error, the BWC challenges the trial court’s interpretation of the BWC’s statutory

rate-setting obligations under former R.C. 4123.29 and 4123.34(C) and its determination

that the BWC’s violation of those statutes warranted an award of equitable restitution to

the plaintiff class. Because the parties offer conflicting interpretations of these statutes,

determining whether the BWC violated former R.C. 4123.29 or 4123.34(C) necessarily

involves an issue of statutory interpretation.

{¶77} “The primary goal in construing a statute is to ascertain and give effect to

the intent of the legislature.” In re M.W., 133 Ohio St.3d 309, 2012-Ohio-4538, 978

N.E.2d 164, ¶ 17, citing State v. Hairston, 101 Ohio St.3d 308, 2004-Ohio-969, 804

N.E.2d 471, ¶ 11. We examine the plain language of the statute, “read words and

phrases in context[,] and construe them according to the rules of grammar and common
usage.” R.C. 1.42. In doing so, we attempt to give effect to “every word, phrase,

sentence, and part of the statute” and to avoid an interpretation that would “restrict,

constrict, qualify, narrow, enlarge, or abridge the General Assembly’s wording” or that

would otherwise render a provision meaningless or superfluous. State ex rel. Carna v.

Texas Valley Local School Dist. Bd. of Edn., 131 Ohio St.3d 478, 2012-Ohio-1484, 967

N.E.2d 193, ¶ 18-19. Words and phrases that have acquired a technical or particular

meaning, whether by legislative definition or otherwise require “a technical interpretation

in the light of the statutory purpose.” State v. Rentex, Inc., 51 Ohio App.2d 57, 60, 365

N.E.2d 1274 (8th Dist.1977), paragraph one of the syllabus, citing R.C. 1.42. If a

statutory term is not defined, and is not shown to have a relevant “technical or particular

meaning,” it is “‘accorded its plain and ordinary meaning.’” State ex rel. Data Trace

Information Servs., L.L.C. v. Cuyahoga Cty. Fiscal Officer, 131 Ohio St.3d 255,

2012-Ohio-753, 963 N.E.2d 1288, ¶ 49, quoting Rhodes v. New Philadelphia, 129 Ohio

St.3d 304, 2011-Ohio-3279, 951 N.E.2d 782, ¶ 17.

1. Violation of Former R.C. 4123.29

{¶78} Former R.C. 4123.29(A)(4)(c) stated, in relevant part:

In providing employer group plans under division (A)(4) of this section, the
administrator shall consider an employer group as a single employing entity
for purposes of retrospective rating.

{¶79} Plaintiffs argue that this provision, specifically the mandatory language “the

administrator shall consider an employer group as a single employing entity for the

purposes of retrospective rating” (emphasis added), required the BWC to implement a
retrospective group rating plan and only a retrospective group rating plan. Because there

is no dispute that the BWC implemented only a prospective group rating plan during the

class period, plaintiffs maintain the BWC violated former R.C. 4123.29(A)(4)(c). The

trial court agreed. Concluding that there was nothing in the statute that authorized the

BWC to implement a prospective group rating plan, the trial court held that the BWC’s

implementation of its prospective group rating plan “was in direct and clear violation of

[R.C. 4123.29], not within their agency discretion, and therefore unlawful.”

{¶80} The BWC contends that the trial court’s ruling was based on a misreading of

former R.C. 4123.29(A)(4)(c), and that, under a proper reading of the statute, the BWC

was not precluded from implementing a prospective group rating plan. The BWC

contends that former R.C. 4123.29(A)(4)(c) should be read only to require the BWC to

consider an employer group as a single employing entity for the purposes of retrospective

rating if it, in its discretion, chose to offer a retrospective group rating plan.

