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Ohio Laws and Rules
(A) Pursuant to sections 4121.441 and 4121.61 of the Revised Code, the bureau shall adopt rules and administer the health partnership program (HPP). Managed care organizations (MCOS) shall provide medical management, including the management of vocational rehabilitation to injured workers, and the bureau shall manage all other aspects of the claim.
(B) The rules of this chapter shall be applicable to all rehabilitation injured workers and employers, whether the rehabilitation services are furnished by the bureau or a private rehabilitation provider, or are administered by an MCO, or by a self-insuring employer participating in the rehabilitation surplus fund. A self-insuring employer not participating in the rehabilitation surplus fund is required to adhere to these rules to ensure that rehabilitation services provided are equal to or greater than the services defined in this chapter.
(C) The bureau shall:
(1) Develop policy to implement vocational rehabilitation services.
(2) Assure that injured workers receive appropriate remain at work and/or return to work vocational rehabilitation services.
(3) Audit the MCO vocational rehabilitation management practices and provision of services.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62, 4121.63, 4121.64, 4121.65, 4121.66, 4121.67, 4121.68, 4121.69
Prior Effective Dates: 7/10/80, 2/3/92, 1/1/01
(A) The bureau shall take measures and make expenditures as it deems necessary to aid injured workers who have sustained compensable injuries or contracted compensable occupational diseases to remain at work or to return to work
(B) The objectives of the surplus-funded vocational rehabilitation program are to be addressed and considered in the following order:
(1) To return the injured worker to the former employer in the original job, or, if this is not possible;
(2) To encourage the employer to modify the original job or to provide employment in a different job, or, if this is not possible;
(3) To assist the injured worker in finding employment in a related industry, and if not possible then in any industry.
The hierarchy of return to work objectives, as outlined above may require appropriate skill enhancement, remedial or short term training to aid injured workers in successfully returning to work at any of the steps.
(C) Injured workers who wish to become self-employed shall be informed by the MCO of the opportunities available through the state rehabilitation services commission, the federal small business administration office, the local Ohio small business development center, the Ohio department of development, or other resources.
(D) The bureau will not make expenditures from the surplus fund established by section 4123.34 of the Revised Code for the medical management of an industrial claim.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4121.05
Rule Amplifies: 4121.61, 4121.62
Prior Effective Dates: 7/10/80, 2/3/92, 1/1/2001
(A) Scope of vocational rehabilitation.
(1) Vocational rehabilitation is the process of restoring the vocational functioning of a worker who experiences an industrial injury or occupational disease. As the injured worker progresses toward medical stability, the worker should be assessed for vocational rehabilitation. Vocational rehabilitation services are not reimbursable from the surplus fund when they are solely directed toward the medical management of a claim.
(2) The vocational rehabilitation rules of Chapter 4123-18 of the Administrative Code shall aid in the development of procedures for providing reimbursable vocational rehabilitation services.
(B) Referrals for vocational rehabilitation services.
(1) Anyone can refer an injured worker for vocational rehabilitation services.
(2) Once eligibility has been determined, the MCO shall contact the potential candidate referred for vocational rehabilitation services within three working days.
(C) To be eligible for rehabilitation services the injured worker must meet the following criteria:
(1) Recognized claim that is either:
(a) A lost time claim allowed by an order of the bureau of workers’ compensation or an order of the industrial commission or of its hearing officers;
(b) A claim certified by a state university or state agency; or
(c) A claim certified by a self-insuring employer.
(2) The recognized allowance must reflect a significant impediment to the injured worker’s employment or maintenance of employment.
(3) The injured worker must have at least one of the following present:
(a) Received or awarded temporary total, non-working wage loss, or permanent total compensation on the date of referral;
(b) Granted a scheduled award under division (B) of section 4123.57 of the Revised Code;
(c) Currently receiving payments in lieu of compensation (e.g., salary continuation);
(d) Received or awarded a permanent partial award and has documented job restrictions as a result of that award;
(e) Reached maximum medical improvement from the lost time claim, but is not currently receiving compensation and continues to have job restrictions in that claim as documented by the physician of record.
(f) Is receiving job retention services to maintain employment or satisfies the criteria set forth in paragraph (C)(2) of this rule;
(g) Sustained a catastrophic injury claim and a vocational goal can be established.
