Rule 4123-18-05 | Individualized written vocational rehabilitation plan.
(A) When vocational rehabilitation services are managed by a managed care organization (MCO), the MCO will 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 will, 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 will include, at a minimum, the following information:
(1) The evaluation questions to be answered by the assessment;
(2) The types of services needed to complete the assessment, including:
(a) The estimated costs for the services;
(b) The estimated length of time needed to complete the services;
(c) The provider for the services;
(3) The estimated length of time needed to complete the assessment.
(C) Each written comprehensive vocational rehabilitation plan will 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 needed;
(3) The estimated costs;
(4) The estimated length of time needed 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 will 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 will 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 needed to complete the services;
(5) The provider for the services.
(E) The MCO will 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 will approve a change in the assigned vocational rehabilitation case management provider only for extraordinary circumstances.
(F) The MCO, in conjunction with the bureau, will 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, a district or staff hearing officer, or by an order of the court;
(8) The claim is settled (medical, indemnity, or both);
(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 are governed by the alternative dispute resolution process provided for in rule 4123-6-16 of the Administrative Code.
Last updated October 1, 2024 at 9:15 AM
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