{¶81} Considering the plain and ordinary meaning of the language used in former

R.C. 4123.29(A)(4) and giving effect to every phrase and word in that part of the statute,

we agree with the trial court that former R.C. 4123.29(A)(4)(c) “reflects the General

Assembly’s conscious choice to require the BWC to use a retrospective plan, and sets

forth that requirement in clear, unambiguous, and mandatory language.” The statute

directs that “[i]n providing employer group plans under division (A)(4)” — the section of

the statute that required the BWC to implement a group rating plan — “the administrator

shall consider an employer group as a single employing entity for purposes of
retrospective rating.” (Emphasis added.) It is undisputed that the word “shall” is

mandatory. The General Assembly is presumed to mean what it said. Where, as here, a

statute is clear on its face, we must apply the statute as written. Had the General

Assembly intended former R.C. 4123.29(A)(4)(c) to authorize the BWC to implement any

form of group rating system, it would not have mandated that the BWC consider an

employer group as a single group entity specifically “for purposes of retrospective

rating,” but rather, generally, for any form of “group rating.”

{¶82} The BWC was constrained by the statutory authority granted to it by the

General Assembly. See, e.g., Taber v. Ohio Dept. of Human Servs., 125 Ohio App.3d

742, 750, 709 N.E.2d 574 (10th Dist.1998) (“‘[A]n administrative agency may not

legislate by enacting rules which are in excess of legislative policy, or which conflict with

the enabling statute.’”), quoting P.H. English v. Koster, 61 Ohio St.2d 17, 19, 399 N.E.2d

72 (1990). The BWC’s administrative rules and practices “cannot add [to] or subtract

from the legislative enactment.” Amoco Oil Co. v. Petroleum Underground Storage

Tank Release Comp. Bd., 89 Ohio St.3d 477, 483-484, 733 N.E.2d 592 (2000), citing

Cent. Ohio Joint Vocational School Dist. Bd. of Edn. v. Ohio Bur. of Emp. Servs., 21

Ohio St.3d 5, 10, 487 N.E.2d 288 (1986). Because former R.C. 4123.29(A)(4)(c)

expressly required that employers be grouped “for purposes of retrospective rating,” and

there is no language in former R.C. 4123.29 authorizing the BWC to implement a

prospective group rating plan, we find no error in the trial court’s determination that the

BWC’s prospective group rating plan violated former R.C. 4123.29.
{¶83} The BWC also argues the trial court’s restitution award should be reversed

because “the restitution awarded has no causal connection to whether [the] BWC

retrospectively rated group plans.” The BWC claims that to award restitution to the

plaintiff class based on a violation of former R.C. 4123.29, the trial court would have had

to “reset premium rates and calculate restitution under a methodology that retrospectively

rated group plans during the Class Period.” We disagree.

{¶84} Although the difference between (1) the premium rates class members were

charged by the BWC during the class period and (2) the

premium rates class members would have been charged

during that time period under a rating system that complied

with former R.C. 4123.29(A)(4)(c) is one way the amount of

the premium overcharges to the plaintiff class could have

been calculated, it was not the only way. Contrary to the

BWC’s assertion, the trial court did not award restitution

“based on a group-experience rating methodology” that it

found “‘was in direct and clear violation’ of R.C. 4123.29.”

The trial court awarded restitution based on the Schwartz

formula. The Schwartz formula is not a “rating

methodology.” The Schwartz formula calculated a

“reasonable value” for the premium overcharges to the

plaintiff class by substituting the inflated off-balance factors
the BWC had used in calculating base rates for the affected

manual classes during the class period with a “corrected”

off-balance factor of 1.23 — an off-balance factor the BWC’s

former chief actuary acknowledged would have resulted in a

“more accurate” premium rates for nongroup-rated employers

had it been used during the class period. The BWC’s “no

causal connection” argument is, therefore, meritless.

2. Violation of R.C. 4123.34

a. Plaintiffs Sufficiently Pled a Violation of R.C.
4123.34(C)

{¶85} With respect to the trial court’s finding that it violated R.C. 4123.34, the

BWC first argues that the trial court’s judgment should be reversed because plaintiffs

never specifically pled a violation of R.C. 4123.34 in their amended complaint and did

not move for leave to further amend their complaint to conform to the evidence at the

close of trial. The BWC’s argument is meritless.

{¶86} During the many years this case has been pending, plaintiffs have

consistently argued that the excessive discounts, subsidies, and inflated premiums

allegedly resulting from the implementation of the BWC’s group rating plan violated both

R.C. 4123.29 and 4123.34(C). Although plaintiffs’ amended complaint specifically

references only R.C. 4123.29, and not R.C. 4123.34, it also expressly includes allegations

that the BWC’s group rating plan exceeded the BWC’s rule-making authority and

violated state law “because it accords group discounts of such an excessive magnitude
that it requires non-group employers in the same occupational classification as

group-rated employers to pay a premium subsidy to cover the cost of excessive

discounts.” It also alleges that as a result of its collection and retention of excessive

premiums from plaintiffs and other members of the class, the BWC has been unjustly

enriched.