(D) Eligibility for rehabilitation services for an employee of a state agency or state university employer.
(1) Notwithstanding that an employee of a state agency or state university may not meet the eligibility criteria of paragraph (C)(3) of this rule, the employee shall be eligible for rehabilitation services where the employee meets the eligibility criteria of paragraph (C)(1)(b) of this rule and the employee and employer agree upon a program of rehabilitation services.
(2) An employee of a state agency or state university shall meet the eligibility criteria of paragraph (C)(1)(b) of this rule if the employer has accepted or certified the employee’s claim.
(E) Job retention services.
(1) Job retention may be furnished when an injured worker is working and experiences a significant work-related problem as a direct result of the allowed conditions in the claim.
(2) Job retention services may be provided if:
(a) The injured worker has received compensation from an allowed lost time claim;
(b) The current work-related problem is a direct result of the allowed conditions in the claim; and
(c) The physician of record and the employer provide a written statement describing the specific job task problems the injured worker is experiencing and a statement describing why these services are needed to maintain the injured worker’s employment.
(F) The injured worker is not eligible for vocational rehabilitation services and such services shall be terminated:
(1) After the effective date of a lump sum settlement; or
(2) If the claim is subsequently disallowed on appeal by an order of the industrial commission, its district or staff hearing officers, or by an order of the court.
(G) Prior to rehabilitation plan implementation by the MCO, diagnostic evaluations may be used in determining feasibility for vocational rehabilitation services. Payment for such examination(s) and the vocational rehabilitation case management occurring during this period may be charged to the surplus fund.
(H) Facts supporting a decision concerning either the acceptance or denial of an injured worker into vocational rehabilitation due to either eligibility or feasibility shall be documented in the MCO’s decision. Written objections shall be governed by the alternative dispute resolution process provided for in rule 4123-6-16 of the Administrative Code.
(I) Denial of rehabilitation services will not affect an injured worker’s right to compensation or benefits under Chapters 4123., 4127., and 4131. of the Revised Code for which the injured worker otherwise qualifies.
HISTORY: Rule replaces: 4123-18-03; Eff 3-16-92; 1-15-99; 8-20-00; 1-1-01; 4-26-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4121.12, 4121.121, 4121.61
Rule amplifies: RC 4121.62, 4121.63
RC 119.032 review dates: 3/1/01, 11/28/03, 3/1/08
The bureau shall order living maintenance to be paid from the surplus fund, established by section 4123.34 of the Revised Code, to each injured worker in accordance with the guidelines listed below. Living maintenance payments are compensation under Chapters 4121. and 4123. of the Revised Code.
An injured worker is eligible for living maintenance payments in accordance with the guidelines of this rule.
(A) Living maintenance payments shall begin at the time that the injured worker actually begins to participate in a vocational rehabilitation plan. This date may or may not coincide with the MCO’s submission of a written vocational rehabilitation plan and the agreement of the injured worker to participate in a vocational rehabilitation plan.
If salary continuation is offered by the employer of record, an injured worker maintains the right to choose to receive either salary continuation or living maintenance during vocational rehabilitation. However, if temporary total or living maintenance has been paid in the claim, the injured worker shall be paid living maintenance when participating in vocational rehabilitation. Whenever salary continuation is paid by the employer, it must be paid at the injured worker’s regular (full) salary level.
(B) The bureau shall order suspension of living maintenance payments at such time as it becomes evident that the injured worker will not be able to participate actively in his/her vocational rehabilitation plan for a period of thirty days or more due to the medical instability of the injured worker. The suspension of living maintenance shall not affect an injured worker’s right to compensation or benefits under the revised code for which the injured worker otherwise qualifies.
(1) The bureau shall, assist the injured worker in obtaining the payment of other workers’ compensation benefits to which the injured worker would normally be entitled absent involvement in a vocational rehabilitation plan upon the cessation of living maintenance payments.
(2) Upon request, the bureau will determine whether the injured worker is eligible for a medical hold. Adequate medical documentation must be provided to support the medical hold. This period may not exceed two years from the date of medical hold determination. The bureau shall thereafter monitor the injured worker’s medical status with the attending physician
(3) When the bureau becomes aware of the restabilization of the injured worker’s medical condition the injured worker shall be reactivated into the division, absent any extenuating circumstances, and appropriate rehabilitation services should begin as soon as possible.
