Chapter 4123-18 | Rehabilitation of Injured and Disabled Workers

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

• Effective: October 1, 2024
• Promulgated Under: 119.03

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

(A) The rules of this chapter are 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 will:

(1) Develop policies to implement vocational rehabilitation services.

(2) Assure that injured workers receive appropriate remain at work or return to work vocational rehabilitation services.

(3) Audit the MCOs' vocational rehabilitation management practices and provision of services.

Last updated October 1, 2024 at 9:14 AM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61 to 4121.69
Five Year Review Date: 10/1/2029
Prior Effective Dates: 1/1/2001

Rule 4123-18-02 | Goals of vocational rehabilitation.

• Effective: May 15, 2023
• Promulgated Under: 119.03

(A) The bureau will 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 necessitate the provision of 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 will 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.

Last updated July 31, 2024 at 1:53 PM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.62
Five Year Review Date: 7/9/2029
Prior Effective Dates: 12/7/1982, 3/1/2020

Rule 4123-18-03 | Guidelines for referral to and acceptance into vocational rehabilitation.

• Effective: October 1, 2024
• Promulgated Under: 119.03

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

(3) The MCO will 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 cannot 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 will issue an order approving or denying the injured worker's participation in vocational rehabilitation services.

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

(C) Eligibility for vocational rehabilitation services.

The following criteria apply to requests for vocational rehabilitation services:

(1) The injured worker has a claim that is:

(a) Allowed by an order of the bureau of workers' compensation or the industrial commission or of a hearing officer, 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 has a significant impediment to employment or the maintenance of employment as a result of the allowed conditions in the referred claim.

(3) The injured worker has 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 includes the date of referral. For purposes of this rule, payments made in lieu of temporary total compensation (e.g. salary continuation) will be treated the same as temporary total compensation;

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

(c) The injured worker is not currently receiving compensation but 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.

(4) The injured worker was not 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 the eligibility criteria of paragraph (C)(3) of this rule, an employee of a state agency or state university is eligible for rehabilitation services where the state agency or state university 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 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;

(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 will include a statement describing why the injured worker needs job retention services to maintain employment.

(F) Non-eligibility for vocational rehabilitation services.

An injured worker becomes ineligible for vocational rehabilitation services and such services will be terminated:

(1) After the effective date of a lump sum settlement (medical, indemnity, or both);

(2) When 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; 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 will 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 makes 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 does 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.

Last updated October 1, 2024 at 9:15 AM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.61
Amplifies: 4121.62, 4121.63
Five Year Review Date: 10/1/2029
Prior Effective Dates: 4/26/2004, 1/9/2015, 10/7/2019, 5/15/2023

Rule 4123-18-04 | Living maintenance allowance.

• Effective: October 1, 2024
• Promulgated Under: 119.03

The bureau will 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 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 or comprehensive vocational rehabilitation plan are considered pre-plan activities for which living maintenance is not paid.

If salary continuation is offered and continues to be offered by the employer of record during participation in an approved vocational rehabilitation plan assessment or comprehensive vocational rehabilitation plan, an injured worker may choose to receive either salary continuation or living maintenance unless temporary total or living maintenance has been paid in the claim. In those cases, the injured worker will be paid living maintenance. Whenever salary continuation is paid by the employer, it must be paid at the injured worker's regular (full) salary level.

(B) The bureau will 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 does 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 will assist the injured worker in obtaining the payment of other workers' compensation benefits to which the injured worker would otherwise be entitled, absent involvement in a vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan.

(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 will forward the request, along with any necessary information, to the bureau. The bureau will 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 worker's approval to participate in vocational rehabilitation services for up to a maximum of six months from the date of vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan file closure.

(b) Upon request of the injured worker and with medical documentation indicating the stabilization of the injured worker's medical condition, the injured worker's vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan will be reactivated and, absent any extenuating circumstances, appropriate rehabilitation services will begin as soon as possible.

(C) The bureau will not pay living maintenance 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 will 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 does 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. In the alternative, the inujured worker may endorse the wages or other remuneration over to the bureau, or the bureau may deduct the amount from future awards of compensation.

(F) Living maintenance payments will 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 or future awards of compensation may be appealed to the industrial commission pursuant to section 4123.511 of the Revised Code.