{¶87} The Ohio Civil Rules require only notice pleading, i.e., (1) “a short and

plain statement of the claim showing that the party is entitled to relief” and (2) a “demand

for judgment for the relief to which the party claims to be entitled” that will give the

defendant fair notice of what the plaintiff’s claim is and the grounds upon which it rests.

Civ.R. 8. R.C. 4123.29 and 4123.34 together set forth the BWC’s rate-setting authority

and obligations. See, e.g., R.C. 4123.34 (“The administrator, in the exercise of the

powers and discretion conferred upon the administrator in section 4123.29 of the Revised

Code, shall * * *.”). Based on a careful reading of plaintiffs’ amended complaint, we

conclude that plaintiffs’ claim that the BWC violated R.C. 4123.34 is fairly encompassed

within the allegations of the amended complaint. Plaintiffs were not required to plead a

legal theory of recovery. They were required to allege sufficient facts to give the BWC

notice of their claim. See, e.g., Thatcher v. Lauffer Ravines, LLC, 10th Dist. Franklin

No. 11AP-851, 2012-Ohio-6193, ¶ 43-48 (although claim was “not spelled out in the

complaint by explicit reference to the appropriate statutory sections,” case could

nevertheless proceed on the theory that defendant violated various statutory provisions if

the allegations in the complaint “provided fair notice to the defendants that the action
could proceed on this theory”), citing Mounts v. Ravotti, 7th Dist. Mahoning No. 07 MA

182, 2008-Ohio-5045, ¶ 25-26 (although complaint did not reference R.C. 5321.04,

allegations of complaint that defendant had a duty to maintain the stairs, knew or should

have known about the condition of the stairs, and failed to abate the condition of the stairs

could be seen to assert both a common law premises liability cause of action and a cause

of action under R.C. 5321.04(A)(2) for failing to repair the steps). Plaintiffs did that

here.

b. Requirements of R.C. 4123.34(C) and the Role of
Deference to the BWC

{¶88} The BWC next argues that the trial court’s judgment should be reversed on

the ground that the trial court’s finding that the BWC violated R.C. 4123.34 “is not

supported by the law or the facts.” We disagree.

{¶89} When reviewing a civil appeal from a bench trial, we apply a manifest

weight standard of review. Revilo Tyluka, L.L.C. v. Simon Roofing & Sheet Metal Corp.,

193 Ohio App.3d 535, 2011-Ohio-1922, 952 N.E.2d 1181, ¶ 5 (8th Dist.2011), citing

App.R. 12(C) and Seasons Coal v. Cleveland, 10 Ohio St.3d 77, 461 N.E.2d 1273 (1984).

Judgments supported by some competent, credible evidence going to all the material

elements of the case must not be reversed as being against the manifest weight of the

evidence. Domaradzki v. Sliwinski, 8th Dist. Cuyahoga No. 94975, 2011-Ohio-2259, ¶

6; C.E. Morris Co. v. Foley Constr. Co., 54 Ohio St.2d 279, 376 N.E.2d 578 (1978),

syllabus. If the evidence is susceptible to more than one interpretation, we must construe

it consistently with the lower court’s judgment. Id. In addition, we are mindful that the
weight to be given the evidence and the credibility of the witnesses are primarily for the

trial court. Kalain v. Smith, 25 Ohio St.3d 157, 162, 495 N.E.2d 572 (1986). “The

underlying rationale of giving deference to the findings of the trial court rests with the

knowledge that the trial judge is best able to view the witnesses and observe their

demeanor, gestures and voice inflections, and use these observations in weighing the

credibility of the proffered testimony.” Seasons Coal at 80. “A finding of an error of

law is a legitimate ground for reversal, but a difference of opinion on credibility of

witnesses and evidence is not.” Id. at 81.

{¶90} Review of the trial court’s determination that the BWC violated R.C.

