Skip to main content
Back To Top Top Back To Top
This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 4123-18 | Rehabilitation of Injured and Disabled Workers

 
 
 
Rule
Rule 4123-18-01 | Provision of vocational rehabilitation services.
 

Managed care organizations (MCOs) shall provide vocational rehabilitation management to injured workers under the health partnership program (HPP).

(A) The rules of this chapter shall be applicable to the vocational rehabilitation of injured workers, whether the vocational rehabilitation services are administered by the bureau and managed by an MCO, or administered by a self-insuring employer . Self-insuring employers shall adhere to these rules to ensure that vocational rehabilitation services provided to their injured workers are equal to or greater than the services defined in this chapter.

(B) 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 MCOs' vocational rehabilitation management practices and provision of services.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61 to 4121.69
Five Year Review Date: 10/1/2024
Rule 4123-18-02 | Goals of vocational rehabilitation.
 

(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 this is not possible;

(4) To assist the injured worker in finding employment in any industry.

The hierarchy of return to work objectives outlined in this paragraph may require appropriate skill enhancement and/or remedial or short term training to aid an injured worker in successfully returning to work at any of the steps.

(C) The bureau shall ensure that an injured worker who wishes to become self-employed is informed of the opportunities available through the opportunities for Ohioans with disabilities agency, the federal small business administration office, the local Ohio small business development center, the Ohio department of development, or other resources.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.62
Five Year Review Date: 10/1/2024
Prior Effective Dates: 1/9/2015
Rule 4123-18-03 | Guidelines for referral to and acceptance into vocational rehabilitation.
 

(A) Scope of vocational rehabilitation.

(1) Vocational rehabilitation is the process of restoring the vocational functioning of a worker who experiences a work related injury and who voluntarily agrees to participate in vocational rehabilitation. Vocational rehabilitation services are focused on return to work and are not reimbursable from the surplus fund if 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) Participation in vocational rehabilitation services.

(1) Anyone can refer an injured worker for vocational rehabilitation services.

(2) The bureau shall determine the injured worker's eligibility under paragraph (C) of this rule for vocational rehabilitation services.

(3) The MCO shall make a recommendation to the bureau regarding the injured worker's feasibility under paragraph (G) of this rule for vocational rehabilitation services.

(4) An injured worker shall not be able to participate in a vocational rehabilitation plan or receive vocational rehabilitation services until the injured worker has been determined to be both eligible and feasible for vocational rehabilitation services. The bureau shall issue an order approving or denying the injured worker's participation in vocational rehabilitation services.

(5) Referrals for vocational rehabilitation in inactive claims shall be processed in accordance with rule 4123-3-15 of the Administrative Code.

(C) Eligibility for vocational rehabilitation services.

To be eligible for rehabilitation services the injured worker must meet the following criteria:

(1) The injured worker must have a claim that is

(a) Allowed by an order of the bureau of workers' compensation or the industrial commission or of its hearing officers with eight or more days of lost time due to a work related injury; or

(b) Certified by a self-insuring employer.

(2) The injured worker must have a significant impediment to employment or the maintenance of employment as a direct result of the allowed conditions in the referred claim.

(3) The injured worker must have at least one of the following present in the referred claim:

(a) The injured worker is receiving or has been awarded temporary total, non-working wage loss, or permanent total compensation for a period of time that must include the date of referral. For purposes of this rule, payments made in lieu of temporary total compensation (e.g. salary continuation) shall be treated the same as temporary total compensation; or

(b) The injured worker was granted a scheduled loss award under division (B) of section 4123.57 of the Revised Code; or

(c) The injured worker is not currently receiving compensation and has job restrictions in the claim documented by the physician of record and dated not more than one hundred eighty days prior to the date of referral; or

(d) The injured worker is receiving job retention services to maintain employment or satisfies the criteria set forth in paragraph (E) of this rule on the date of referral; or

(e) The injured worker sustained a catastrophic injury claim and a vocational goal can be established

(4) The injured worker must not be working on the date of referral, with the exception of referral for job retention services.

