Temporary Total Compensation
4123-3-09(B)(1)(b), 4123-3-32, 4123-5-18(C) and (D), 4123-5-20, 4123-6-20(B)
4123.511(H), 4123.53(B), 4123.55, 4123.56, 4123.61, 4123.651(C), 5101.141(C)(1)-(2a),
Commission of Ohio (IC) Hearing Officer Memo C3
Percy, Chief of Operational Policy, Analytics and Compliance (Signature on
Total Compensation policy number CP-20-02 dated 07/28/15
07/28/15; Rev. 11/20/15
I. POLICY PURPOSE
purpose of this policy is to ensure that the Ohio Bureau of Workers’
Compensation (BWC) evaluates and makes an accurate determination regarding
payment of temporary total compensation (TT) to an injured worker (IW) who is
unable to return to the former position of employment for eight days or more
due to a work-related injury or occupational disease.
policy applies to Field Operations staff and BWC attorneys.
Average Weekly Wage (AWW): For purposes of this policy, the basis upon which to compute benefit payments subsequent to
the first twelve weeks of temporary total disability.
Disability Evaluators’ Panel (DEP): Qualified medical specialists hired by
BWC to provide quality, impartial medical evaluations and medical file reviews
to support claims management.
Due Process: Legal principle that government may not deprive an
individual of life, liberty, or protected property rights without providing
notice and an opportunity to be heard.
Extent of Disability (EOD) Exam: An evaluation of the condition(s)
allowed in the IW’s claim in regard to:
- The IW’s ability to return to the
former position of employment;
- Restrictions that prevent the IW’s
return to the former position of employment;
- The IW having reached maximum
medical improvement (MMI);
- The feasibility of a referral for
vocational rehabilitation services; and
- The IW’s eligibility for continued
Full Weekly Wage (FWW): For purposes of this policy, the basis for
payment of compensation for the first 12 weeks of TT.
Lost Time Claim: A claim with eight or more days of lost time
directly caused by a work-related injury, even if compensation or wages in lieu
of compensation have not been paid to the IW or in any claim in which BWC
Maximum Medical Improvement: A treatment plateau (static or
well-stabilized) at which no fundamental functional, physiological, or
psychological change can be expected within reasonable medical probability in
spite of continuing medical or rehabilitative procedures. An IW may need supportive treatment to
maintain this level of function.
Medical Only Claim: A claim with seven or fewer days of lost time
from work directly caused by a work-related injury, for which the IW receives
no compensation for lost wages (e.g., TT, salary continuation) or is not
awarded any compensation for the life of the claim.
Net Pay: Gross wages minus taxes.
Off: A pool of time offered by the
employer that the IW can call in at any time; can be used as sick time,
vacation time, or holiday pay.
Parties to the Claim: The IW, IW representative, employer, and employer
representative. BWC is considered a
party to the claim and may present arguments when:
- The employer or employer
representative does not appear at a hearing; or
employer or employer representative does appear at a hearing, as long as the
arguments and/or evidence presented by BWC is not cumulative or duplicative of
what the employer has presented.
Profit Sharing: Employees are paid a portion of the
profits of a business.
Voluntary Abandonment: When a worker leaves the job at which the
injury occurred for reasons not related to the injury, or otherwise removes
himself/herself from the workforce.
Wage Agreement: An agreement between the IW and employer
in which the employer advances wages to the IW for a period of up to 12 weeks
(except under special circumstances) closely following the date of injury or
disability and with the understanding that BWC will forward the IW’s check(s)
for TT to the employer as reimbursement for the advancement when TT becomes
payable to the IW.
Policy Statements - It is the policy of BWC to:
1. Provide due
process when a new (initial or subsequent) period of TT has been
2. Compensate an IW
who is totally disabled from work for eight (8) or more days due to a
work-related injury or occupational disease.
- It is BWC’s policy to begin paying
TT on day eight (8) when the IW is disabled for seven (7) or more days,
but less than 14 consecutive days, due to a work-related injury.
- BWC shall begin to pay TT for the
first seven (7) days of disability once an IW has been disabled for 14 or
more consecutive days due to a work-related injury, whenever that occurs
in the life of the claim.