4123.34 involves a mixed question of law and fact. As to the trial court’s factual

findings, we are “guided by a presumption” that the fact finder’s findings are correct. Id.

at 79-80. The interpretation of R.C. 4123.34, however, presents a legal issue that we

review de novo. Lang v. Dir., Ohio Dept. of Job & Family Servs., 134 Ohio St.3d 296,

2012-Ohio-5366, 982 N.E.2d 636, ¶ 12.

{¶91} R.C. 4123.34 sets out various requirements that the BWC “shall observe” in

setting rates. As it relates to this case, R.C. 4123.34 provides, in relevant part:

It shall be the duty of the bureau of workers’ compensation board of
directors and the administrator of workers’ compensation to safeguard and
maintain the solvency of the state insurance fund * * * . The administrator,
in the exercise of the powers and discretion conferred upon the
administrator in section 4123.29 of the Revised Code, shall fix and
maintain, with the advice and consent of the board, for each class of
occupation or industry, the lowest possible rates of premium consistent with
the maintenance of a solvent state insurance fund and the creation and
maintenance of a reasonable surplus, after the payment of legitimate claims
* * * . In establishing rates, the administrator shall take into account the
necessity of ensuring sufficient money is set aside in the premium payment
security fund to cover any defaults in premium obligations. The
administrator shall observe all of the following requirements in fixing the
rates of premium for the risks of occupations or industries:

***
(C) The administrator may apply that form of rating system that
the administrator finds is best calculated to merit rate or individually rate
the risk more equitably, predicated upon the basis of its individual industrial
accident and occupational disease experience, and may encourage and
stimulate accident prevention. The administrator shall develop fixed and
equitable rules controlling the rating system, which rules shall conserve to
each risk the basic principles of workers’ compensation insurance.
(Emphasis added.)

{¶92} Based on the evidence presented at trial, including reports from numerous

independent actuarial experts highlighting the premium inequity problems created by the

BWC’s group rating plan and admissions by current and former BWC representatives that

its group rating plan was causing nongroup-rated employers to pay “extra premium,”

substantial and inequitable subsidies, and “an additional ‘off-balance’ premium” on top of

the amounts they should have paid, the trial court found that the BWC was “charging

excessive premiums to non-group employers during the class period.” The trial court

further held that by knowingly overcharging nongroup-rated employers, the BWC

“violated the very purpose of [R.C. 4123.34(C)]” and thus violated R.C. 4123.34(C). As

the trial court explained:

In reviewing [R.C. 4123.34], the Court finds that the statute’s purpose is to
achieve a result; equity and fairness in the merit rating system. It is
accurate that the specific method of achieving that equity is not explicitly
prescribed, and therefore left to the BWC’s discretion so long as it comports
with workers’ compensation [principles.] However, the evidence that has
been established * * * displays that the BWC: was aware of the inequity in
the system; was aware it was violating the statutory mandate; and was
aware that the non-group employers were being charged excessive
premiums back to 1991. * * * By charging non-group employers excess
premiums that the BWC [knew] created inequity[,] the BWC engaged in a
course of conduct that it knew violated the very purpose of the statute. * * *
[T]he statute is devoid of any language affording the BWC the discretion to
completely disregard the statute’s purpose. * * * Therefore, the Court finds
that the Defendant violated [R.C. 4123.34(C).]

{¶93} Relying on State ex rel. Cafaro Mgt. Co. v. Kielmeyer, 113 Ohio St.3d 1,

2007-Ohio-968, 862 N.E.2d 474, ¶ 8, and State ex rel. RMS of Ohio, Inc. v. Ohio Bur. of

Workers’ Comp., 113 Ohio St.3d 154, 2007-Ohio-1252, 863 N.E.2d 160, ¶ 6, the BWC

maintains that R.C. 4123.34 grants the BWC authority to implement whatever “form of

rating system” the BWC, in its discretion, finds rates risks “more equitably” or “may

encourage and stimulate accident prevention.” The BWC argues that it, therefore, acted

lawfully, i.e., within its discretion under R.C. 4123.34, in implementing and continuing its

group rating plan to promote workplace safety, notwithstanding that the group rating plan

created substantial premium inequity in the rating system. The BWC further argues that

the trial court could not properly “intervene” in the BWC’s rate-setting decisions without

first finding that the BWC acted in an “arbitrary, capricious, or discriminatory manner”