(D) Eligibility for rehabilitation services for an employee of a state agency or state university employer.

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 state agency or state university has certified the claim and the employee and employer agree upon a program of rehabilitation services.

(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 temporary total compensation or salary continuation from an allowed claim with eight or more days of lost time due to a work related injury; and

(b) The physician of record provides a written statement in office notes or correspondence indicating that the injured worker has work limitations related to the allowed conditions in the claim that negatively impact the injured workers' ability to maintain the injured worker's employment; and

(c) The injured worker's employer describes the specific job task problems the injured worker is experiencing to the MCO and the MCO documents these problems in the claim. The MCO shall include a statement describing why the injured worker needs job retention services to maintain employment.

(F) Non-eligibility for vocational rehabilitation services.

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 (medical and/or indemnity); or

(2) If 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; or

(3) When the injured worker, after successfully completing a comprehensive vocational rehabilitation plan, subsequently resigns from employment or is terminated for cause and the resignation or termination is not due to the allowed conditions in the claim.

(G) Determination of feasibility for vocational rehabilitation services.

(1) Feasibility for vocational rehabilitation services means, based upon all available information:

(a) The injured worker is willing to participate in vocational rehabilitation services;

(b) The injured worker is able to participate in vocational rehabilitation services; and

(c) There is a reasonable probability that the injured worker will benefit from vocational rehabilitation services and return to work as a result of the services.

(2) "All available information" means records, documents, written and oral statements, and any and all medical, psychological, vocational, social, and historical data, of any kind whatsoever, developed in the claim through which vocational rehabilitation is sought or otherwise, that is relevant to the determination of an injured worker's feasibility for vocational rehabilitation services.

(H) Appeal process.

Facts supporting a decision concerning either the acceptance or denial of an injured worker into vocational rehabilitation shall be documented in the bureau's order approving or denying the injured worker's participation in vocational rehabilitation services. The bureau's order approving or denying participation in vocational rehabilitation services may be appealed to the industrial commission pursuant to section 4123.511 of the Revised Code.

(I) Injured worker's right to compensation or benefits.

(1) Approval of an injured worker to participate in vocational rehabilitation services shall make the injured worker eligible to receive living maintenance payments in accordance with section 4121.63 of the Revised Code and rule 4123-18-04 of the Administrative Code.

(2) Denial of an injured worker to participate in vocational rehabilitation services will shall 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.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.61
Amplifies: 4121.62, 4121.63
Five Year Review Date: 10/1/2024
Prior Effective Dates: 1/9/2015
Rule 4123-18-04 | Living maintenance allowance.
 

The bureau shall make living maintenance payments from the surplus fund to an injured worker approved to participate in vocational rehabilitation pursuant to rule 4123-18-03 of the Administrative Code, in accordance with the criteria set forth in this rule. Living maintenance payments are compensation under Chapters 4121. and 4123. of the Revised Code.

(A) Living maintenance payments shall begin on the date that the injured worker actually begins to participate in an approved vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan as defined in rule 4123-18-05 of the Administrative Code. Living maintenance is not payable on the date of referral for vocational rehabilitation services, nor the date the injured worker signed the rehabilitation agreement. Activities performed prior to the injured worker's active participation in the approved vocational rehabilitation assessment plan and/or comprehensive vocational rehabilitation plan are considered pre-plan activities for which living maintenance is not paid.

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 an approved vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan. 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 their vocational rehabilitation assessment plan or comprehensive 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 assessment plan or comprehensive vocational rehabilitation plan upon the cessation of living maintenance payments.

(2) Medical hold and eligibility.

The injured worker, the employer, or their representatives may make a request to the MCO for a medical hold. The MCO shall forward the request, along with any necessary information, to the bureau. The bureau shall determine whether, based on adequate medical documentation, the injured worker's vocational rehabilitation plan should be closed with a medical hold.