(C) The bureau shall order termination of living maintenance payments at such time as:
(1) The injured worker has returned to work; or
(2) The injured worker has failed to fulfill the responsibilities outlined in the vocational rehabilitation plan; or
(3) The injured worker is unable to attain the goals of his/her vocational rehabilitation; or
(4) The injured worker has refused, without good cause, to accept an offer of employment within the vocational goal of the rehabilitation plan; or
(5) The injured worker is no longer living.
The termination of living maintenance shall not affect an injured worker’s right to compensation or benefits under the Revised Code for which the injured worker otherwise qualifies.
(D) The bureau may, order deduction from any living maintenance payment an amount equal to:
(1) One-seventh of the weekly payment to which an injured worker is entitled for each full day during which injured worker fails, without good cause, to participate in his/her vocational rehabilitation plan.
(2) Any wages or other remuneration received by the injured worker while participating in a vocational rehabilitation plan and receiving living maintenance must either be endorsed over to the bureau, or will be deducted from the injured worker’s living maintenance payments or from future awards of compensation.
(E) Living maintenance payments shall not be ordered by the bureau for a period or periods exceeding six months in the aggregate, unless review by the bureau reveals that the injured worker will be benefited by an extension of vocational rehabilitation services.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.62, 4121.63, 4121.66
Prior Effective Dates: 7/10/80, 127/82, 2/3/92, 1/1/01
(A) When surplus funds are used, the MCO shall oversee that a vocational case management provider contacts the injured worker and prepares an individualized written vocational rehabilitation plan for the injured worker’s acknowledgement and approval. The vocational case management provider shall, where practical, consult with the injured worker’s employer, the physician of record, and others considered appropriate.
(B) Each written vocational rehabilitation plan shall include the following information:
(1) Identification of the injured worker’s return to work goals and barriers to employment;
(2) The types of services required;
(3) The estimated costs;
(4) The estimated length of time required to attain the goals of the plan;
(5) An explanation of the specific strategies that will be employed to assist the injured worker in returning to work. The MCO must document that the return to work goal is addressed in the following order:
(a) His/her original job; or
(b) Another job with the same employer; or
(c) A job in a related industry or business; or
(d) A job in another industry or business;
(e) The hierarchy of return to work objectives, as outlined above may require appropriate skill enhancement, remedial or short term training to aid injured workers in successfully returning to work at any of the steps.
(6) The method of evaluating services.
(C) The MCO shall administer the development of the vocational rehabilitation plan, monitor the injured worker’s progress and where circumstances warrant, direct the amendment or modification of the plan.
(D) The bureau shall determine if living maintenance payments are appropriate and shall monitor all other surplus fund expenditures.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.62, 4121.63
Prior Effective Dates: 7/10/80, 12/7/82, 2/3/92, 1/1/01
(A) As used in this rule the following definitions shall apply:
(1) “Transitional work” means a work-site program that provides an individualized interim step in the recovery of an injured worker with job restrictions resulting from the allowed conditions in the claim. Developed in conjunction with the employer and the injured worker, or with others as needed, including, but not limited to the collective bargaining agent (where applicable), the physician of record, rehabilitation professionals, and the MCO, a transitional work program assists the injured worker in progressively performing the duties of a targeted job.
(2) “Transitional work developer” means the provider who submits a proposal of transitional work services to the employer and then develops the transitional work program. This provider must be qualified in accordance with paragraph (C)(1) of this rule.
(3) “Transitional work on-site therapist” means the provider who provides the on-site transitional work therapy services.
(B) Grant monies for development of a transitional work program.
Pursuant to rule 4123-17-55 of the Administrative Code, the administrator may grant monies to employers who wish to implement a transitional work program as set forth in this rule.
(C) Bureau recognition of authority to provide transitional work services.