— a finding that it contends the trial court never made. The BWC also disputes the trial

court’s finding that the plaintiff class paid “inequitable premiums,” claiming that the

evidence shows that the class paid “appropriate premiums” and that the rating system

implemented by the BWC, in fact, rated risks “more equitably” within the meaning of

R.C. 4123.34(C). Once again, we disagree.
{¶94} Courts have long recognized the importance of granting the BWC deference

in premium rate setting. Rate setting involves numerous complexities that courts are

ill-equipped to address. As a result, courts generally have a narrow role in reviewing the

rate-setting decisions of the BWC:

Setting premium rates for workers’ compensation coverage is one of the
bureau’s most challenging responsibilities. As early as 1928, we
acknowledged the difficulty of this task, and we have repeatedly affirmed
the deference due the agency in these matters. State ex rel. Reaugh Constr.
Co. v. Indus. Comm., 119 Ohio St. 205, 209, 162 N.E. 800 (1928); State ex
rel. McHugh v. Indus. Comm., 140 Ohio St. 143, 149, 42 N.E.2d 774
(1942); State ex rel. Minutemen, Inc. v. Indus. Comm., 62 Ohio St.3d 158,
161, 580 N.E.2d 777 (1991); State ex rel. Progressive Sweeping Contrs.,
Inc. v. Ohio Bur. of Workers’ Comp., 68 Ohio St.3d 393, 395, 627 N.E.2d
550 (1994). Deference is required “in all but the most extraordinary
circumstances,” with judicial intervention warranted only when the agency
has acted in an “arbitrary, capricious or discriminatory manner.” Id. at
395-396, 627 N.E.2d 550.

Cafaro at ¶ 8.

{¶95} In Cafaro, supra, a real estate management firm objected to the BWC’s

reclassification of its clerical workers and security personnel in setting its premium rates

for workers’ compensation coverage, which resulted in higher basic premium rates. Id.

at ¶ 2-4. Cafaro appealed, arguing that the BWC’s reclassification of its workers placed

its workers in classifications with other positions for which the risk was not equivalent.

Id. The BWC’s adjudicating committee rejected Cafaro’s arguments, and the

administrator’s designee affirmed the adjudicating committee’s decision, leading Cafaro

to file a writ of mandamus with the Ohio Supreme Court. Id. at ¶ 5-7.
{¶96} Specifically, Cafaro objected to (1) the BWC’s placement of its clerical

employees working at corporate headquarters into the same classification as its clerical

employees working in shopping malls and (2) the BWC’s placement of both Cafaro’s

maintenance and security personnel into the same classification. Id. at ¶ 14-16. Cafaro

argued, based on its own claims history, that mall clerical workers have a more hazardous

job than corporate clerical workers and that maintenance workers were more injury prone

than security personnel and that the BWC’s classification of these disparate workers into

the same groups, therefore, violated the BWC’s directive to classify workers according to

hazard. Id. at ¶ 15, 19. The court disagreed. The court held that Cafaro’s individual

claims experience did not establish that, industrywide, the hazard to clerical workers in a

mall office was sufficiently greater than the hazard to other clerical workers to support

Cafaro’s claims that its employees were not classified according to hazard and that

Cafaro’s employees reasonably fell within the classifications to which they had been

reassigned by the BWC. Id. at ¶ 15-17, 19. Because neither of the occupational

reclassifications was shown to be arbitrary, capricious, or discriminatory, the court denied

the writ. Id. at ¶ 20.

{¶97} Similarly, in RMS, supra, the BWC reclassified the plaintiff’s employees

into a classification that required payment of a higher workers’ compensation premium.

RMS, 113 Ohio St.3d 154, 2007-Ohio-1252, 863 N.E.2d 160, at ¶ 2. RMS provided

in-home care services to mentally handicapped and developmentally disabled individuals.

Id. Although RMS conceded that it did not provide services to individuals in a
group-home setting and was not a charitable institution — the businesses explicitly

covered by the classifications to which its employees had been previously assigned — it

argued that reclassification was unwarranted because the duties (and risks) of employees

within those classifications were similar to those of its employees. Id. at ¶ 8-20. After

an unsuccessful appeal to the BWC, RMS filed a mandamus action in the Tenth District.