(a) A medical hold will retain the injured workers eligibility for vocational rehabilitation services for up to a maximum of two years from the date of vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan file closure. The bureau and the MCO shall thereafter monitor the injured worker's medical status with the attending physician.

(b) When the bureau becomes aware of the re-stabilization of the injured worker's medical condition, the injured worker's vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan shall be reactivated and, absent any extenuating circumstances, appropriate rehabilitation services shall begin as soon as possible.

(C) The bureau shall not pay living maintenance benefits for any period during which an injured worker has returned to work while the injured worker's vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan remains open, other than as part of a gradual return to work plan.

However, the bureau may resume living maintenance payments if the injured worker subsequently stops working while the vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan is still open and the injured worker resumes services in said plan.

(D) The bureau shall terminate living maintenance payments upon the closure of the injured worker's vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan pursuant to paragraph (F) of rule 4123-18-05 of the Administrative Code.

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.

(E) 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 the injured worker fails, without good cause, to participate in their approved vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan.

(2) Any wages or other remuneration received by the injured worker while participating in an approved vocational rehabilitation assessment plan or comprehensive 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.

(F) Living maintenance payments shall not be paid by the bureau for a period or periods exceeding six months in the aggregate, unless the bureau determines that the injured worker will benefit from an extension of vocational rehabilitation services.

(G) Bureau orders regarding suspension of, or deduction from an injured worker's living maintenance payments may be appealed to the industrial commission pursuant to section 4123.511 of the Revised Code.

Supplemental Information

Authorized By: 4121.12 , 4121.121, 4121.30 , 4121.31 , 4123.05
Amplifies: 4121.61 , 4121.62, 4121.63, 4121.66
Five Year Review Date: 10/1/2024
Prior Effective Dates: 12/7/1982, 11/5/2009
Rule 4123-18-05 | Individualized written vocational rehabilitation plan.
 

(A) When surplus funds are used, the managed care organization (MCO) shall ensure that a vocational rehabilitation case management provider contacts the injured worker and prepares a written vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan for the injured worker's acknowledgment 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. A vocational rehabilitation assessment plan may be prepared prior to the individualized written comprehensive vocational rehabilitation plan. The assessment plan may be up to four weeks in length, during which time the injured worker will be actively engaged in career exploration and assessment activities.

(B) Each written vocational rehabilitation assessment plan shall include, at a minimum, the following information:

(1) The evaluation questions to be answered by the assessment;

(2) The types of services required to complete the assessment, including:

(a) The estimated costs for the services;

(b) The estimated length of time required to complete the services;

(c) The provider for the services;

(3) The estimated length of time required to complete the assessment.

(C) Each written comprehensive 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 following the hierarchy of return to work objectives set forth in rule 4123-18-02 of the Administrative Code.

(6) The method of evaluating services.

(D) Each written job retention plan shall include the following information:

(1) The problems to be addressed by the plan;

(2) The specific services necessary for the injured worker to maintain current employment;

(3) The estimated costs for the services;

(4) The estimated length of time required to complete the services;

(5) The provider for the services.

(E) The MCO shall oversee the development and implementation of the vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan by the assigned vocational rehabilitation case management provider. Once a comprehensive vocational rehabilitation plan is initiated, the MCO shall approve a change in the assigned vocational rehabilitation case management provider only for extraordinary circumstances.

(F) The MCO, in conjunction with the bureau, shall close an injured worker's vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan for the following reasons:

(1) The injured worker has completed a vocational rehabilitation assessment plan and it is determined further vocational rehabilitation services are not needed;

(2) The injured worker has failed to fulfill the responsibilities outlined in the vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan;

(3) The injured worker is unable to attain the goals of the vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan;

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

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

(10) The injured worker has completed a job retention plan;

(11) The injured worker is determined to be no longer feasible for vocational rehabilitation services as defined in rule 4123-18-03 of the Administrative Code.