3. Pay TT for the
first 12 weeks at 72% of the IW’s FWW, subject to the statewide maximum for the
injury year and any applicable offsets.
a. If the FWW is at
or below 1/3 of the statewide average weekly wage (SAWW) for the injury year,
TT will be paid at the FWW.
b. If the FWW is
above 1/3 of the SAWW for the injury year, but 72% of the FWW is at or below
1/3 of the SAWW for the injury year, TT will be paid at 1/3 of the SAWW for the
c. If 72% of the
FWW is above 1/3 of the SAWW for the injury year and at or below the statewide
maximum for the injury year, TT will be paid at 72% of the FWW.
d. If 72% of the
FWW is above the statewide maximum for the injury year, TT will be paid at the
statewide maximum for the injury year.
4. Pay TT after the
first 12 weeks at 66 2/3% of the IW’s AWW, subject to the statewide maximum for
the injury year and any applicable offsets.
a. If the AWW is at
or below 1/3 of the SAWW for the injury year, TT will be paid at the AWW.
b. If the AWW is
above 1/3 of the SAWW for the injury year, but 66 2/3% of the AWW is at or below
1/3 of the SAWW for the injury year, TT will be paid at 1/3 of the SAWW for the
c. If 66 2/3% of
the AWW is above 1/3 of the SAWW for the injury year and at or below the
statewide maximum for the injury year, TT will be paid at 66 2/3% of the AWW.
d. If 66 2/3% of
the AWW is above the statewide maximum for the injury year, TT will be paid at
the statewide maximum for the injury year.
5. Consider the
following as payments in lieu of TT and count them toward the first 12 weeks of
c. Full sick leave;
sickness and accident benefits fully funded by the employer of record; and
Injury Leave (OIL).
6. Make payment of
TT based on the available return to work information.
reassign a Medical Only claim to the appropriate service office for
investigation and processing when an IW submits a Request for Temporary Total Compensation (C-84)/equivalent
8. Issue a BWC Order
to grant TT or refer the request for payment of TT to the IC, unless the IW
withdraws the request.
9. Determine if an
IW is receiving Unemployment Compensation benefits from the Ohio Department of
Job and Family Services (ODJFS) prior to issuing payment of TT.
Prohibit payment of TT
when the IW:
a. Has returned to
released without restrictions to return to the former position of employment by
the treating physician;
a written offer of work within his/her physical capabilities made by the
employer of record or another employer;
working (full time or part time) for any employer during the disability period;
returned to work and is requesting TT for a doctor’s appointment and/or medical
abandons his/her employment;
profit sharing benefits over the same period the TT is requested, and the IW
attended meetings and other employment-related activities that would constitute
working. However, BWC may pay TT and
profit sharing benefits over the same period if the IW is not performing any
form of employment-related activity;
receiving Department of Administrative Services (DAS) Hostage Leave according
to the collective bargaining agreement;
a volunteer and the IW has lost no earnings;
serving as an elected political official and is attending meetings, whether
frequent or infrequent, or performing any other activity related to the
on active military duty;
active duty requires physical activities and pay that is inconsistent with the
receipt of TT.
ii. Soldiers who report for
any drills, including weekend duty, are often paid for reporting for duty and
any payment received as a result of reporting for duty is also inconsistent
with the receipt of TT.
working as a poll worker. The poll
worker is considered an employee of the Board of Elections for the day worked
at the polls; or
to use paid time off (PTO) as sick leave.
- The Request
1. It is the policy
of BWC to consider payment of TT when it receives:
a. A C84 or equivalent
form with no IW signature filed on behalf of an IW who is completely
incapacitated (e.g., coma); or
b. A completed C-84
or an equivalent form; and
c. Medical evidence
(See Section IV.C., below).
2. The C-84/equivalent
form must have at least the following information for BWC to award TT:
a. An IW signature
on the completed form, unless the IW is completely incapacitated (e.g., coma)
and unable to sign the C-84/equivalent form;
i. The date of the
IW’s signature is generally close in time to the requested period of disability
the treating physician has certified. If the signature is not close in time,
BWC may further investigate.
ii. The IW’s
attorney cannot sign the C-84/equivalent form on behalf of the IW.
iii. The only
exception to having a signed C-84/equivalent form is when the IC issues an IC
Order granting TT. For all subsequent
requests, BWC shall only grant on-going TT when the IW has signed the
b. Verification of
receipt (or lack of receipt) of any other benefits, salary continuation or
i. The IW’s receipt
of welfare benefits has no impact on the payment of TT unless the IW is working
to receive the benefits.
ii. When receipt of
welfare benefits is indicated, BWC shall contact the IW to determine if the IW
is required to work in order to receive the benefits.
iii. If the IW claims
he/she has a waiver of the work requirement due to his/her disability, BWC may
consider the waiver by verifying it by phone with the Welfare Department;
however, the IW will need to submit written verification as soon as possible.
c. Work history
over the requested period;
d. Light duty
that the IW understands he/she cannot work and collect TT.
