OF PERMANENT PARTIAL DISABILITY OR INCREASE OF PERMANENT PARTIAL DISABILITY
4121.32; 4121.34; 4121.63; 4123.57; 4123.511; 4123.68; 4123.84 O.A.C.
4121-3-10; 4123-3-15; 4123-3-18; 4123-10-03
Hearing Officer Manual Memo E7, I5
R. Abrams, Chief Operating Officer (Signature on file)
# CP-16-04, effective 09/09/2016
09/29/2017; New 09/09/2016
purpose of this policy is to ensure BWC correctly determines eligibility for
percentage of permanent partial (%PP) compensation awards and bases decisions
on sufficient and appropriate supporting medical evidence from an exam or a
policy applies to BWC Field Operations staff.
unpaid portion of an award of compensation in an allowed claim due to the
decedent at the time of his or her death, regardless of whether the death was
the result of an allowed injury or occupational disease.
The basis upon which to compute benefit payments for: temporary total
disability (TT) and Living Maintenance (LM) after the initial 12-week period of
disability; death benefits; permanent total disability benefits (PTD); percent
of permanent partial disability benefits (%PP); wage loss (WL) benefits; and
may be used for payment of living maintenance wage loss (LMWL) if greater than
the full weekly wage (FWW).
management system-reference to compensation and benefit payments that cover
past periods but do not extend to future scheduled payments.
Evaluators’ Panel (DEP): A panel of physicians contracted by BWC to perform high-quality,
impartial Independent Medical Exams (IME) and Physician File Reviews (PFR) that
result in concise, timely and justifiable reports.
Workers’ Relief Fund (DWRF): A fund, separate from the state fund,
established to provide supplemental benefits to injured workers (IW) who are
receiving PTD compensation when the total of the PTD compensation plus the
social security disability (SSD) benefit is less than the DWRF eligibility
of Permanent Partial Award: Also known as a %PP and/or a C-92 award; compensation
awarded for residual impairment, either physical or psychological, resulting
from an allowed injury or occupational disease (OD) in state fund or self-insured
An impairment granted beyond the scheduled loss award as derived from the
American Medical Association’s “Guides to the Evaluation of Permanent
Impairment, Fifth Edition” (AMA guides), unless otherwise specified.
1. Application for %PP
shall be made on an Application for Determination of Percentage of Permanent
Partial Disability or Increase of Permanent Partial Disability (C-92).
2. The C-92 application
contains three check boxes to address %PP requests. The IW or IW representative
will mark the check box that appropriately describes his/her request:
a. Box one
i. Request for an initial
%PP award; and
ii. No supporting medical
evidence is required.
b. Box two
i. Request for a %PP award
for a newly allowed condition (condition allowed since the last %PP award); and
ii. No supporting medical
evidence is required.
c. Box three
i. Request for an increase
from a previously granted award of %PP; and
ii. Requires medical
evidence to be attached that supports an increase over the previously granted
3. The IW or IW’s
representative may file the C-92 application electronically through www.bwc.ohio.gov; however, BWC will not
honor the authorization to receive a workers’ compensation check on the
application unless BWC receives the IW’s signature on a:
a. Copy of the electronic
b. Hardcopy application;
c. Completed and signed Authorization
to Receive Workers’ Compensation Payment (C-230) form.
4. The employer, if it
chooses to do so, must submit any proof bearing upon the application (e.g.,
medical documentation) within 14 days of receipt of the C-92 application.
B. General Policy
Statements – It is the policy of BWC to:
1. Consider a previously
awarded %PP in one claim when an application for a %PP award is received in
another claim for the same body part.
2. Change a claim to a
lost time (LT) claim when a %PP award is granted; however, BWC shall not change
a claim to a LT claim based solely on the filing of a C-92 application.
C. Determining Eligibility
of a C-92
1. Waiting periods before
an IW can file for an initial %PP:
a. Claims with dates of
injury (DOI) on or after 6/30/06: the application may be filed 26 weeks from:
day after the last payment of TT or WL compensation;
day after the DOI or contraction of an OD in absence of payments; or
day after the DOI when the employer paid full salary/wages and no other
compensation has been paid.
b. Claims with DOI prior
to 06/30/06: the application may be filed 40 weeks from:
day after the last payment of TT or WL compensation;
day after the DOI or contraction of an OD in the absence of payments; or
day after the DOI when the employer paid full salary/wages and no other compensation
has been paid.
c. The 40-week or 26-week
waiting period applies to initial applications only.
