OhioBWC - Basics: (Policy library) - File

Policy Name:

Living Maintenance Compensation

Policy #:

CP-12-03

Code/Rule Reference:

R.C. 4121.63; OAC 4123-18-04 

Effective Date:

10/07/19

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy #CP-12-03, effective 09/08/16

History:

Revised 10/07/19, 09/08/16; New 04/11/14

 


 

Living Maintenance Compensation 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

 

 


 

I. POLICY PURPOSE

 

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.

 

II. APPLICABILITY

 

This policy applies to claims services staff, specifically disability management coordinators (DMC) and claim service specialists (CSS).

 

III. DEFINITIONS

 

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 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.

 

B.    Payment of LM During Vocational Rehabilitation Plan Interruptions

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.

 

C.   Stopping and Resumption of LM

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.

 

V. PROCEDURE

 

A.    Standard Claim File Documentation

1.    BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note requirements; and

2.    Shall follow any other specific instructions for claim notes included in this procedure.

 

B.    Establishing LM

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.

 

C.   Payment of LM

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.

 

D.    Salary Continuation in Lieu of LM

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 policy.

 

E.    Ongoing Management of LM

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.