- Supporting Medical
1. It is BWC’s
policy to require medical documentation [e.g., Physician’s Report of Work Ability (MEDCO-14)], except as noted in
C2. below, to pay initial and subsequent requests for TT from the treating
physician to support the:
a. Period of
disability the IW is requesting; and
b. Disability is due
to the allowed work-related injury/disease.
2. EXCEPTION: When TT and medical benefits are identified
on a First Report of Injury, Occupational
Disease, or Death (FROI-1), field staff may approve payment of TT for a
period up to four (4) weeks without medical documentation if the FROI-1 is:
b. Signed by both
c. Certified by the
3. It is BWC’s
policy to require the following information from the treating physician in
order to consider payment of TT:
a. The date of the
b. The date of the
International Classification of Diseases (ICD) diagnosis code(s) recognized in
the claim for all conditions and all parts of the body being treated that are
affecting the length of disability, including a primary diagnosis code, with a
narrative description identifying the
condition(s) and specific area(s) of the body being treated;
d. Any reason why
recovery has been delayed;
e. The date
temporary total disability began;
f. The current
physical capabilities of the claimant;
g. An estimated or
actual return to work date;
h. An indication of
need for vocational rehabilitation;
i. Objective findings;
findings supporting the above information.
4. It is BWC’s
policy to consider payment of TT when supporting medical documentation
(including the MEDCO-14) lists an allowed condition(s) only as causing
temporary total disability.
5. BWC will not
consider payment of TT when supporting medical documentation (including the
MEDCO-14) lists a condition(s) that is not allowed or a disallowed condition(s)
as causing temporary total disability.
In this situation, the supporting medical documentation is defective,
and it is BWC’s policy to attempt to obtain medical evidence that supports
temporary total disability due to a condition(s) allowed in the claim.
6. It is BWC’s
policy to require the treating physician’s signature on supporting medical
documentation in order to pay TT. Refer
to the Medical Evidence for Diagnosis
Determinations policy for more information regarding signatures on
supporting medical evidence.
7. BWC policy does
not require the treating physician to be BWC-certified to complete and sign a
D. Considerations for Determining if TT is Payable
may pay TT over the same period as the following:
pay in lieu of sick leave;
leave benefits paid by an employer other than the employer of record;
leave benefits paid by the employer of record that are intended to supplement
used as any leave time other than sick leave;
of a non-occupational sick and accident program that is fully or partially
funded by the IW;
Employees Retirement System (PERS) benefits;
security disability benefits;
accrued sick leave paid in a lump sum (e.g., employee cashing in sick leave or
receiving payment upon separation);
accrued vacation time; or
unemployment compensation paid by Ohio.
may pay TT with an offset:
claims with a date of injury on or after 11/3/1989, when an IW is receiving
social security retirement benefits (the actual amount of the benefits is not a
factor) and where the TT rate is greater than 66 2/3% of the SAWW for the date
an IW is receiving unemployment compensation that was paid and funded by the
Ohio Department of Job and Family Services (ODJFS);
an IW is receiving benefits of a non-occupational sick and accident program
that is fully funded by the employer of record; or
the IW has received sick leave from the injury employer at less than 100% of
the IW’s earnings and the sick leave is not intended to supplement TT. If the
sick leave is paid from the injury employer at 100% of the IW’s earnings, and
the sick leave replaces earnings, BWC shall not pay TT. Also see IV.D.5. (Sick Leave Buy Back/Wage
the treating physician releases the IW to return to work with restrictions, but
an employer does not accommodate the IW’s restrictions, BWC may continue to pay
TT to the IW. As long as the restrictions are preventing the IW from performing
the job the IW held at the time of the injury, BWC shall continue payment
of TT to an eligible IW unless:
employer accommodates the restrictions; or
treating physician releases the IW to return to the former position of
treating physician makes a finding that the IW has reached MMI.