2. A C-92 application
shall be dismissed when the IW is not eligible for a %PP award for any of the
a. The initial application
is filed prior to the end of the waiting period;
b. Permanent Total
Disability has been granted in the claim;
c. The application is for
an increase for %PP and there is no attached medical evidence that shows new
and changed circumstances since the time of the original or most recent %PP
determination that supports an increase;
d. The injured worker
failed to respond to an attempt to schedule a %PP examination or failed to appear
for a scheduled %PP examination without explanation when the application was
filed on or after 9/29/2017;
e. For all applications
statute of limitations for the claim has expired;
IW has already received %PP awards of 100% or greater in all claims combined
(including SI claims);
application is not signed by the IW or IW’s authorized representative and field
staff is unable to obtain the signature;
application is requesting an award for partial hearing loss or loss of vision;
is prohibited due to the type of OD allowance, specifically:
a) Firefighters and police
officers with cardiovascular, pulmonary or respiratory diseases;
b) Firefighters with an
allowance of cancer due to the presumption in the Firefighters with Cancer
Occupational Disease Claims policy;
c) Allowances for
silicosis, asbestosis, or coal miners’ pneumoconiosis; and
d) Any other OD of the
respiratory tract, except berylliosis, resulting from injurious exposure to
D. Considerations Specific
to a C-92 Request for an Increase of %PP
1. A request shall be held
for 60 days from the date a copy of the request is mailed to the employer and
employer’s representative. The 60-day hold may not be waived. However, if BWC
has determined the employer is out of business, the request will not be mailed
and BWC may process the request without waiting the 60-day period.
2. BWC shall request a
physician file review (PFR) or independent medical exam (IME) when the IW
requests an increase in %PP and submits supporting medical evidence
demonstrating new and changed circumstances that have developed since the time
of the original or most recent %PP determination.
3. Except where an
additional condition has been allowed in the claim and the request is for an
increase in %PP based solely on that additional condition, BWC shall dismiss any request for an increase of %PP when
medical documentation is not submitted or is not available to support the
4. BWC shall request an
exam if the medical evidence submitted by the IW shows an increase greater than
E. Medical Evidence
Submitted by Parties to the Claim
1. Medical evidence for an
initial %PP request or a %PP request for a newly allowed condition is not
2. When a BWC scheduled
impairment exam is complete, BWC shall refer an initial C-92 application to the
IC without issuing a decision if any party submits conflicting medical evidence
(e.g., employer’s defense exam or IW’s impairment exam) prior to BWC’s
determination of the application.
3. A medical report that
has been rejected can never be submitted as evidence again.
a. A report is rejected if
the report was on file at the time a decision was made and its conclusion is
contrary to the finding of a hearing officer;
b. Example: IW filed for
Permanent Total Disability (PTD) based on a report finding 66 %PP and
indicating the IW is PTD. The report was rejected when the SHO denied
PTD. A C-92 increase was filed after the PTD hearing relying on the same
physician’s report. That report can no longer be used as evidence.
F. Exams, File Reviews,
and Addendums Specific to %PP Requests
1. It is the policy of BWC
to ensure examining physicians consider previous impairment awards for the same
part(s) of body in any of the IW’s claims.
a. The employer may
schedule an exam at any time during the C-92 process at the employer’s expense.
b. The purpose of the C-92
examination is to provide an opinion on the whole person percentage of
impairment (WPI) for an allowance for the IW based on the 5th edition AMA
Guides unless otherwise specified.
c. The IW shall be
scheduled for an examination when requesting an initial determination of %PP.
d. The IW shall be
scheduled for an examination when:
a %PP award for a newly allowed condition for a new body part;
IW has highly complex injuries;
psychological exam is necessary for an initial psychological allowance;
IW is requesting an increase of 20% or greater; or
DEP file reviewer recommends an examination.
e. BWC may schedule an
exam based on the age of the claim and/or impairment percentages previously
f. A “Percent Permanent
Partial Notice of Application” letter will be sent to the IW (copy to the IW
representative) upon receipt of a C-92 application:
letter explains the purpose of the exam;
letter requests IW availability for scheduling the exam;
the letter is returned due to an incorrect address, BWC shall attempt to obtain
the correct address.
g. BWC shall consider and
request an examination on all conditions allowed at the time the physician
notice letter is sent unless instructed otherwise by the IW/IW Rep.
h. BWC shall schedule and
pay for %PP examinations, file reviews, addendums and related travel.
for state fund claims are charged to the surplus fund;
for SI employers are charged to the SI surplus fund.
i. Residual Effects – BWC
may grant a %PP award for residual effects over and above a scheduled loss
impairment award if a loss of use/amputation produces a residual impairment.