(G) 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.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30 , 4121.31, 4123.05
Amplifies: 4121.61, 4121.62, 4121.63
Five Year Review Date: 10/1/2024
Prior Effective Dates: 7/10/1980, 1/1/2001
Rule 4123-18-06 | Transitional work programs.
 

(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 4123-6-02.2 of the Administrative Code;

(ii) An occupational therapist as provided in paragraph (C)(18) of rule 4123-6-02.2 of the Administrative Code; or

(iii) A physical therapist as provided in paragraph (C)(23) of rule 4123-6-02.2 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 4123-6-02.2 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.

Supplemental Information

Authorized By:
Amplifies:
Five Year Review Date:
Rule 4123-18-08 | Payment for rehabilitation services and related expenses from the surplus fund.
 

(A) General principles.

(1) Vocational rehabilitation services and related expenses, as set forth in this rule, 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 assessment plan, comprehensive vocational rehabilitation plan, or job retention plan.

(2) Vocational rehabilitation services can include but must not be solely directed toward medical management and allied medical treatment of the injured worker in an approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan.

(3) 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 physician of record in the claim, by a specialist to whom the injured worker has been referred by the physician of record, the injured worker's employer, the managed care organization (MCO), or the bureau of workers' compensation, and which extends into the calendar period of the injured worker's approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention 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 approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan, including costs for necessary medical, psychological, and vocational evaluations, 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 as part of the approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan.

(B) Nonallowed conditions.

(1) The MCO may authorize payment for treatment of a condition which is unrelated to the work related injury or occupational disease as long as it is clearly evident that the unrelated condition is impeding vocational rehabilitation or is a barrier to returning to work. The payment for treatment of these conditions shall not exceed two thousand dollars for each claim.

(2) The MCO shall fully document the rationale for these expenditures in both the approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention 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 claim.

(4) As soon as the unrelated condition is no longer affecting the work related injury or occupational disease, or payment for treatment of the condition has reached the two thousand dollar maximum, payment for any subsequent treatment is the responsibility of the injured worker.

(C) Expenses incurred by injured workers.

The following expenses may be paid when authorized as part of an approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan.

(1) Travel expenses may be reimbursed consistent with the provisions of paragraph (B) of rule 4123-6-40 of the Administrative Code.

(2) Reasonable and necessary relocation expenses may be authorized up to three thousand dollars per injured worker.

(a) Relocation expenses may be approved when, as determined by the MCO, the following criteria are met:

(i) Job opportunities for which the injured worker is qualified do not exist within a reasonable commute on a daily basis, and

(ii) The injured worker has secured a job at the new location.

(b) Relocation expenses may include temporary lodging for up to sixty days.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30 , 4121.31, 4123.05
Amplifies: 4121.61, 4121.62, 4123.53, 4123.66
Five Year Review Date: 10/1/2024
Prior Effective Dates: 3/16/1992
Rule 4123-18-09 | Vocational rehabilitation provider fee schedule.
 

(A) Pursuant to sections 4121.441 and 4121.61 of the Revised Code, the bureau shall adopt rules for the provision of vocational rehabilitation services to injured workers. The administrator hereby adopts the vocational rehabilitation provider fee schedule indicated in appendix A to this rule, developed with stakeholder input, effective October 1, 2021.

(B) Notwithstanding the provisions of paragraph (A) of this rule, consistent with the provisions of division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agreements with medical, professional and pharmacy providers.

Last updated October 1, 2021 at 8:30 AM

Supplemental Information

Authorized By: 4121.12, 4121.30, 4121.31, 4123.05
Amplifies: 4121.44, 4121.441, 4121.61, 4121.62, 4123.53, 4123.66
Five Year Review Date: 10/1/2024
Prior Effective Dates: 2/15/2010, 10/1/2020
Rule 4123-18-11 | Incentive payments to employers who hire or retain injured workers who have completed a rehabilitation program.
 

