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OhioBWC - Basics: (Policy library) - File

Policy Name:

Living Maintenance Compensation

Policy #:

CP-12-03

Code/Rule Reference:

R.C. 4121.63; O.A.C. 4123-18-04 

Effective Date:

09/08/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance (Signature on file)

Origin:

Claims Policy

Supersedes:

Policy #CP-12-03, effective 04/11/14

History:

New 04/11/14

 

 

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 Field Operations staff, specifically disability management coordinators and claim service specialists.

 

III. DEFINITIONS

 

None

 

IV. POLICY

 

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.   LM payments will begin on the date that the IW begins to actively participate in an approved vocational rehabilitation plan service (e.g., work conditioning).

 

D.   LM payments shall not exceed the amount the IW would receive if receiving TT, but shall not be less than fifty-percent (50%) of the current statewide average weekly wage.

 

E.    Any offset that would be applied to TT shall also be applied to LM. See the Temporary Total Compensation policy for further information about offsets.

 

F.    If an IW is paid wages 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 wages over to BWC, such wages will be deducted 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.

 

G.   An IW will not receive more than a total of six months of LM, unless BWC determines that the IW will benefit by an extension.

 

H.   Salary Continuation in Lieu of LM

If the employer of record offers salary continuation, an IW with a lost time claim may choose to receive either salary continuation or LM during active participation in the vocational rehabilitation plan, unless the IW has already received TT or LM in the claim. If the IW has already received TT or LM in the claim, the IW will only receive LM. See the Salary Continuation policy for more information.

 

I.      Interruptions and Termination of LM

1.    Non-Medical Interruptions Beyond the IW’s Control

a.    LM may continue up to a total of five (5) business 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 a non-medical interruption extends beyond five (5) business days, the plan may be closed and LM terminated.

2.    Medical Interruptions

a.    LM will continue up to thirty (30) days in an open plan when the IW is unable to actively participate in the plan due to medical instability.

b.    LM will be suspended in an open plan after thirty (30) days when the IW continues to be unable to actively participate in the plan due to medical instability.

3.    Interruptions Without Good Cause - BWC may deduct one-seventh (1/7) of the weekly LM payment for each full day the IW fails, without good cause, to actively participate in the plan.

4.    LM Termination- LM shall terminate upon the earlier of:

a.    The IW’s return to work, other than as part of a gradual return to work plan; or

b.    The closure of the IW’s vocational rehabilitation plan pursuant to OAC 4123-18-05(E).

5.    The suspension or termination of LM shall not affect the IW’s right to any other workers’ compensation or benefits to which he or she may be entitled.

 


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