The examining physician may consider the impact of disability factors to the
IW. This includes, but is not limited to, the impact of current symptoms and
limitations or difficulty caused by the disability to the IW.
3. Failure to Appear
a. BWC shall follow the
failure to appear process in the Independent Medical Exams (IME) and
Physician File Reviews (PFR) policy and procedures when an IW fails to appear
for a BWC scheduled exam.
b. BWC shall refer the Motion
(C-86) to the Industrial Commission of Ohio (IC) when an employer files a C-86 requesting
claim suspension due to an IW’s failure to appear for an employer-scheduled
a. Requests for addendums
to a DEP %PP examination report shall be sent to all parties in the claim.
b. Addendum reports shall
be attached to and processed with original %PP examination reports.
c. Additional information
is available in the Independent Medical Exams (IME) and Physician File
Reviews (PFR) policy.
G. Suspending the
1. It is the policy of BWC
to indefinitely suspend a C-92 application if a lump sum settlement (LSS)
application is filed as detailed in the Lump Sum Settlement policy and
2. The C-92 application
will remain suspended until:
a. The IW withdraws the
C-92 application; or
b. The LSS is approved and
the C-92 application can be dismissed; or
c. The LSS is denied and
field staff moves forward with processing the C-92 application.
H. Tentative Orders for
1. It is the policy of BWC
a tentative order (TO) to grant, dismiss or suspend a C-92 application,
except for initial C-92 applications with conflicting medical evidence,
which shall be referred to the IC as provided in Section IV.E.2 above.
the recommendation of the BWC medical reviewer and issue a TO if there is
a conflict in the medical evidence involving a request for an increase in
the current application and grant the IW the remaining percentage up to
100% in the claim in which the medical evidence is supporting a whole
person impairment (WPI) of 90% or more.
the %PP request is granted but earnings information is not available:
i. Issue a TO indicating
that the %PP has been granted but is not payable until earnings information is
ii. Issue an order setting
wages when the earnings information is received.
the %PP request is granted and earning information is available but wages
have not been set, issue one TO granting the %PP award and concurrently
issue a BWC order setting the wages for the award.
the TO for a 20-day objection period plus mailing time.
the objection period if a written waiver signed by the employer and IW is
objections to a TO to the Industrial Commission of Ohio (IC).
2. Parties objecting to
the TO may file:
a. Using the Objection
to Tentative Order Determining the Percentage of Permanent Partial Disability
Compensation (IC-167-T); or
utilizing the IC’s online appeal process (ICON) located on the IC website.
3. If the last decision of
the IC was to allow a claim or a condition and that decision is appealed to the
court by the employer:
a. A C-92 requesting a %PP
for the conditions under appeal shall be suspended until a decision is issued;
b. A C-92 requesting a %PP
for conditions previously allowed in the claim and not under appeal may be
processed without waiting for a decision from the court;
c. If the decision of the
IC to allow a condition is appealed by the employer and the IW subsequently
dismisses the complaint with the consent of the employer, the C-92 application
can be processed until such time as the complaint is re-filed by the IW and is
considered pending by the court.
I. Payment of a %PP Award
1. BWC shall not issue a
payment until the administrative decision that grants the award is final.
2. For claims with a DOI
on or after 01/01/1979, it is the policy of BWC to pay %PP awards at 2/3 of the
IW’s AWW, but not to exceed a maximum of 1/3 of the statewide average weekly
3. An IW is awarded two
weeks of %PP for each percent of impairment.
4. BWC shall pay the IW
the number of weeks needed to bring the IW up to the maximum award of 200 weeks
if the IW is awarded a %PP of 90% or greater, whether upon initial application
or after a request for an increase in %PP.
5. Payment Dates
a. The %PP award cannot be
made until after the last payment of compensation is paid to the injured
worker. This includes:
b. BWC shall pay %PP
beginning the day after the DOI in a claim where no other compensation has been
paid, and to continue even if another compensation type is subsequently awarded
and payment of it overlaps payment of the %PP.
c. If no compensation has
been paid, payment begins from the day after the DOI or date of diagnosis (DOD)
for an OD.
d. If TT with a Salary
Continuation deduction plan is the only benefit plan built, the %PP payment
begins the day after the DOI.
e. If TT or WL is paid
after salary continuation ends, the %PP payment begins the day after the DOI.
f. If there are no open
periods when TT or WL compensation was not paid, the %PP plan begins after the
end date of any TT or WL compensation. This may result in the payment
going into scheduled payments for the future.
6. Public Works Relief
Employees (PWRE) – A %PP award is payable after:
a. Six (6) months of
receiving compensation directly out of the fund from which the employee was
receiving relief; or,
b. After the employer’s
funds to compensate the IW have been exhausted.