The bureau, as a means of encouraging employers to retain, rehire, or hire injured workers who have successfully completed a prescribed rehabilitation program, 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 and the injured worker and approved by the bureau. The basis for negotiation shall be:

(1) The nature of the disability of the injured worker as determined by the bureau;

(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 the bureau determines that the injured worker would benefit from an extension of payments.

(C) Payments under this rule shall be made directly to the employer on a monthly basis, provided the employer is a complying employer in the state in which it is subject to workers' compensation coverage requirements. . However, a self-insuring employer shall not be eligible for payments under this rule in any claim in which a self-insuring employer is the employer of record.

(D) 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 injured worker within Ohio.

(E) The bureau may make incentive payments from the surplus fund to an employer where the employer offers the injured worker paid transitional work activities at the employer's worksite and the injured worker has completed required medical rehabilitation services and has successfully satisfied vocational rehabilitation readiness requirements. An injured worker meets vocational rehabilitation readiness requirements when the injured worker has been officially referred for vocational rehabilitation, is medically stable, and has a significant impediment to a return to full employment.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.62, 4121.65, 4121.66, 4121.67, 4123.35
Five Year Review Date: 10/1/2024
Prior Effective Dates: 1/9/2015
Rule 4123-18-14 | Injured workers suffering compensable injuries, occupational diseases or death while in an approved vocational rehabilitation plan.
 

(A) Claims for injury, occupational disease or death incurred in the course of and arising out of participation in an approved vocational rehabilitation plan may be filed for compensation and benefits.

(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 account established by section 4123.34 of the Revised Code, and not charged through the state insurance fund to the employer against which the claim was allowed so long as the employer pays assessments into the surplus fund account for the payment of such compensation and benefits. If an employer is a self-insuring employer, the self-insuring employer shall pay these compensation and benefits directly as a part of a claim.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.68
Five Year Review Date: 10/1/2024
Prior Effective Dates: 7/10/1980
Rule 4123-18-15 | Annual reports.
 

(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.

Supplemental Information

Authorized By:
Amplifies:
Five Year Review Date:
Prior Effective Dates: 7/10/1980, 2/3/1992
Rule 4123-18-16 | Self-insuring employer's obligation to provide vocational rehabilitation services.
 

(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 administered by the bureau and managed by the managed care organizations (MCOs).

(B) Upon referral, a self-insuring employer shall determine whether the injured worker is eligible and feasible for vocational rehabilitation services 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 services, the self-insuring employer shall provide vocational rehabilitation case management services equal to or greater in quality and content than the services administered by the bureau and managed by the MCOs, utilizing the services of a provider who meets the minimum credentialing criteria set forth in rule 4123-6-02.2 of the Administrative Code. The self-insuring employer shall submit a copy of the approved vocational rehabilitation plan to the injured worker and the injured worker's representative.

(C) The bureau shall inspect and review the quality and content of all authorized self-insuring employers' vocational rehabilitation services in order to determine whether or not such services are equal to or greater in quality and content than the services administered by the bureau and managed by the MCOs. Such inspections and reviews shall be conducted upon receipt of evidence indicating that a self-insuring employer's vocational rehabilitation services are of a lesser quality than the services administered by the bureau and managed by the MCOs.

(D) The bureau may direct complaints of sub-standard vocational rehabilitation programs to the bureau's self-insured department for review.

(E) 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 of rule 4123-18-04 of the Administrative Code.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4123.05
Amplifies: 4121.61, 4121.65, 4121.66, 4123.35
Five Year Review Date: 10/1/2024
Prior Effective Dates: 11/5/2009
Rule 4123-18-21 | Wage loss payments to injured workers who complete rehabilitation plans.
 

(A) For purposes of this rule:

(1) "Successful return to work" as a result of an approved vocational rehabilitation plan means that the injured worker has obtained employment no later than sixty days from the date of closure of the injured worker's approved comprehensive vocational rehabilitation plan or has retained employment following the closure of the injured worker's job retention plan, and the employment:

(a) Is within the physical and/or psychiatric limitations caused by the impairments resulting from the allowed conditions in the claim in which the injured worker completed the comprehensive vocational rehabilitation plan or job retention plan; and

(b) Is reasonable in comparison with the return to work goals of the comprehensive vocational rehabilitation plan or job retention plan completed by the injured worker.

