4123-3-32, 4123-5-18(C) and (D), 4123-5-20, 4123-6-20(B)
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
R. Abrams, Chief Operating Officer
Injury Management policies, directives and memos regarding temporary total
compensation claims that predate the effective date of this policy
07/28/15; Rev. 11/20/15
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 claims services staff and BWC attorneys.
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.
Evaluators’ Panel (DEP): Qualified medical specialists hired by BWC to provide
quality, impartial medical evaluations and medical file reviews to support
Legal principle that government may not deprive an individual of life, liberty,
or protected property rights without providing notice and an opportunity to be
of Disability (EOD) Exam: An evaluation of the condition(s) allowed in the IW’s claim
in regard to:
IW’s ability to return to the former position of employment;
that prevent the IW’s return to the former position of employment;
IW having reached maximum medical improvement (MMI);
feasibility of a referral for vocational rehabilitation services; and
IW’s eligibility for continued TT.
Weekly Wage (FWW): For
purposes of this policy, the basis for payment of compensation for the first 12
weeks of TT.
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 compensation.
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.
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
Gross wages minus taxes.
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.
to the Claim:
The IW, IW representative, employer, and employer representative. BWC is
considered a party to the claim and may present arguments when:
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.
are paid a portion of the profits of a business.
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
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 requested.
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.
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.
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 injury
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
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 TT:
a. Living Maintenance;
b. Salary Continuation;
c. Full sick leave;
sickness and accident benefits fully funded by the employer of record; and
e. Occupational Injury
6. Make payment of TT
based on the available return to work information.
7. Automatically 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.
10. Prohibit payment of TT when the
a. Has returned to work;
b. Is released without
restrictions to return to the former position of employment by the treating provider;
c. Refuses a written offer
of work within his/her physical capabilities made by the employer of record or
d. Has reached MMI;
e. Is working (full time
or part time) for any employer during the disability period;
f. Has returned to work
and is requesting TT for a doctor’s appointment and/or medical
g. Voluntarily abandons
h. Receives 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;
i. Is receiving Department
of Administrative Services (DAS) Hostage Leave according to the collective
j. Is a volunteer and the
IW has lost no earnings;
k. Is serving as an
elected political official and is attending meetings, whether frequent or
infrequent, or performing any other activity related to the political
l. Is on active military
i. Generally, active duty
requires physical activities and pay that is inconsistent with the receipt of
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.
m. Is 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
n. Elects to use paid time
off (PTO) as sick leave.
Request for TT
1. It is the policy of BWC
to consider payment of TT when BWC 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. If an IW cannot
physically sign the C-84/equivalent form, but is lucid, he/she may:
a. Have another person
sign the IW’s name, noting beside the signature that the IW is physically
unable to sign; or
b. Place an “X” or other
mark that is intended to reflect the IW’s acknowledgement in place of the IW’s
3. 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;
date of the IW’s signature is generally close in time to the requested period
of disability the treating provider 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 C-84/equivalent form.
b. Verification of receipt
(or lack of receipt) of any other benefits, salary continuation or earnings.
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
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)] from the treating provider, except as noted in C2. below, to pay
initial and subsequent requests for TT. The medical documentation shall 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), claims services staff may approve payment of TT
for a period up to four (4) weeks without medical documentation if the FROI-1 is:
a. Properly completed;
b. Signed by both parties;
c. Certified by the
3. It is BWC’s policy to
require the following information from the treating provider in order to
consider payment of TT:
a. The date of the
b. The date of the last
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
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 provider’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 provider to be BWC certified to complete and sign a
D. Considerations for Determining
if TT is Payable
1. BWC may pay TT over the
same period as the following:
a. Vacation pay;
b. Vacation pay in lieu of
c. Holiday pay;
d. Compensatory time;
e. Sick leave benefits
paid by an employer other than the employer of record;
f. Sick leave benefits
paid by the employer of record that are intended to supplement TT;
g. Jury duty pay;
h. PTO used as any leave
time other than sick leave;
i. Supplemental payments;
j. Benefits of a
non-occupational sick and accident program that is fully or partially funded by
k. Public Employees
Retirement System (PERS) benefits;
l. Social security
m. Severance pay;
n. Unused accrued sick
leave paid in a lump sum (e.g., employee cashing in sick leave or receiving
payment upon separation);
o. Unused accrued vacation
p. Federal unemployment
compensation paid by Ohio.