7. Family support
a. %PP Payments issued
through daywork are treated like lump sum payments for family support
arrearages and are subject to attachment.
b. Scheduled payments
(pension) are subject to weekly family support deductions.
c. Refer to the Family
Support Orders and Attorney Fees Paid Pursuant to Deductions of Child Support
from Lump Sum Payments policy for additional information.
d. BWC shall not send the
“Notice to Attorney of Lump Sum Award” letter if the %PP award is granted, and
there is a family support obligation on file but wages have not been previously
have been set;
appeal periods have expired; and
%PP award is payable.
8. %PP and Concurrent
a. LM/LMWL and %PP
IW cannot receive %PP and LM awards or %PP and LMWL awards concurrently in the
the IW is receiving LM or LMWL, the IW may apply for a %PP award and the
request may be processed, but payment shall not be made in the same claim until
the LM or LMWL ends unless there are broken periods in the past in which the
award can be paid.
IW may receive %PP and LM or LMWL concurrently in different claims.
b. WL and %PP
%PP award and WL are payable over the same period in the same claim if the %PP
award becomes final prior to the WL being awarded.
and WL may be paid concurrently in different claims.
c. TT and %PP
and %PP can be paid over the same period in the same claim when the %PP was
paid first and the injured worker later is awarded TT compensation over the
period the %PP is paid.
and %PP can be paid over the same period in different claims as long as the %PP
was started prior to TT.
d. PTD and %PP
applications filed on or prior to the date of filing for PTD will be processed
prior to processing the PTD application.
applications subsequently filed to the PTD application are processed after the
determination of the PTD application if PTD benefits are denied.
shall not be awarded when PTD benefits have previously been awarded in the same
is payable in a different claim for a condition not allowed in the PTD claim.
the PTD is awarded for a back period that overlaps with the period in which the
%PP was awarded and both awards are for the same injuries/conditions, the %PP
is deducted from the PTD to be paid.
e. Lump Sum Settlement
(LSS) and %PP
LSS application takes precedence over any %PP application.
signed LSS Agreement causes all pending %PP applications for claims listed on
the LSS Agreement to suspend without an order.
the IW was granted and paid a %PP award prior to the settlement, the percentage
paid in the settled claim is considered in the total WPI percentage if
subsequent C-92 applications are received and granted in the other claims.
f. Violation of Specific
Safety Requirements (VSSR) and %PP – The IW is entitled to concurrent payments
of VSSR and %PP.
g. Scheduled Loss (SL) and
shall not pay a scheduled loss (SL) and a %PP award for the same condition,
except for residual impairment beyond the SL.
is BWCs policy to deduct any previous %PP award for the same body part loss
(but not for residual effects) from the SL award.
may pay both a %PP award and a SL award concurrently in the same claim or
different claims when the conditions/injuries/body parts are different.
the SL award produces a residual impairment beyond the SL/loss of use, the injured
worker may file a %PP for that additional impairment.
subsequent %PP award should not attribute any part of the percentage to that
which has been covered by the SL award.
h. Temporary Partial (TP)
shall deduct TP payments from %PP awards for any claim with a DOI before
9/28/86 and receiving a TP payment.
to the Temporary Partial Compensation/Change of Election policy for
i. Death and %PP
spouse, surviving dependent(s), or the estate may apply for the %PP award within
one year of the IW’s death if a %PP award was not requested or completed prior
to the death of the IW.
no BWC %PP examination was ever completed, BWC shall request a PFR:
a) If the IW had been
examined prior to death and if the examining physician designated a whole
person impairment for the IW, or
b) If no exam was
performed prior to the IW’s death but there is medical on file dated within one
year of the date of death that can be used in a physician file review to
establish a percentage, field staff shall request a PFR.
where an additional condition has been allowed in the claim and the request is
for an increase in %PP based solely on that additional condition, BWC shall dismiss an application for an increase in %PP if medical
evidence is not submitted or available to support the request.
shall deny a request for an increase in %PP if the medical evidence is not
dated after the previous %PP award, the supporting documentation states the
medical impairment is lower than previously awarded, supporting medical
documentation is not dated within one year of the date of death, and as
outlined in section IV.E.3.
a %PP award is made prior to the death of an IW, the award is payable to the
spouse, surviving dependents, or the estate of the IW, regardless of whether
the death is related to the injury or not.
information about payment of accrued compensation can be found in the Accrued
BWC staff may refer to
the corresponding procedure for this policy entitled “Percentage of Permanent
Partial Disability or Increase of Permanent Partial Disability” for further