(1) A transitional work developer shall:
(a) Be either:
(i) A vocational/medical case manager as provided in paragraph (C)(32) of rule 4123-6-022 of the Administrative Code;
(ii) An occupational therapist as provided in paragraph (C)(18) of rule 4123-6-022 of the Administrative Code; or
(iii) A physical therapist as provided in paragraph (C)(23) of rule 4123-6-022 of the Administrative Code;
(b) Complete bureau sponsored transitional work development training prior to delivering transitional work programs and at two year intervals; and,
(c) Have verified experience in developing transitional work programs according to the bureau’s transitional work policy; or, verified mentoring experience with a developer of transitional work services according to the bureau’s transitional work policy.
(2) An on-site transitional work therapist shall be a bureau certified provider as provided in rule 4123-6-022 of the Administrative Code and shall be licensed and certified to provide transitional work therapy within the provider’s scope of practice.
(D) The bureau may deny or revoke a transitional work developer’s authority to provide services if there is reasonable evidence that the developer:
(1) Engaged in unethical or illegal activities in the provision of transitional work services;
(2) Failed to maintain appropriate qualifications for providing transitional work in accordance with this rule;
(3) Failed to provide transitional work services in accordance with this rule and bureau transitional work guidelines; or,
(4) Failed to maintain valid Ohio workers’ compensation coverage.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62, 4121.63, 4121.64, 4121.65, 4121.66, 4121.67, 4121.68, 4121.69
Prior Effective Dates: 1/1/01
(A) General principles.
(1) Vocational rehabilitation services and living maintenance shall be paid from the surplus fund, established by section 4123.34 of the Revised Code, so long as such costs are incurred in a lost time claim pursuant to an approved vocational rehabilitation plan.
(2) Vocational rehabilitation services, as mentioned in paragraph (A)(1) of this rule, can include but must not be solely directed at medical management and allied medical treatment of the injured worker in an approved vocational rehabilitation plan.
(3) Notwithstanding paragraph (A)(1) of this rule, any period of treatment relating to the allowed condition(s) of the claim which has been prescribed and provided prior to the approval of the vocational rehabilitation plan by the attending physician in the claim, by a specialist to whom the injured worker has been referred by the attending physician, the injured worker’s employer, the MCO, or the bureau of workers’ compensation, and which extends into the calendar period of the injured worker’s vocational rehabilitation plan shall continue to be charged to the risk of the employer.
(4) Vocational rehabilitation case management costs incurred in the development and preparation of an MCO administered vocational rehabilitation plan are vocational rehabilitation services and are paid from the surplus fund. On-going vocational rehabilitation case management professional services and travel are also paid from the surplus fund while the rehabilitation case is open.
(5) Preacceptance or vocational rehabilitation plan development costs for medical, psychological, and vocational evaluations may be charged to the surplus fund.
(B) Nonallowed conditions.
(1) The MCO and bureau shall authorize payment for treatment of a condition which is unrelated to the injury or occupational disease as long as it is clearly evident that the unrelated condition is aggravating the industrial injury or occupational disease, preventing healing, impeding vocational rehabilitation, or is a barrier to returning to work. The payment for these conditions shall not exceed one thousand five hundred dollars for each claim.
(2) The MCO shall fully document the rationale for these expenditures in both the vocational rehabilitation plan and the MCO’s rehabilitation case file.
(3) Payment for such treatment shall not constitute a recognition of the unrelated condition as a part of the disability in the claim.
(4) As soon as the unrelated condition is no longer affecting the industrial injury or occupational disease, the responsibility for its treatment ceases and payment for any subsequent treatment that may be given will be injured worker’s own responsibility.
(C) Expenses incurred by injured workers.
Travel expenses shall be paid in an MCO authorized vocational rehabilitation plan in accordance with rule 4123-6-40 of the Administrative Code, except as additionally provided under the following circumstances:
(1) The MCO and the bureau may authorize advancements for planned and preauthorized travel expenses, provided such an advancement does not cover more than fourteen calendar days.
(2) All bureau-approved expenses under this rule shall be paid from the surplus fund established by section 4123.34 of the Revised Code.
(3) Relocation expenses may be paid from the surplus fund. The MCO shall determine the reasonable and necessary costs. These payments may be authorized up to two thousand dollars per injured worker. These costs may be approved when all of the following criteria are met:
(a) Job opportunities for which the injured worker is qualified do not exist within a reasonable commute on a daily basis.
(b) The injured worker has secured a job at the new location as determined by the MCO.