The Tenth District denied the writ, and RMS appealed to the Ohio Supreme Court. Id. at ¶

4-5. In affirming the denial of the writ, the Ohio Supreme Court discussed the

challenges involved in establishing workers’ compensation premium rates and the

deference, therefore, accorded the BWC “in these matters”:

The rate-making process starts with “classif[ying] occupations or industries
with respect to their degree of hazard.” R.C. 4123.29(A)(1). The goal is to
“assign the one basic classification that best describes the business of the
employer within a state.” Ohio Adm.Code 4123-17-08(D). It is an
undertaking, however, in which “absolute precision * * * is often
impossible.” Progressive Sweeping, 68 Ohio St.3d at 395, 627 N.E.2d
550. Accordingly, we are “reluctant to find an abuse of discretion merely
because the employer’s actual risk does not precisely correspond with the
risk classification assigned.” Id. at 396, 627 N.E.2d 550.

RMS at ¶ 7.

{¶98} Because RMS had not established a clear legal right to inclusion in the

original classifications to which its employees had been assigned, the court held that the

BWC’s reclassification of its employees was not an abuse of discretion. Id. at ¶ 25.

{¶99} This case, however, is different. The BWC has no discretion to violate a

statute in setting premium rates. See, e.g., State ex rel. Minutemen, 62 Ohio St.3d at 161,

580 N.E.2d 777 (notwithstanding the “considerable deference generally afforded to the
commission to set rates[,] * * * [t]his “rate-setting expertise * * * cannot supersede a

statutory mandate”); Arth Brass, 104 Ohio St.3d 547, 2004-Ohio-6888, 820 N.E.2d 900,

at ¶ 37 (although BWC policy of immediately charging employer’s risk account for

amounts paid for employee’s medical expenses may have seemed “reasonable as a way of

doing business,” BWC could not act “contrary to law”). Given that the trial court

determined that the BWC violated R.C. 4123.34(C), it was not also required to make an

explicit determination that the BWC had acted in an “arbitrary, capricious or

discriminatory manner” in setting premium rates.

c. Interpretation of R.C. 4123.34(C)

{¶100} In interpreting R.C. 4123.34(C), we apply the principles of statutory

construction set forth above. We are also mindful that“‘if a statute provides the authority

for an administrative agency to perform a specified act, but does not provide the details

by which the act should be performed, the agency is to perform the act in a reasonable

manner based upon a reasonable construction of the statutory scheme.’” Frisch’s

Restaurants, Inc. v. Ryan, 121 Ohio St.3d 18, 2009-Ohio-2, 901 N.E.2d 777, ¶ 16,

quoting Northwestern Ohio Bldg. & Constr. Trades Council v. Conrad, 92 Ohio St.3d

282, 287, 750 N.E.2d 130 (2001); see also State ex rel. V&A Risk Servs. v. State Bur. of

Workers’ Comp., 10th Dist. Franklin No. 11AP-742, 2012-Ohio-3583, ¶ 23 (When

interpreting statutes, “[c]ourts generally must give due deference to an administrative

interpretation formulated by an agency that has accumulated substantial expertise and that

has responsibility for implementing a legislative command.”). Nonetheless, we agree
with the trial court that the BWC’s group rating plan “does not result from a reasonable

interpretation” of R.C. 4123.34.

{¶101} Under the first sentence of R.C. 4123.34(C), the BWC has discretion to

implement the rating system the administrator determines is best calculated to merit rate

or individually rate the risk “more equitably.” The statute also provides that the BWC

may also consider the state’s interests in “encourag[ing] and stimulat[ing] accident

prevention” in deciding which form of rating system to use. However, the exercise of

discretion granted in the first sentence of R.C. 4123.34(C) is expressly constrained by the

second sentence of R.C. 4123.34(C) — which the BWC completely ignores in its

interpretation of the statute. Under the second sentence of R.C. 4123.34(C), the BWC

“shall” develop “fixed and equitable rules controlling the rating system that conserve to

each risk the basic principles of workers’ compensation insurance.” This, as is clear

from the record, the BWC did not do.

