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),
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
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
- Restrictions that prevent the IW’s return to the
former position of employment;
- The IW having reached maximum medical improvement
- The feasibility of a referral for vocational
rehabilitation services; and
- The IW’s eligibility for continued TT.
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 awards
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.
Gross wages minus taxes.
Paid Time 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 injury year.
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.
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).
C-84/equivalent form must have at least the following information for BWC to
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;
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
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
e. Certification that
the IW understands he/she cannot work and collect TT.
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
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
c. 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;
current physical capabilities of the claimant;
g. An estimated or
actual return to work date;
h. An indication of
need for vocational rehabilitation;
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
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 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 advancement.
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.
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:
a. Allow TT;
b. Deny TT if included on the initial allowance
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
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.
d. When 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
4. Initial TT
a. If the claim is
not certified, BWC will not pay TT until one of the following occurs:
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
appropriate waivers are received. For
reference, see Orders, Waivers, Appeals,
and Hearings policy.
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 allowance.
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
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
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
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
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
- Medical 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 refusal.
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;
b. Temporary 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 different
a. Wage Loss (WL);
b. Living Maintenance
c. Living 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 claim.
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 become permanent.
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 following:
a. If any recent C-9s
approving treatment could potentially affect the IME findings; and
b. 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
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 of
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 (MMI); or
d. The IW’s employer
or another employer makes work available within the IW’s physical
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
7. Treating 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.
8. Treating 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:
to attend a medical examination or vocational evaluation;
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;
to submit to any employer-initiated examination, without good cause; or
to release any medical information, record, or report that is required to be
released and involves an issue pertinent to the alleged condition.
a. The termination 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:
receives notification that the IW has appeared for the examination or
vocational evaluation; or
IW submits a completed vocational questionnaire or releases required medical
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.
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.