(c) When the criteria under paragraphs (C)(3)(a) and (C)(3)(b) of this rule are satisfied, the bureau may order the payment of relocation expenses with temporary lodging for up to sixty days to find a new residence if the injured worker must sell his or her last place of residence. The relocation expenses may include temporary lodging for up to sixty days.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62, 4123.53, 4123.66
Prior Effective Dates: 7/10/80, 12/7/82, 3/16/92, 1/1/01
The rehabilitation division, as a means of encouraging employers to retain, rehire, or hire claimants who have successfully completed a prescribed rehabilitation plan, may make payments to employers from the surplus fund established by section 4123.34 of the Revised Code.
(A) The payments shall be negotiated with the employer and based upon a written agreement signed by the employer, the claimant and the division. The basis for negotiation shall be:
(1) The nature of the disability of the claimant as determined by the division;
(2) The relationship of the disability to the job requirements; and
(3) The individual merits of the case.
(B) The period(s) of such payment shall not exceed six months in the aggregate, unless a review by the division determines that the claimant would be benefited by an extension of payments.
(C) Payments under this rule shall be made directly to the employer, pursuant to an administrative order of the division, ordering such to be paid on a monthly basis, provided the employer is a complying employer in the states in which it is subject to workers’ compensation coverage requirements or has been accepted by the administrator of workers’ compensation as a self-insuring employer under section 4123.35 of the Revised Code. Payments may be made to out-of-state employers who are not subject to the workers’ compensation laws of Ohio if a reasonable but unsuccessful effort has been made to secure employment for the claimant within Ohio. Such payments shall be in amounts stated in the written agreement and shall be charged to the surplus fund, established by section 4123.34 of the Revised Code.
(D) The bureau may make incentive payments from the surplus fund to an employer where the employer offers its employee paid transitional work activities at the employer’s worksite and the employee has completed required medical rehabilitation services and has successfully satisfied vocational rehabilitation readiness requirements. An employee meets vocational rehabilitation readiness requirements when the employee has been officially referred for vocational rehabilitation, is medically stable, and has a significant impediment to a return to full employment.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62, 4121.65, 4121.66, 4121.67, 4123.35
Prior Effective Dates: 2/3/92, 7/17/00
(A) The bureau may sponsor, cooperate with, or employ the services and resources of any public entity or private person, business or association in fulfilling its responsibilities to provide vocational rehabilitation for eligible injured workers as prescribed by the rules of the bureau of workers’ compensation.
(B) The rehabilitation services commission, the department of job and family services, and any other public officer, employee or agency of the state shall, pursuant to this rule and section 4121.69 of the Revised Code, give to the bureau full cooperation and shall, at the request of the administrator of workers’ compensation, enter into a written agreement stating the procedures and criteria for referring, accepting, and providing services to injured workers in rehabilitation plans.
HISTORY: Replaces rule 4121-18-12; Eff 7-10-80; 2-3-92; 4-26-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4121.12, 4121.30, 4121.31, 4123.05
Rule amplifies: RC 4121.61, 4121.62, 4121.66, 4121.69
RC 119.032 review dates: 11/28/03, 3/1/08
(A) In appropriate cases, the bureau may refer a claimant to the rehabilitation services commission to participate in a plan offered by the rehabilitation services commission (the bureau of vocational rehabilitation and the bureau of services for the visually impaired).
(B) The administrator of workers’ compensation will order payment from the surplus fund established by section 4123.34 of the Revised Code to compensate the rehabilitation services commission for the nonfederal portion of its services.
HISTORY: Replaces rule 4121-18-13; Eff 7-10-80; 2-3-92; 4-26-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4121.12, 4121.30, 4121.31, 4123.05
Rule amplifies: RC 4121.61, 4121.62, 4121.66, 4121.69
RC 119.032 review dates: 11/28/03, 3/1/08
(A) Claims for injury, occupational disease or death incurred in the course of and arising out of participation in a MCO authorized rehabilitation program may be filed for compensation and benefits as if the injured worker’s employer were the bureau of worker’s compensation.