Last updated October 1, 2024 at 9:15 AM

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: 10/1/2029
Prior Effective Dates: 9/1/2014

Rule 4123-18-05 | Individualized written vocational rehabilitation plan.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(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

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: 10/1/2029
Prior Effective Dates: 7/10/1980, 2/3/1992

Rule 4123-18-08 | Payment for rehabilitation services and related expenses from the surplus fund.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(A) General principles.

(1) Vocational rehabilitation services and related expenses, as set forth in this rule, are 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 cannot 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 will 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 will not exceed three thousand dollars for each claim.

(2) The MCO will 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 does 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 three 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 a maximum of four 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.

Last updated October 1, 2024 at 9:15 AM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.62, 4121.66, 4123.53
Five Year Review Date: 10/1/2029
Prior Effective Dates: 12/7/1982, 3/16/1992, 1/1/2001

Rule 4123-18-09 | Vocational rehabilitation provider fee schedule.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(A) Pursuant to sections 4121.441 and 4121.61 of the Revised Code, the administrator hereby adopts the vocational rehabilitation provider fee schedule indicated in the appendix to this rule, developed with stakeholder input.

(B) Notwithstanding paragraph (A) of this rule, consistent with 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.

View Appendix

Last updated October 1, 2024 at 9:16 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: 10/1/2029
Prior Effective Dates: 8/1/2011, 10/1/2012, 10/1/2023

Rule 4123-18-11 | Incentive payments to employers who hire or retain injured workers who have completed a rehabilitation program.

• Effective: October 1, 2024
• Promulgated Under: 119.03

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 such employers from the surplus fund established by section 4123.34 of the Revised Code.

(A) The payments will be negotiated with the employer based upon a written agreement signed by the employer and the injured worker and approved by the bureau.

(B) The period(s) of such payment will 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 are 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 . However, a self-insuring employer is not eligible for payments under this rule in any claim in which a self-insuring employer is the employer of record.

Last updated October 1, 2024 at 9:16 AM

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: 10/1/2029
Prior Effective Dates: 11/5/2009, 1/9/2015, 5/15/2023

Rule 4123-18-14 | Injured workers suffering compensable injuries, occupational diseases or death while in an approved vocational rehabilitation plan.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(A) Claims for injury, occupational disease or death incurred in the course of and arising out of participation in an approved vocational rehabilitation plan and not in the course of and arising out of any employment, may be filed for compensation and benefits.

(B) The full or average weekly wage for the rehabilitation injury, occupational disease, or death claim will 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 will 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 are 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 of record in the claim through which the injured worker was receiving vocational rehabilitation services so long as the employer pays assessments into the surplus fund account for the payment of such compensation and benefits. If the employer is a self-insuring employer, these compensation and benefits are paid by the self-insuring employer directly as a part of a claim.

Last updated October 1, 2024 at 9:16 AM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.61, 4121.68
Five Year Review Date: 10/1/2029
Prior Effective Dates: 1/9/2015

Rule 4123-18-16 | Self-insuring employer's obligation to provide vocational rehabilitation services.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(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 will 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 will submit a copy of the approved vocational rehabilitation plan to the injured worker and the injured worker's representative.

(C) The bureau will inspect and review the quality and content of 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 will 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 will promptly pay living maintenance, wages in lieu of compensation, or salary continuation directly to the injured worker, in accordance with rule 4123-18-04 of the Administrative Code.

Last updated October 1, 2024 at 9:16 AM

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: 10/1/2029
Prior Effective Dates: 12/7/1982, 2/3/1992, 11/5/2009

Rule 4123-18-21 | Wage loss payments to injured workers who complete rehabilitation plans.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(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 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," "comparably paying work," and "present earnings" 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 will 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 may request living maintenance wage loss payments by submitting an application for living maintenance wage loss (on form RH-18 or equivalent) and medical documentation of their physical or psychiatric limitations, or both.

(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) If an 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 will 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 will 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) If the injured worker accepts employment 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. The bureau will 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 making such determination.

(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 present 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 are charged to the surplus fund established by section 4123.34 of the Revised Code.

(C) The bureau will calculate living maintenance wage loss payment amounts based upon the information submitted by the injured worker pursuant to paragraph (B)(4) of this rule. Payments will 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 will 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 will 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.

Last updated October 1, 2024 at 9:16 AM

Supplemental Information

Authorized By: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Amplifies: 4121.67
Five Year Review Date: 10/1/2029
Prior Effective Dates: 8/22/1986 (Emer.), 11/5/2009