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OhioBWC - Basics: (Policy library) - File

Temp Partial Policy Draft_KM_11-03-15

Policy Name:

Temporary Partial (TP) Compensation – Change of Election

Policy #:

CP-20-03

Code/Rule Reference:

R.C. 4123.57 (prior to 08/22/86); Senate Bill (SB) 307-116th General Assembly, approved 05/23/86 and codified into R.C. 4123.57 in which temporary partial is no longer recognized as a compensation available in claims with a date of injury 08/22/86 or later.

Effective Date:

11/14/2016

Approved:

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

Origin:

Claims Policy

Supersedes:

Policy # CP-20-03 effective 11/17/2015

History:

New 11/17/2015

 

 

I.      POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC staff properly manages claims in which compensation for temporary partial compensation – change of election (TP) is paid.

II.    APPLICABILITY

 

This policy applies to Field Operations staff.

III.   DEFINITIONS 

 

Change of election: Occurs when an injured worker (IW) requests an impairment of earning capacity award paid bi-weekly until the maximum is reached or requests a percentage of a permanent partial award for medical impairment paid in one lump sum.

 

Earning capacity: The estimated amount of money the IW could have earned or could now earn.

 

Temporary partial (TP) compensation: An award that, when requested, is payable in claims with a date of injury (DOI) or date of disability (DOD) prior to 08/22/86 and is based on the IW’s whole body impairment as the result of the allowed conditions in the claim. The award is based on a comparison between the IW’s earning capacity prior to the injury and the earning capacity after the injury.

 

IV.   POLICY

A.    It is the policy of BWC to process TP claims that meet the following criteria:

1.    The DOI or DOD was prior to 08/22/86; and

2.    The IW demonstrated impairment in earning capacity; and

3.    The IW has elected to receive TP; or 

4.    The IW has a date of injury prior to 08/22/86, and he/she is receiving benefits under R.C. 4123.57(B), and has requested a change of election pursuant to R.C. 4123.57(A).

 

B.    It is BWC’s policy to refer new requests for TP to the Industrial Commission of Ohio (IC).

 

C.   TP Payments

1.    State, ex rel. Bouchonville v. Indus. Comm., (1988), 36 Ohio St.3d 50

a.    It is BWC’s policy that claims with previous IC or BWC orders awarding TP pursuant to the Bouchonville court case be calculated in accordance with this case.

b.    Pursuant to the Bouchonville case, TP is paid up to the maximum amount for the injury year, less any previously paid percent permanent partial (%PP). 

c.    The IW does not have to submit an Employer Report of Earnings for Wage Loss Compensation (C-142).

d.    BWC shall continue to pay TP when a wage statement is filed to support the payment.

i.      An employer’s objection to ongoing TP payment, with or without evidence for the objection, shall be referred to the IC for Hearing.

ii.     TP shall continue to be paid with supporting wage statements pending the outcome of the hearing.

2.    State, ex rel. Eaton corp., v. Industrial Comm., (1993), 66 Ohio St. 3d 180

a.    It is BWC’s policy that orders awarding TP pursuant to the Eaton court case require the IW to demonstrate that the IW’s earning capacity post-injury has been impaired compared to the pre-injury earning capacity.

b.    The determination of pre-injury and post-injury earning capacity is based on both physical and non-medical factors (e.g., age, level of education, work experience, training).

3.    Concurrent Payments

a.    Same claim:

i.      It is BWC’s policy that the following compensation types, when paid in the same claim, are payable concurrently with TP:

a)    Scheduled loss (SL);

b)    Facial disfigurement (FD); and

c)    Violation of specific safety requirements (VSSR).

ii.     It is BWC’s policy that the following compensation types, when paid in the same claim, are not payable concurrently with TP:

a)    Change of occupation (COO);

b)    Death (accrued up to the date of death);

c)    Disabled workers’ relief fund (DWRF);

d)    Living maintenance (LM);

e)    Living maintenance wage loss (LMWL);

f)     % Permanent partial (%PP);

g)    Permanent total disability (PTD);

h)    Temporary total (TT); and

i)      Wage loss (WL).

b.    Different claim:

i.      It is BWC’s policy that the following compensation types, when paid in a different claim of the IW’s, are payable concurrently with TP:

a)    SL;

b)    %PP;

c)    FD; and

d)    VSSR.

ii.     It is BWC’s policy that the following compensation types, when paid in a different claim of the IW’s, are not payable concurrently with TP:

a)    COO;

b)    Death;

c)    DWRF;

d)    LM;

e)    LMWL;

f)     PTD;

g)    TP;

h)    TT; and

i)      WL.

4.    When the IW requests a change of election, it is BWC’s policy to deduct any previously paid percentage of permanent partial (%PP) compensation granted under R.C. 4123.57(B) from the TP award.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Procedure for Temporary Partial Compensation – Change of Election” for further guidance.


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