{¶102} The terms “equitable” and “conserve” and the phrases “more equitably”

and “basic principles of workers’ compensation insurance” are not defined by the

statute. 20 Black’s Law Dictionary defines “equitable,” in relevant part, as “[j]ust;

conformable to the principles of justice and right.” Black’s Law Dictionary 537 (6th

Ed.1990). The Webster’s New World Dictionary similarly defines “equitable” as

20
While we respect the General Assembly’s desire not to unduly constrain the rate-setting
process, perhaps much of the litigation surrounding this issue could have been avoided if the General
Assembly had provided more specific guidance to the BWC as to what should be deemed to constitute
“equitable” rules or how to evaluate whether a particular rating system rates risk “more equitably.”
“characterized by equity; fair; just.” Webster’s New World Dictionary 383 (3d College

Ed.1988). The Webster’s New Collegiate Dictionary defines “equitable” as “having or

exhibiting equity” and “dealing fairly and equally with all concerned.” Webster’s New

Collegiate Dictionary 363 (1980). “Conserve” means “[t]o save and protect from loss or

damage” or to “keep,” “guard,” “observe.” Black’s Law Dictionary at 306; Webster’s

New Collegiate Dictionary at 239. The “basic principles of workers’ compensation”

have been generally recognized to include protecting injured workers and employers from

losses that result from workplace accidents, compensating injured workers and their

beneficiaries, promoting workplace safety and accident prevention, and ensuring that each

employer participating in the workers’ compensation system pays an amount in premiums

that reasonably corresponds with the risk that employer presents to the system. See, e.g.,

State ex rel. Crystal Tissue Co. v. Indus. Comm. of Ohio, 129 Ohio St. 320, 322, 195 N.E.

546 (1935); State ex rel. Powhatan Mining Co. v. Indus. Comm. of Ohio, 125 Ohio St.

272, 275-277, 181 N.E. 99 (1932); State ex rel. Superior Foundry, Inc. v. Indus. Comm.

of Ohio, 168 Ohio St. 537, 542, 156 N.E.2d 742 (1959).

{¶103} The BWC argues that, as used in R.C. 4123.34(C), the phrase “more

equitably” should be interpreted as matching “the right rate for the right risk.”

Bravender, the director of the BWC’s actuarial department, testified that she interpreted

“equitable” to mean “not necessarily equal” and “to set rates in a manner that provides

premium to cover the insurance exposure that’s presented by the insured.” She further

testified that she believed R.C. 4123.34(C) required the BWC to charge an “appropriate
premium” to an employer or group of employers “based on the costs they bring to the

system.” The BWC’s former chief actuary, Pedrick, testified that there is no common

actuarial definition of what it means to charge “equitable rates” but that the BWC

generally interpreted R.C. 4123.34(C) as requiring rates that are reasonable and not

excessive, inadequate, or unfairly discriminatory. He further testified that equity is not a

fixed goal, that there are “levels of equity,” and that “loss ratio” is often a “principal

means of measuring equity.”

{¶104} Accordingly, we interpret R.C. 4123.34(C) as requiring the BWC to

implement a premium rating system with set rules that fairly and reasonably allocate the

total premiums to be collected among all employers participating in Ohio’s workers’

compensation system based on the risk each employer presents to the workers’

compensation system, resulting in rates that are fair and reasonable and not excessive,

inadequate, or unfairly discriminatory.

{¶105} There are undoubtedly countless ways the BWC could design an

experience rating plan to merit rate or individually rate risk “more equitably” or to

“encourage and stimulate accident prevention.” The specific method of achieving that

result is not prescribed in the statute and is, therefore, left to the discretion of the BWC,

provided the BWC otherwise complies with the statute. What the BWC did not have the

authority to do under the statute — and what the trial court found that it did — was adopt
an experience rating system that was grossly inequitable, i.e., that rated employers’ risks

in a way that was significantly more inequitable than without that system.21

{¶106} The BWC argues that whether the BWC matched the right rate to the right

risk should be determined solely through a “net income analysis” that compares the “net

premiums” collected from the plaintiff class with the “ultimate claims costs” and

expenses attributable to employees of the plaintiff class, considering “both the benefits

and detriments of the group rating plan on class members.”

{¶107} There is

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/2701677. Public record. Not legal advice.