(B) The full or average weekly wage for the rehabilitation injury, occupational disease, or death claim shall be calculated using the full or average weekly wage information in the original claim pursuant to which the injured worker undertook participation in the prescribed rehabilitation program; provided, that if the statewide average weekly wage in the year of the rehabilitation injury, occupational disease or death is different from that applicable to the original claim, the injured worker’s full or average weekly wage shall be calculated using the original wage information but subject to the maximum compensation rate in such subsequent year.
(C) All compensation and benefit awards arising out of such a claim shall be charged to the surplus fund established by section 4123.34 of the Revised Code.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.68
Prior Effective Dates: 7/10/80, 2/3/92, 1/1/01
(A) Annually, the bureau shall prepare and submit to the administrator of workers’ compensation a report of vocational rehabilitation activities during the prior calendar year.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62
Prior Effective Dates: 7/10/80, 2/3/92, 1/1/01
(A) Employers who provide compensation and benefits pursuant to section 4123.35 of the Revised Code shall furnish all eligible and feasible injured workers with vocational rehabilitation services equal to or greater in quality and content than the services provided by the bureau and the MCO.
(B) Self-insuring employers who have elected to furnish rehabilitation services directly pursuant to section 4123.66 of the Revised Code may utilize the services of the bureau rehabilitation center.
(C) Upon referral, a self-insuring employer shall determine whether the injured worker is eligible and feasible for vocational rehabilitation service using the criteria set forth in rule 4123-18-03 of the Administrative Code. If it is determined that the injured worker is eligible and feasible for vocational rehabilitation service, the self-insuring employer shall provide rehabilitation case management services equal to or greater in quality and content than the services provided by the bureau and the MCO utilizing the services of a provider who meets the minimum credentialing criteria set forth in Rule 4123-6-022 of the Administrative Code.
(D) The bureau shall inspect and review the quality and content of all authorized self-insuring employers’ rehabilitation services in order to determine whether or not such services are equal to or greater in quality and content than the services provided by the bureau or the MCO. Such inspections and reviews shall be conducted upon receipt of evidence indicating that a self-insuring employer’s rehabilitation services are of a lesser quality than the services provided by the bureau or the MCO.
(E) The bureau may direct complaints of sub-standard vocational rehabilitation programs to the bureau’s self-insured department for review.
(F) The self-insuring employer shall promptly pay living maintenance, wages in lieu of compensation, or salary continuation directly to the injured worker. Payments shall be made in accordance with guidelines outlined in paragraph (A) of rule 4123-18-04 of the Administrative Code.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.61
Rule Amplifies: 4121.61, 4121.65, 4121.66, 4123.35
Prior Effective Dates: 7/10/80, 12/7/82, 2/3/92, 1/1/01
(A) As provided in section 4121.70 of the Revised Code, A statewide labor-management-government advisory council shall be created consisting of twelve members having special knowledge on matters concerning various aspects of rehabilitation of workers who are disabled due to an injury or occupational disease.
(B) Vacancies on the council shall be filled in the same manner as the original appointment as provided in section 4121.70 of the Revised Code. The council shall appoint a chairperson and vice-chairperson.
(C) The administrator or the administrator’s designee shall serve as secretary of the council without vote.
(D) The council shall meet at the call of the chairperson or a majority of the members, and meetings may be requested by the administrator or the administrator’s designee. The council shall meet not less than quarterly. Meetings may be held at any location in the state.
(E) Council members shall serve without compensation, except that they shall be reimbursed for the actual and necessary costs of attending meetings upon approval of the bureau of workers’ compensation. Payment shall be made in the same manner as other administrative costs of the bureau.
(F) The administrator or the administrator’s designee shall prepare the agendas and provide secretarial services to the council to record minutes, prepare reports, and perform other related support services.
(G) The council shall serve in an advisory capacity to the bureau Those voting affirmatively and negatively on all recommendations of the council shall be identified in the official record (minutes). All recommendations of the council shall be reviewed and considered by both the bureau, and the administrator or the administrator’s designee shall inform each council member of the disposition of each recommendation.
