Policy
Name:
|
Living
Maintenance Compensation
|
Policy
#:
|
CP-12-03
|
Code/Rule
Reference:
|
R.C. 4121.63; R.C. 4123.57(B); O.A.C 4123-18-04; O.A.C. 4123-18-05(E)
|
Effective
Date:
|
02/04/2025
|
Approved:
|
Shawn
Crosby, Chief Operations Officer
|
Origin:
|
Claims
Policy
|
Supersedes:
|
Policy
#CP-12-03, effective 10/07/2019
|
History:
|
Previous
versions of this policy are available upon request
|
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. General Claim
Note and Documentation Requirements
B. Establishing LM
C. Payment of LM
D. SC 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 compensation (LM) to an injured worker (IW) who is actively
participating in a BWC-approved vocational rehabilitation plan.
This
policy applies to BWC Claims Services staff, specifically disability management
coordinators (DMC) and claims service specialists (CSS).
See
Vocational
Rehabilitation Definitions.
IV.
POLICY
1. LM and
Temporary Total Disability
a. It is BWC’s
policy to pay an IW LM compensation in place of temporary total compensation
(TT) when the IW is actively participating in a vocational rehabilitation plan.
b. An IW receiving
LM is considered temporarily totally disabled and will not receive any other
compensation while collecting LM, except for scheduled loss, as provided in R.C.
4123.57(B).
c. BWC will 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 will
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. Must not exceed
more than a total of six months, unless BWC determines that the IW will benefit
from an extension.
3. Rate of Payment
of LM
a. LM payments will
not exceed the amount the IW would receive if receiving TT, including any
offsets that would be applied to TT; or
b. Will be paid at
50% of the current statewide average weekly wage (SAWW) if the amount
determined is less than 50% of the current 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, they
are 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 will
be deducted from LM; or
b. Deducted as an
overpayment from any future compensation that the IW receives if the IW is no
longer receiving LM.
c. See the Overpayment of
Compensation
policy for more information.
1. It is BWC’s
policy 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 will 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 active
services in the plan.
b. BWC will 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 will not affect the IW’s right to any other workers’
compensation or benefits to which they may be entitled.
1. BWC staff will refer
to the Standard Claim
File Documentation and Altered Documents policy and procedure for claim
note and documentation requirements; and
2. Must follow any
other specific instructions for claim notes and documentation included in this
procedure.
1. The DMC must evaluate
an IW’s ability to participate in vocational rehabilitation, pursuant to the Referrals,
Eligibility, and Feasibility policy and procedure, and issue an
order that addresses both:
a. The IW’s ability
to participate in vocational rehabilitation; and
b. 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 Ohio Industrial Commission (IC):
a. The DMC must:
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 must:
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 will issue
payment of LM at the rates described in Section IV.A.3 of this policy, unless the
IW has chosen to receive SC (see Section V.D below for further guidance).
2. The CSS will 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 or LM unless the IW has
already received TT or LM in the claim, in which case the IW will receive LM.
2. The DMC or CSS must
contact the IW to determine if the IW chooses to receive SC or LM during
participation in the plan.
3. The DMC will 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 will 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.
1. The DMC must 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 must instruct
the IW to:
i.
Submit
a personal check, cashier’s check, or money order for the net amount of their
paycheck in cases where the IW receives a direct deposit; or
ii. Endorse the
paycheck over to BWC in cases where the IW receives a paper paycheck; and
iii. In either case:
a) Include the
claim number and contact information with the check; and
b) Forward the
check for deposit to:
BWC Cash
Control
PO Box 15487
Columbus, OH
43215-0487
b. If the IW does
not forward such payment to BWC and is receiving LM for that period:
i.
The
DMC will issue an order declaring the deduction;
ii. The DMC must notify
the CSS of the payment; and
iii. The CSS will deduct
the payment from LM if the IW is receiving LM for that period.
c. If the IW does
not forward such payment to BWC and is no longer receiving LM for that period:
i.
The
DMC will notify the CSS;
ii. The CSS will
issue an order declaring the overpayment; and
iii. Process as an
overpayment from any future compensation that the IW receives once the order is
final (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 will consider and decide if the plan should
be closed, and LM stopped.
2. Medical
Interruptions
a. The DMC will 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 will 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 must 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 must 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 must:
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 has failed to participate in their plan without good
cause, the DMC must review the allegation. If, after review, the DMC finds that
the IW did, in fact, fail to participate in their plan without good cause and:
i.
The
IW is still receiving LM for that period:
a) The DMC will
issue an order declaring the deduction;
b) The DMC must
notify the CSS of the deduction; and
c) The CSS will
deduct one-seventh of the weekly amount of LM for each full day the IW failed
to participate in their plan.
ii. The IW is no
longer receiving LM for that period:
a) The DMC will
notify the CSS;
b) The CSS will
issue an order declaring the overpayment; and
c) The CSS will
declare the IW overpaid by one-seventh of the weekly amount of LM for each full
day the IW failed to participate in their plan as an overpayment from any
future compensation that the IW receives (see the Overpayment of
Compensation
policy
for more information).
b. In both cases
the order must include:
i.
That
a deduction/overpayment is being made for the identified dates;
ii. Why the
deduction/overpayment is being made; and
iii. That the
deduction/overpayment does not affect the IW’s right to compensation or
benefits for which the IW may otherwise qualify.
4. Stopping LM
a. The DMC must notify
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 must assist
the IW in obtaining other workers’ compensation benefits the IW may be eligible
to receive.