January 13th, 2020

Injured Worker Vocational Rehabilitation Participation Streamlined

Workers Comp 0

Effective Oct. 7, 2019, the Ohio BWC made changes to vocational rehabilitation rules, policies, and procedures to simplify how an injured worker enters into a voc rehab program. The rules impacted are OAC 4123-18-03 and OAC 4123-18-04. The BWC and the managed care organizations (MCOs) will no longer complete multiple decisions about eligibility, feasibility, and living maintenance (LM).

The MCO still makes the initial determination about feasibility and sends this recommendation to the BWC. The BWC will then review the eligibility criteria. Based on their review and the MCO decision, the BWC will issue a single participation order either approving or denying an injured worker’s participation in voc rehab. Employers are to send appeals of the voc rehab participation order directly to the Ohio Industrial Commission (IC) for adjudication. Any party to the claim may submit an appeal within 14 days of receipt of the order through the IC’s online network or the Notice of Appeal (IC-12) form.

Eligibility criteria changes
The BWC also made changes to simplify the eligibility criteria for voc rehab. These changes remove the requirements that the injured worker:

Has received or been awarded a permanent partial award under Ohio Revised Code 4123.57(A).
Must have been determined to have reached maximum medical improvement (MMI). The MMI criteria was changed that the injured worker is not currently receiving compensation and has job restrictions dated not more than 180 days from the date of referral.
Was receiving LM wage loss not more than 90 days prior to the date of referral and has continuing job restrictions documented by the physician of record.
All other eligibility criteria still apply.

An injured worker will no longer be eligible for voc rehab services if they:

Successfully complete a comprehensive voc rehab plan and subsequently resign from employment.
Are terminated for cause and the resignation or termination is not due to the allowed conditions in the claim.

There are four circumstances when a BWC order addresses Living Maintenance (LM). They are:

Initial voc rehab participation decision.
Suspension of LM for more than 30 days for medical interruption.
Resuming LM.
Deductions from LM.



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