shall not consider a request for TT until a final decision is reached on a
previously filed request for an additional condition(s) when the requested
condition(s) is the sole basis for the period of disability covered by the
Sick Leave Buy Back/Wage Agreement – It is the
policy of BWC to honor a sick leave buy back/wage agreement, and issue payment
of TT to an IW when TT is payable and a written agreement between the employer
and IW is submitted to BWC. The agreement must state that the employer agrees
to pay an advancement of wages or sick leave to the IW for a period up to 12
weeks closely following the date of injury or beginning of disability, unless
special circumstances exist.
circumstances include, but are not limited to the following:
clearly defined human resource policy/employee handbook policy; or
bargaining unit contract.
agreement must acknowledge that:
employer shall be reimbursed for wages or sick leave advanced to the IW up to
the amount of TT paid to the IW over the same period in which the employer paid
an advancement(s); and
has the authority to send warrants for TT to the IW in care of the employer
with instructions that the warrant(s) must be personally signed by the IW.
c. BWC will not
honor a sick leave buy back/wage agreement unless written notice of the
agreement is signed by the employer and IW and filed with BWC within 30 days of
the beginning date of payment to the IW.
d. BWC must be notified
in writing within 30 days of the end date of payment of wages, sick leave, or
e. Failure to
comply with the terms of the agreement may result in BWC’s refusal to honor the
terms of the agreement between the employer and the IW.
f. BWC does not
consider wage agreements the same as salary continuation.
volunteer IW with no other employment is not entitled to TT as no loss of wages
has occurred due to a work-related injury.
may pay TT when a volunteer IW has multiple jobs, one as a volunteer with no
earnings and the other as an employee with earnings.
Example: A volunteer firefighter also works as a
mechanic at a local garage. He/she
suffers an injury and cannot work at either job. TT may be payable.
- Issuing the
TT Decision and Award
1. It is BWC’s
policy to take one of the following actions:
b. Deny TT if included on the initial
allowance order; or
c. Refer the issue of
payment of TT to the IC if the request for TT is not part of the initial
allowance order and there is a conflict.
2. It is BWC’s
policy to deny TT at the time of initial determination or refer to the IC
subsequent to initial determination, any request for a back period of TT in
excess of two years prior to the date of filing of the application requesting
the TT award.
Certification and Payment of TT
a. When the
employer has certified a claim for payment of compensation, BWC may pay TT
immediately upon the issuance of the BWC Order on initial determinations of the
claim only. BWC shall not hold payment
for receipt of waivers or for expiration of the appeal period of the order.
b. If a certified
claim is changed over from medical only to lost time, and the initial allowance
order has not yet been issued, it is BWC’s policy to pay TT without waiting for
the expiration of the appeal period of the allowance order.
c. When the claim
is certified and BWC has issued an initial allowance order and subsequently
receives a request for TT, if the request is made within the appeal period with
no appeal filed, it is BWC’s policy to vacate the order and re-issue an order
allowing payment of TT. BWC will then pay the TT immediately upon issuance of
the re-issued initial allowance order.
certification is received after the initial allowance order is issued, it is
BWC’s policy to pay TT when the certification is received if the appeal period
has not yet expired.
4. Initial TT
a.If the claim is
not certified, BWC will not pay TT until one of the following occurs:
i. The appeal
period of the initial allowance order expires and no appeal is filed;
certification is received before the appeal period of the initial allowance
order expires; or
iii. The appropriate
waivers are received. For reference, see
Orders, Waivers, Appeals, and Hearings
b. BWC may allow or
deny a request for TT on the BWC Initial Allowance Order when issuing a
decision for an initial award of TT at the same time as the initial claim
c. When the initial
request for TT is received after the claim is allowed, it is BWC’s policy to issue
an order to award payment of TT when no conflict or dispute exists. BWC will attempt to resolve conflicts or
disputes to avoid holding an IC hearing to resolve the issue(s).
d. BWC will not
deny a request for TT after the BWC
Initial Allowance Order is issued, or when a conflict or dispute exists in the
5. Changing a
Medical Only Claim to a Lost Time Claim and Paying TT
a. When an allowed
claim is changed over from a medical only claim to a lost time claim and TT
needs to be addressed, BWC shall issue a subsequent BWC Order to address TT
when no conflict exists.
b. When TT
compensation is granted on a subsequent BWC Order, BWC shall not pay TT until
the appeal period expires and no appeal was filed, or until appropriate
waiver(s) is received (see Orders,
Waivers, Appeals, and Hearings policy and procedure), even if the claim was
certified by the employer prior to issuing the order granting TT.
c. When the claim
is changed over and the allowance order from Medical Claims is still within the
appeal period and no appeal has been filed, BWC may vacate the allowance order
and issue a new order to allow the claim and payment of TT.