2. BWC may pay TT with an
a. In 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 of injury;
b. When an IW is receiving
unemployment compensation that was paid and funded by the Ohio Department of
Job and Family Services (ODJFS);
c. When an IW is receiving
benefits of a non-occupational sick and accident program that is fully funded
by the employer of record; or
d. When 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 Agreement) below.
3. When the treating provider
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:
a. An employer
accommodates the restrictions; or
b. The treating provider releases
the IW to return to the former position of employment; or
c. The treating provider makes
a finding that the IW has reached MMI.
4. BWC 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 TT.
5. Sick Leave Buy Back/Wage
– 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.
a. Special circumstances
include, but are not limited to the following:
i. A clearly defined human
resource policy/employee handbook policy; or
ii. A bargaining unit contract.
b. The agreement must
i. The 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
ii. BWC 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.
a. A volunteer IW with no
other employment is not entitled to TT as no loss of wages has occurred due to
a work-related injury.
b. BWC 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.
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 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.
3. Employer 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 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;
ii. Claim 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 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 claim.
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
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
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 Multiple
– 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 attending
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
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 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 earnings.
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
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:
initial allowance decision in the claim is final; or
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
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 provider file review or
present exam findings to support denial of the request prior to IC referral.
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 the C-86.
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 provider until there is an MMI finding or the
IC makes a determination on the IC-2.
the IC allows the IC-2, BWC will terminate TT as ordered by the IC.
an IC-2 is filed and/or is being processed by the IC and the evidence on
file is from a provider other than the treating provider who indicates
the IW has reached MMI, BWC may send the MMI issue to the IC while the
IC-2 is still under consideration.
an IC-2 is filed and is being processed by the IC and BWC receives
medical evidence from the treating provider 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 IC-2.
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 provider to obtain a date.
Example #1: On the MEDCO-14, the
treating provider 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
#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 refusal.
4. For more information
regarding exams, refer to BWC’s Independent Medical Examinations policy.
and Concurrent Payments
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 conditions;
c. Facial Disfigurement
d. Violation of Specific
Safety Requirement (VSSR);
e. Statutory 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;
f. Percentage 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 between
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 claim:
a. Wage Loss (WL);
b. Living Maintenance
c. Living Maintenance Wage
d. Change of Occupation;
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 provider 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 provider 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 provider’s report must strongly conclude that the IW has reached MMI
in order for the report to support TT termination. However, if the treating provider
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 provider 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 provider
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 provider specifies an MMI effective date. It is BWC’s policy to
pay TT through the day before the MMI effective date.
treating provider performs an exam on 10/01/2009.
treating provider’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 provider’s
paid through 9/30/2009.
treating provider 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 provider 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 circumstances exist.
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:
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 provider’s concurrence or the specific date given by
the treating provider. It is BWC’s policy to pay TT through the day before the
MMI effective date.
IME is performed on 10/01/2013.
report dated 10/03/2013 states the IW has reached MMI.
treating provider’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.
services 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 provider
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
provider, regardless if the date is before or after the MMI date noted in the
IME is performed on 10/01/2013.
IME report dated 10/03/2013 states the IW has reached MMI.
treating provider’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
services 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 TT.
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
b. The IW’s treating provider
has made a written statement that the IW is capable of returning to the former
position of employment;
c. The IW’s treating provider
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 capabilities.
job offer must be in writing.
ii. The IW’s treating provider
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 provider 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
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 payment.
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 payment.
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 provider provided an MMI date).
6. Return to Work (RTW) –
The effective date for termination is the actual date the IW returned to work.
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.
7. Treating Provider
Releases the IW without Restrictions – The effective date of the termination is
the date the treating provider releases the IW to return to work to his/her
former position of employment.
8. Treating Provider
Releases the IW with Restrictions - When the treating provider 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 for hearing.
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 &
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.
11. Reinstating TT
1. Reinstating Terminated
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.
2. Reinstating 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
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 provider following the period of
i. Supporting 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 provider. 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.