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Policy Name:
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Living Maintenance Compensation
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Policy #:
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CP-12-03
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Code/Rule Reference:
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R.C. 4121.63;
OAC 4123-18-04
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Effective Date:
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10/07/19
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Approved:
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Ann M. Shannon, Chief of Claims Policy and Support
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Origin:
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Claims Policy
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Supersedes:
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Policy #CP-12-03, effective 09/08/16
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History:
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Previous versions of this policy are available upon
request
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Table of Contents
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
IV. POLICY
A. LM Compensation
B. Payment of LM During
Vocational Rehabilitation Plan Interruptions
C. Stopping and Resumption
of LM
V. PROCEDURE
A. Standard Claim File
Documentation
B. Establishing LM
C. Payment of LM
D. Salary Continuation in
Lieu of LM
E. Ongoing Management of
LM
F. Interruptions and
Stopping of LM
The purpose of this policy is to ensure that BWC
appropriately pays living maintenance (LM) to an injured worker (IW) who is
actively participating in a BWC-approved vocational rehabilitation plan.
This policy applies to claims services staff, specifically
disability management coordinators (DMC) and claim service specialists (CSS).
See Vocational
Rehabilitation Definitions.
IV. POLICY
A.
LM Compensation
1. LM and Temporary
Total Disability
a. It is the
policy of BWC to pay an IW LM compensation in place of temporary total (TT)
compensation when the IW is actively participating in a vocational
rehabilitation plan.
b. An IW
receiving LM is considered temporarily totally disabled and shall not receive
any other compensation while collecting LM, except for scheduled loss, as
provided in R.C. 4123.57(B).
c. BWC shall
allow the payment of salary continuation (SC) in lieu of LM in the same way BWC
allows the payment of SC in lieu of TT. For additional information, see the Salary
Continuation/Wages in Lieu of Temporary Total Compensation policy.
2. LM Payment
Timeframes
a. LM
payments shall begin on the date that the IW begins to actively participate in
an approved vocational rehabilitation assessment plan or comprehensive
vocational rehabilitation plan service; and
b. Shall not
exceed more than a total of six months, unless BWC determines that the IW shall
benefit from an extension.
3.
Rate of Payment of LM
a. LM
payments shall not exceed the amount the IW would receive if receiving TT,
including any offsets that would be applied to TT; or
b. Shall be
paid at 50% of the current SAWW if the amount determined is less than 50% of
the current statewide average weekly wage (SAWW).
c. See
the Temporary
Total Compensation policy for further information about offsets.
4. If an IW
is paid for activities while participating in a vocational rehabilitation plan,
the IW is required to endorse that paycheck over to BWC for deposit into the
State Insurance Fund. If the IW does not endorse the payment over to BWC:
a. Such
payment shall be deducted from LM; or
b. If the IW
is no longer receiving LM, as an overpayment from any future compensation that
the IW receives.
c. See
the Overpayment
of Compensation policy for more information.
1. It is the
policy of BWC to recognize three types of interruptions to an approved vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation plan service:
a. Non-medical
interruptions beyond the IW’s control;
b. Medical interruptions;
and
c. Interruptions
without good cause.
2. BWC may
suspend or stop LM in the event of these interruptions.
3. See
Section V.F of this procedure for
more information.
1.
LM shall not be paid for any period during which an IW has returned to
work while the IW’s vocational rehabilitation assessment plan or comprehensive
vocational rehabilitation plan remains open, other than as part of a gradual
return to work plan.
a. LM may
resume if the IW:
i. Subsequently
stops working while the plan is still open; and
ii. Resumes
services in the plan.
b. BWC shall
stop LM upon the closure of the IW’s vocational rehabilitation assessment plan
or comprehensive vocational rehabilitation plan, pursuant to OAC 4123-18-05(E).
2. The
suspension or stopping of LM shall not affect the IW’s right to any other
workers’ compensation or benefits to which he or she may be entitled.
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
2. Shall
follow any other specific instructions for claim notes and documentation
included in this procedure.
1. The DMC
shall evaluate an IW’s ability to participate in vocational rehabilitation,
pursuant to the Referrals,
Eligibility and Feasibility policy and procedure and issue an order
which addresses both an IW’s ability to participate in vocational
rehabilitation and the IW’s entitlement to the payment of LM.