(2) "Suitable employment" and "comparably paying work" shall have the same meaning as in rule 4125-1-01 of the Administrative Code.

(B) 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 approved comprehensive vocational rehabilitation plan or job retention plan, successfully return to work as defined in paragraph (A)(1) of this rule, and experience a wage loss while employed as a consequence of the physical and/or psychiatric limitation caused by the impairments resulting from the allowed conditions in the claim.

(1) An injured worker requesting living maintenance wage loss payments shall submit an application for living maintenance wage loss (on form RH-18 or equivalent) and medical documentation of their physical and/or psychiatric limitations.

(2) Subsequent applications for living maintenance wage loss payments must be submitted by the injured worker before the specified end date of the documented restrictions or every six months, whichever occurs first.

(a) If the physical or psychiatric limitations are temporary, medical documentation regarding the ongoing status of the restrictions must be submitted with any subsequent application for living maintenance wage loss payments.

(b) If the physical or psychiatric limitations are permanent, the bureau may request supplemental medical documentation be submitted with subsequent applications.

(3) An injured worker requesting living maintenance 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. If the injured worker voluntarily limits their income by choosing to work fewer hours or by accepting a job which does not constitute suitable employment which is comparably paying work, the injured worker's living maintenance wage loss benefits shall be calculated as 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 the injured worker would have earned had the injured worker not voluntarily limited their income.

(a) In determining whether an injured worker has voluntarily limited their income, the bureau may review all relevant factors set forth in rule 4125-1-01 of the Administrative Code in determining whether the injured worker has returned to suitable employment which is comparably paying work.

(b) An injured worker who wishes to change jobs after the initial receipt of living maintenance wage loss payments must notify the bureau. The bureau shall review the criteria set forth in paragraph (A)(3)(a) of this rule to ensure that the job the injured worker wishes to change to constitutes suitable employment which is comparably paying work.

(4) In the event the injured worker accepts employment that is below the reasonable expectations of the return to work goals of the vocational rehabilitation plan, or if the injured worker can reasonably be expected to obtain different employment for which earnings are more comparable to those prior to the injury, the injured worker may be required to make a good faith effort to search for suitable employment which is comparably paying work. In determining whether a good faith effort to search for suitable employment is required, the bureau shall consider factors such as the goals of the vocational rehabilitation plan, the labor market, the skills and work history of the injured worker, and any other factors that would assist in determining whether a good faith job search should be required.

(5) To receive living maintenance wage loss payments under this rule after approval of these benefits by the bureau, an injured worker must provide proof of earnings at least every four weeks, or on a quarterly basis if the injured worker has a substantial variation in income, in the form of pay stubs, payroll reports from the injured worker's current employer, or a wage statement on form RH-94(A) or equivalent.

(6) Living maintenance wage loss payments shall be charged to the surplus fund established by section 4123.34 of the Revised Code.

(C) The bureau shall be responsible for calculating living maintenance wage loss payment amounts based upon the information submitted by the injured worker pursuant to paragraph (B)(4) of this rule. 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.

(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.

(E) Facts supporting a decision concerning the eligibility or non-eligibility of an injured worker for living maintenance wage loss shall be documented in the bureau's order approving or denying the living maintenance wage loss. The bureau's order approving or denying living maintenance wage loss may be appealed to the industrial commission pursuant to section 4123.511 of the Revised Code.

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.67
Five Year Review Date: 10/1/2024
Prior Effective Dates: 1/10/1987, 2/3/1992
Rule 4123-18-22 | Fees for use of services of the bureau rehabilitation center.
 

(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.

Supplemental Information

Authorized By:
Amplifies:
Five Year Review Date:
Prior Effective Dates: 10/11/1994