(H) The functions of the council shall include the following:
(1) Provide timely advice and counsel relative to the rendering of rehabilitation services to injured workers and the quality and effectiveness of such services;
(2) Provide active support of the rehabilitation function and program of the bureau and verbalize that support to peers, legislators, and the community-at-large;
(3) Offer advice on current and future planning within the bureau concerning rehabilitation services;
(4) Offer recommendations for changes of laws, rules, policies, and procedures relative to rehabilitation services;
(5) Offer encouragement to employees with work-related injuries or occupational diseases relative to utilization of the specialized rehabilitation services
(I) The administrator or the administrator’s designee shall keep all members informed of the internal affairs of the bureau insofar as such may be applicable to their service on the labor-management-government advisory council.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.62, 4121.70
Prior Effective Dates: 12/7/82, 8/22/86 (Emer), 11/8/86, 2/3/92, 1/1/01
(A) In claims with a date of injury on or after August 22, 1986, the bureau shall make living maintenance wage loss payments to injured workers who complete an authorized vocational rehabilitation plan, successfully return to work, and experience a wage loss while employed.
(1) The wage loss must be as a consequence of the physical and/or psychiatric limitations caused by the impairments resulting from the allowed conditions in the claim.
(2) Injured workers requesting living maintenance wage loss payments shall be required to submit medical documentation of the physical and/or psychiatric limitations as referenced in paragraph (A)(1) of this rule at each six month request for continuation of wage loss payments.
(3) Injured workers requesting wage loss payments shall not voluntarily limit their income by choosing to work fewer hours or at wages below reasonable expectations, if more appropriate jobs are reasonably available within their labor market.
(a) The bureau may review an injured worker’s physical limitations, residual abilities, skills, education, labor market and other factors as necessary in making the determination of voluntary limitation of income.
(b) An injured worker who wishes to change jobs after the initial receipt of wage loss payments must notify the assigned bureau customer service team. The customer service team will review the criteria set forth in paragraph (A)(3) of this rule to ensure that no voluntary limitation of income will occur.
(B) The bureau shall be responsible for calculating wage loss payment amounts based upon the injured worker’s wage statement or other information on the subject. Payments shall be sixty-six and two-thirds per cent of the difference between the greater of the injured worker’s full weekly wage or average weekly wage on the claim for which the injured worker underwent a rehabilitation plan and the weekly wage received while employed up to a maximum per week equal to the statewide average weekly wage.
(C) Such wage loss payments shall be issued on a biweekly basis, or on a quarterly basis if the injured worker has a substantial variation in income and reports income to the bureau on a quarterly basis. Wage loss payments shall be charged to the surplus fund established by section 4123.34 of the Revised Code.
(D) Payments may continue for up to a maximum of two hundred weeks but shall be reduced by the corresponding number of weeks in which an injured worker receives payments pursuant to division (B) of section 4123.56 of the Revised Code.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.67
Prior Effective Dates: 8/22/86 (Emer), 11/17/86 (Emer), 1/10/87, 2/3/92, 1/1/01
(A) Pursuant to division (C) of section 4121.62 of the Revised Code, the administrator of workers’ compensation shall establish fees for use of services offered by the bureau’s rehabilitation center, the BWC rehabilitation center in Columbus
(B) The fees will take into account the usual, customary, and reasonable fees charged for like services in the area in which the services are provided, as determined by the bureau’s medical section. No fees shall be established in excess of the bureau’s current fee maxima schedule.
(C) Fees for use of programs or services of the centers will be charged to the in accordance with the approved fee schedule with authorization of the MCO for the services rendered. Upon receipt of an approved itemized bill, the fees will be paid by the MCO from the appropriate fund for state fund employers, and by the bureau from the self-insured surplus fund for self-insuring employers who have not elected to pay rehabilitation costs directly, and by self-insuring employers who have elected to pay rehabilitation costs directly pursuant to division (D) of section 4121.66 of the Revised Code.
(D) The specific program descriptions, protocols, and fee schedules for the programs and services offered by the rehabilitation center shall be published periodically by the bureau. The bureau will provide fourteen days advance notice of any changes in programs or fee schedules, and any increases in fees shall apply prospectively only to services authorized after the effective date of the change. The bureau may discount fees from the fee schedule at its discretion. Copies of the services offered and the fee schedule may be obtained upon request by contacting the rehabilitation center.
R.C. 119.032 review dates: 11/28/2003 and 03/01/2008
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.62, 4121.66
Prior Effective Dates: 10/11/94, 1/1/01