6. TT Split among
– It is BWC’s policy to refer the issue to the IC when a request to split TT
among multiple claims is filed.
7. Paid vs.
Considered - IC Order Language
a. If the IC orders
that TT shall be paid upon submission
of supporting medical evidence and the evidence is received, BWC shall pay TT
based on the IC Order. A separate BWC
Order granting TT is not necessary.
b. If the IC orders
that payment of TT shall be considered
upon submission of supporting medical evidence and the evidence is received,
BWC shall issue a BWC Order granting TT or shall refer the request to the IC
recommending denial of the request.
F. Special Considerations for Payment of TT
1. Assault Leave
a. When assault
leave is paid according to a collective bargaining contract, the injured worker
may be eligible to receive TT concurrently.
b. IWs must submit
the actual collective bargaining contract for consideration.
2. Seasonal Employees - An injured
worker who was engaged in seasonal employment (e.g., construction, landscaping,
farming) may continue to receive TT once his/her
seasonal employment ends.
3. Student Workers - An IW may
attend school and receive TT if the injury prevents the IW from returning to
his/her former position of employment, but does not prevent the IW from
4. Teachers and
Other School Employees
a. In general, a
teacher or other school employee is not entitled to receive wages and TT over
the same period of time. However, if a
teacher or other school employee is deemed to be temporarily and totally
disabled, but is receiving a portion of his/her pro-rated wages over the summer
months for work performed during the school year (prior to the period of
disability), TT may be payable with no offset.
b. A teacher or
other school employee who has been unable to work during the 9-month academic
year, and who is receiving his/her prorated wages, is not entitled to TT during
the summer months unless he/she can prove his/her intent to work during the
summer break by submitting evidence of one of the following:
job offer for that summer;
history of working at another job during the summer months; or
job search for summer employment performed prior to the injury.
c. Once BWC has
determined that a teacher or other school employee is entitled to TT, payments may
continue as long as the teacher or other school employee is unable to return to
work at one of his/her former places of employment.
d. If a teacher or
other school employee has been receiving continuous TT, and is unable to work
during the previous 9-month academic year as a result of the industrial injury,
the teacher or other school employee is entitled to continue to receive TT
during the summer months as long as the teacher is not receiving payment of any
e. If a teacher or
other school employee has been receiving continuous TT
and is unable to
work during the previous 9-month academic year as a result of the industrial injury,
the teacher or other school employee is entitled to continue to receive TT
during the summer months as long as the teacher or other school employee is not
receiving payment of any wages.
Example 1: A teacher gets injured in May and is off work
until August (a new school year begins in September). The teacher continues to be paid wages over a
pro-rated 12-month period and has never worked over the summer months. The teacher is able to return to the teaching
job once school resumes. TT is not payable
to the teacher during his/her period of disability (May-August) because he/she
did not show intent to work over the summer months and there was no loss in
Example 2: Same facts as example 1, but the IW has
worked every summer for the last three years.
TT is payable to the teacher during his/her period of disability because
he/she had a loss in earnings over the summer.
Example 3: A teacher gets injured in November, is not
paid anything under the teaching contract during the period of disability, and
has received TT during the remainder of the school year. The teacher is now applying for TT for the
summer months. TT is payable to the
teacher for the summer months because he/she was unable to earn any wages
during the school year and will not receive his/her regular pro-rated
G. Subsequent TT Award/Decision
1. If there is no
dispute or conflict with the requested TT, it is BWC’s policy to generate a BWC
Order outlining the TT award being granted in the following situations:
- The initial allowance decision in
the claim is final; or
- BWC is paying TT after an
interrupted, omitted, or extended period between TT payments, regardless
of the period of time.
2. It is BWC’s
policy to pay TT when the appeal period expires with no appeal filed, unless
appropriate waiver(s) is received (see Orders,
Waivers, Appeals, and Hearings policy and procedure).
3. BWC shall not
issue an order for the continued or on-going payment of TT after TT has been
initially awarded by order.