2. When an
IW’s participation in vocational rehabilitation (including LM) has been
approved by order, by either BWC or the Industrial Commission (IC):
a. The DMC
shall:
i. Enter
the plan into the claims management system; and
ii. Create
a work item for the CSS to begin LM on the date the DMC identifies as the first
day the IW begins to actively participate in the plan.
b. The DMC
shall:
i. Consider
“actively participating” in an original plan as the first day the IW attends their
first approved plan service (e.g., work conditioning); and
ii. Not
consider “actively participating” in an original plan as any of the following:
a) The date
of referral to vocational rehabilitation services;
b) The date
the IW signs the plan; or
c) The date
of any pre-plan activities.
1. The CSS
shall issue payment of LM at the rates described in IV.A.3
of this policy, unless the IW has chosen to receive SC (see below for further guidance).
2. The CSS
shall apply the same offsets to LM as would be applied to TT, pursuant to the Temporary
Total Compensation policy and procedure.
1. If the
employer of record offers SC, the IW may choose to receive SC unless the IW has
already received TT or LM.
2. The DMC or
CSS shall contact the IW to determine if the IW chooses to receive SC or LM
during participation in the plan.
3. The DMC
shall develop and manage the plan with SC in the same manner as a plan in which
LM is provided.
4. After the
plan is completed, the DMC and CSS shall assist an IW that has received SC in
obtaining other workers’ compensation benefits the IW may be eligible to
receive (e.g., living maintenance wage loss compensation).
5. For
additional information, see the Salary
Continuation/Wages in Lieu of Temporary Total Compensation policy.
1. The DMC
shall provide ongoing LM-qualifying dates to the CSS prior to the end of the
current benefit plan.
2. When an IW
is paid for activities while participating in a plan service (e.g., work
adjustment):
a. The DMC
shall:
i. Require
the IW to endorse the paycheck over to BWC; and
ii. Forward
the endorsed check for deposit to:
Ohio Bureau of
Workers Compensation
P.O. Box 89492
Cleveland, OH
44101-6492
iii. If
overnight, express, or signature-required delivery is needed, forward to:
Attn: Lockbox
89492
4910 Tiedeman
Road
Cleveland, OH
44144
b. If the IW
does not forward such payment over to BWC:
i. The
DMC shall notify the CSS of the payment; and
ii. The
CSS shall deduct the payment from LM or, if the IW is no longer receiving LM,
as an overpayment from any future compensation that the IW receives (see the Overpayment
of Compensation policy for more information).
F. Interruptions
and Stopping of LM
1. Non-Medical
Interruptions Beyond the IW’s Control
a. The DMC
may continue to authorize LM up to a total of seven calendar days when an IW is
unable to actively participate in the plan due to non-medical circumstances
beyond the IW’s control (e.g., death in the family).
b. If the
non-medical interruption extends beyond a total of seven calendar days, the
managed care organization (MCO) and DMC shall consider and decide if the plan should
be closed and LM stopped.
2. Medical
Interruptions
a. The DMC
shall continue to authorize LM for a maximum of 30 calendar days in an open
plan when an IW is unable to actively participate in the plan due to medical
instability.
b. The DMC
shall notify the CSS to suspend payment of LM in an open plan when the IW
continues to be unable to actively participate in the plan due to medical
instability and this timeframe will exceed the 30 calendar days referenced
above.
c. The
DMC shall issue an order suspending LM, which includes:
i. The
effective date of the suspension;
ii. The
reason for the suspension;
iii. What
conditions are required to resume LM; and
iv. The IW’s right
to compensation or benefits for which the IW may otherwise qualify.
d. During a
medical interruption, the CSS shall assist the IW in obtaining other workers’
compensation benefits the IW may be eligible to receive.
e. When an IW
resumes active participation in a plan following a medical interruption, the
DMC shall:
i. Issue
an order restarting LM; and
ii. Notify
the CSS to resume payment of LM.
3. Interruptions
Without Good Cause
a. When the
DMC is notified that the IW, without good cause, has failed to participate in their
plan, the DMC shall review the allegation, and if appropriate, notify the CSS
to deduct one-seventh of the weekly amount of LM for each full day the IW
failed to participate in their plan; and
b. Issue an
order, which includes:
i. That
a deduction is being made for identified dates;
ii. Why
the deduction is being made; and
iii. That the
deduction does not affect the IW’s right to compensation or benefits for which the
IW may otherwise qualify.
4. Stopping
LM
a. The DMC
shall advise the CSS to stop payment of LM upon the earlier of:
i. The
IW returning to work, other than as part of a gradual return to work plan; or
ii. When
the IW’s plan has been closed.
b. When the
CSS receives notification from the DMC to stop payment of LM, the CSS shall
assist the IW in obtaining other workers’ compensation benefits the IW may be
eligible to receive.