4123-18-05 Individualized written vocational rehabilitation plan.

(A) When surplus funds are used, the MCO shall oversee that a vocational rehabilitation 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 rehabilitation 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, at a minimum, 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) The injured worker's 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 and/or 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.

(E) MCO, in conjunction with the bureau, shall close an injured worker's vocational rehabilitation plan for the following objectively determined or identified reasons:

(1) The injured worker has completed a vocational rehabilitation plan;

(2) The injured worker has failed to fulfill the responsibilities outlined in the vocational rehabilitation plan;

(3) The injured worker is unable to attain the goals of the vocational rehabilitation plan;

(4) The injured worker has refused, without good cause, to accept an offer of employment within the vocational goal of the rehabilitation plan;

(5) The injured worker is no longer living;

(6) The injured worker does not agree with the MCO's or bureau's decision to approve or deny specific vocational rehabilitation plan services; or

(7) The claim is subsequently disallowed by an order of the industrial commission, its district or staff hearing officers, or by an order of the court.

(8) The claim is settled (medical and/or indemnity).

(F) Appeals regarding vocational rehabilitation plan closure shall be governed by the alternative dispute resolution process provided for in rule 4123-6-16 of the Administrative Code.

Effective: 11/05/2009
R.C. 119.032 review dates: 07/10/2009 and 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 4121.12 , 4121.121 , 4121.30 , 4121.31 , 4123.05
Rule Amplifies: 4121.61 , 4121.62 , 4121.63
Prior Effective Dates: 7/10/80, 12/7/82, 2/3/92, 1/1/01