4. It is BWC’s
policy to continue to pay TT and refer the issue of payment of ongoing TT to
the IC for hearing when a conflict or dispute exists. BWC does not have the authority to terminate
TT when a conflict or dispute exists with ongoing payment.
5. If BWC is
recommending denial of payment of TT, it is BWC’s policy to obtain a physician
file review or present exam findings to support denial of the request prior to
6. BWC will not
consider a C-86 requesting payment of TT when a completed and signed
C-84/equivalent form has not been submitted to support the request for TT on
a. It is BWC’s
policy to dismiss the C-86 if the completed and signed C-84/equivalent form is
not received and payment of TT was the only issue requested on the C-86.
b. If there are
multiple issues on the C-86, it is BWC’s policy to refer the C-86 to the IC
with the evidence for the other issue(s).
7. When the IW has
filed an Application for Compensation for
Permanent Total Disability (IC-2) after BWC has made an MMI referral to the
IC, the process to terminate TT due to a finding of MMI may continue.
8. BWC will
continue to pay TT while the IW is receiving TT and an IC-2 is filed, unless
the IW is found to have reached MMI.
Payment will continue with supporting medical evidence from the IW’s
treating physician until there is an MMI finding or the IC makes a
determination on the IC-2.
- If the IC allows the IC-2, BWC
will terminate TT as ordered by the IC.
- If an IC-2 is filed and/or is
being processed by the IC and the evidence on file is from a physician other
than the treating physician who indicates the IW has reached MMI, BWC may
send the MMI issue to the IC while the IC-2 is still under consideration.
- If an IC-2 is filed and is being
processed by the IC and BWC receives medical evidence from the treating
physician indicating the IW has reached MMI, it is BWC’s policy to
terminate TT as of the MMI date and not wait for a determination on the
9. If a claim is
changed from a medical only claim to a lost time claim anytime following an
initial decision (an order has been issued and is final), it is BWC’s policy to
issue an order allowing payment of TT, and hold payment of TT until expiration
of the appeal period of that order, even if the claim is certified, or until a
waiver of the appeal period is received from the employer.
10. When salary
continuation has been paid previously, and TT is now payable, it is BWC’s
policy to issue an order granting payment of TT.
H. Paying TT - BWC will pay TT through the day
before the actual or estimated return to work date. If no date is provided, BWC
will contact the treating physician to obtain a date.
Example #1: On the MEDCO-14, the treating physician lists
a period of disability from 05/16/2012 to 05/30/2012 and lists an estimated
return to work date of 05/31/2012. TT is
paid up to and including 05/30/2012.
Example #2: The IW’s actual return to work date is 05/31/2012. TT is paid up to and including 05/30/2012.
Exams Impacting Ongoing TT
1. It is BWC’s
policy to schedule a 90-day exam and a 200-week exam as required by law.
2. The employer of
record or BWC may waive a 90-day exam.
a. The waiver must
be received in writing.
b. BWC may waive
the exam even if the employer indicates that the exam should proceed.
3. BWC may schedule
the IW for an extent of disability exam anytime, when appropriate. If the IW
fails to attend the exam, his/her TT may be suspended during the period of
4. For more
information regarding exams, refer to BWC’s Independent
Medical Examinations policy.
- TT and
1. It is BWC’s policy
to pay the following compensation types concurrently with TT when substantiated
by supporting medical evidence:
a. Scheduled Loss;
Partial (TP) only if in a different claim involving different body parts and
d. Violation of
Specific Safety Requirement (VSSR);
Permanent Total Disability (PTD) only if the IW returned to work and had a new
injury resulting in a new claim. TT can
be paid in the new injury claim concurrently with the Statutory PTD in the
original claim; the TT for the new injury is not payable in the original claim;
Permanent Partial (%PP) only when the %PP was paid first and the IW later
requests TT over the same period in the same claim; or
g. TT in another
claim, but only if paid as a split (i.e. one payment of TT is issued, but split
2. It is BWC’s
policy to prohibit payment of the
following compensation types concurrently with TT in the same claim or in a
a. Wage Loss (WL);
Maintenance Wage Loss (LMWL);
d. Change of
e. Permanent Total
Disability (PTD), except Statutory PTD as noted above.
Medical Improvement (MMI)
1. It is BWC’s
policy to issue a BWC TT Termination Order to terminate TT when the treating
physician states or concurs with a finding of MMI and TT is being paid in the
2. Medical evidence
that has determined a condition is permanent may be sufficient to terminate TT if the IW has reached MMI. When the treating physician indicates that
the IW’s medical condition is not improving further, no other treatment options
are feasible, and the condition has reached a level of permanency, this may be evidence that the IW has reached
MMI and TT termination may be appropriate.
The treating physician’s report must strongly conclude that the IW has reached
MMI in order for the report to support TT termination. However, if the treating physician indicates
that the IW’s condition is permanent, but is still responding to medical
treatment and is improving, this is not evidence that the IW has reached MMI. TT termination is not appropriate.
knee sprain/strain is allowed in an IW’s claim.
IW is receiving treatment for the condition; however, a progress report recently
submitted by the treating physician states that the IW is no longer benefitting
from treatment, no other treatment options are viable, and the condition has
IW may have reached MMI and TT
termination may be appropriate.
IW has an amputation and permanent loss of the leg, but the IW’s condition is
still improving with medical treatment.
IW’s condition is permanent, but has not reached a maximum level of medical
IW has not reached MMI and TT termination is not appropriate.
3. When the
treating physician submits a MEDCO-14/equivalent form and indicates the IW has
reached MMI, the effective date of the termination is the date of the last
examination, unless the treating physician specifies an MMI effective date. It is BWC’s policy to pay TT through the day
before the MMI effective date.
treating physician performs an exam on 10/01/2009.
treating physician’s medical report dated 10/03/2009 states the IW is MMI, but
an effective date is not given.
effective date of the termination is 10/01/2009, the date of the treating
physician’s medical exam.
is paid through 9/30/2009.
treating physician indicates on the MEDCO-14/equivalent form that the IW has
reached MMI on 10/1/2009.
MMI effective date entered in the MMI section of the MEDCO-14 is the
is paid through 9/30/2009.
4. When an IW is in
a rehabilitation plan and the treating physician submits a MEDCO-14/equivalent
form indicating the IW has reached MMI, compensation is not affected. If the IW subsequently requests TT, the MMI
finding may be sufficient for a referral to the IC if no new and changed
5. Before BWC
refers a claim to the IC requesting TT termination based on a BWC exam with a
finding of MMI, it is BWC’s policy to review the claim to determine the
e. If any recent
C-9s approving treatment could potentially affect the IME findings; and
f. If the DEP
physician was aware of the treatment being sought. If there is treatment being sought that is
not mentioned in the BWC exam report, it is BWC’s policy to obtain an addendum
from the DEP physician.
6. When a BWC IME
finds the IW has reached MMI, the effective date of the termination is the date
of the IME with the treating physician’s concurrence or the specific date given
by the treating physician. It is BWC’s
policy to pay TT through the day before the MMI effective date.
An IME is performed on 10/01/2013.
report dated 10/03/2013 states the IW has reached MMI.
treating physician’s statement dated 10/15/2013 concurs that the IW has reached
MMI, but an effective date is not given.
effective date of the termination is 10/01/2013, the date the IME was performed.
staff will enter 10/01/2013 as the MMI date in the claims management system to
pay TT up to and including 09/30/2013.
7. When the
treating physician gives a specific MMI date in the statement of concurrence
with the IME results, the effective date of the termination is the MMI date
indicated by the treating physician, regardless if the date is before or after
the MMI date noted in the IME report.
IME is performed on 10/01/2013.
IME report dated 10/03/2013 states the IW has reached MMI.
treating physician’s statement dated 10/15/2013 concurs with the MMI finding
and provides an effective date of 10/16/2013.
effective date of the termination is 10/16/2013, the date provided by the
staff will enter 10/16/2013 as the MMI date in the claims management system to
pay TT up to and including 10/15/2013.
8. When TT has been
terminated by the IC because the IW has reached MMI, it is BWC’s policy to
terminate TT with an effective date of the date of the IC hearing at which the
decision to terminate TT was made.
9. BWC may consider
payment of TT if a C-84/equivalent form is submitted subsequent to a BWC or IC
finding of MMI.
a. BWC may issue an
order when the request for payment of TT is supported by medical evidence of
new and changed circumstances and no conflict or dispute exists. It is BWC’s policy to hold the order for the
appeal period unless a waiver is received.
b. It is BWC’s
policy to refer the issue to the IC when the recommendation is to deny payment
10. When TT has been
terminated by BWC due to a previous finding of MMI for a condition(s), and a
C-84/equivalent form is submitted requesting TT for a different condition(s),
it is BWC’s policy to consider payment of TT for the condition(s) that has not
1. It is BWC’s
policy to terminate TT without a hearing for any of the following reasons when
no conflict or dispute exists:
a. The IW returns to work;
b. The IW’s
treating physician has made a written statement that the IW is capable of
returning to the former position of employment;
c. The IW’s
treating physician indicates the IW has reached maximum medical improvement
d. The IW’s
employer or another employer makes work available within the IW’s physical
i. The job offer
must be in writing.
ii. The IW’s treating
physician must be in agreement with the job offer.
2. BWC shall
terminate TT as of the date listed on the MEDCO-14 or medical documentation
when the treating physician indicates that the IW has reached MMI.
3. BWC does not
have the authority to deny or terminate TT when a conflict or dispute exists
with the ongoing payment.
a. If there is a
conflict or dispute with the requested TT payment, the conflict/dispute shall
be referred to the IC for hearing. BWC
shall attempt to resolve conflicts or disputes to avoid holding an IC hearing
to resolve the issue(s).
b. A conflict or
dispute regarding payment of compensation can be created by opposing medical
opinions, or by any party to the claim, including BWC, objecting to the
c. When BWC is the
party objecting to ongoing payment of TT, BWC must submit supporting evidence to
support a referral to the IC (conflict or dispute) regarding the ongoing
d. It is BWC’s
policy to refer an employer’s C-86 (with supporting evidence) objecting to
ongoing payment of TT to the IC. TT will
continue to be paid with medical documentation supporting the disability until
the IC issues a decision.
4. The IC will
decide the issue of terminating TT when a conflict or dispute exists.
5. According to IC
Resolution R98-1-04, the appropriate date for termination of TT compensation
when a conflict exists is the date of the IC hearing at which the decision to
terminate TT was made. However, the IC
may determine another effective date of termination to be more appropriate
(e.g., IC affirms BWC Order terminating TT when the treating physician provided
an MMI date).
6. Return to Work
(RTW) – The effective date for termination is the actual date the IW returned
IW returns to work on 03/10/2013.
receives notice that the IW has returned to work and terminates TT by letter
effective date of termination is 03/10/2013 and TT is paid up to and including 03/09/2013.
Physician Releases the IW without Restrictions – The effective date of the
termination is the date the treating physician releases the IW to return to
work to his/her former position of employment.
Physician Releases the IW with Restrictions - When the treating physician
releases the IW to return to work with restrictions, it is BWC’s policy to
examine the evidence regarding the IW’s ability to perform the offered job. BWC will refer conflicting evidence to the IC
9. Incarceration - BWC
may terminate TT due to IW’s incarceration. For information regarding
termination of TT due to incarceration, refer to the Incarceration policy & procedure.
M. Suspending TT
1. BWC will suspend
TT when the IW:
a. Fails to attend
a medical examination or vocational evaluation;
b. Refuses to
submit a completed vocational questionnaire to BWC or the IC within 30 days
after BWC or the IC mails the request to complete the questionnaire;
c. Refuses to
submit to any employer-initiated examination, without good cause; or
d. Refuses to
release any medical information, record, or report that is required to be
released and involves an issue pertinent to the alleged condition.
of TT, whether by BWC Order, IC Order or court order, does not preclude the
commencement of TT at another point in time if the IW becomes temporarily and
totally disabled, unless TT is forever barred by the IC or the IW has
voluntarily abandoned the work force.
b. If the IW
becomes eligible to receive TT after termination, TT will be reinstated with
supporting factual and medical evidence after an order to grant payment of TT
has been issued and approved.
Suspended TT – BWC will reinstate TT when:
a. BWC receives
notification that the IW has appeared for the examination or vocational
b. The IW submits a
completed vocational questionnaire or releases required medical information.
3. Reinstating TT after
a Period of Incarceration
a. If TT is being
considered after a period of incarceration has ended, payment may begin on the
date the IW is first seen by the treating physician following the period of
evidence must be submitted.
ii. The IW may be
examined to determine his/her extent of disability.
b. Payment of TT will
not begin on the date the IW was released from confinement, unless it is the
same date that the IW was first seen by his/her treating physician. Supporting evidence must be submitted.
BWC staff may
refer to the corresponding procedure for this policy entitled “Procedure for Temporary
Total Compensation” for further guidance.