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OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Disputes Regarding Vocational Rehabilitation Decisions

Policy #:

VR-04-01

Code/Rule Reference:

R.C. 4121.441; O.A.C. 4123-6-16; O.A.C. 4123-18-03

Effective Date:

10/10/16

Approved:

Deborah Kroninger, Chief of Medical Operations (Signature on file)

Origin:

Vocational Rehabilitation Policy

Supersedes:

All vocational rehabilitation policies, procedures, directives and memos regarding disputes of vocational rehabilitation decisions  that predate the effective date of this policy and procedure.

History:

New

Review date:

10/10/19

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure disputes related to vocational rehabilitation services are handled appropriately.

 

II. APPLICABILITY

 

This policy applies to:

·         BWC staff;

·         Managed care organization (MCO) staff; and

·         Vocational rehabilitation case managers (VRCMs) assigned by the MCO.

 

III. DEFINITIONS

 

See “Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy Reference Guide.

 

IV. POLICY

 

A.    It is the policy of BWC to resolve disputes related to vocational rehabilitation services in a fair, timely and efficient manner.

 

B.    Appeals

1.    It is the policy of BWC that MCO vocational rehabilitation feasibility or case closure decisions  may be appealed pursuant to the alternative dispute resolution (ADR) process contained in O.A.C. 4123-6-16.

2.    Appeals to a BWC Vocational Rehabilitation Decision:

 

a.    It is the policy of BWC that decisions made by BWC related to vocational rehabilitation may be appealed to the BWC Rehabilitation Eligibility Appeals Unit.

b.    The types of appealable vocational rehabilitation decisions BWC typically makes include:

i.      Eligibility for vocational rehabilitation;

ii.     Medical hold closure;

iii.    Eligibility for living maintenance or living maintenance wage loss; and

iv.   Travel reimbursement related to vocational rehabilitation services.

3.    An appeal or dispute to a BWC vocational rehabilitation decision must be filed within 14 calendar days of receipt of the decision.

 

V. Procedures

 

A.    The MCO shall inform the disability management coordinator (DMC) if an appeal is filed with the MCO.

 

B.    The MCO shall follow the ADR procedures for processing an appeal as provided in O.A.C 4123-6-16.

 

C.   The BWC Rehabilitation Appeals Unit shall review, investigate and respond to any appeal received regarding a BWC vocational rehabilitation decision.

 


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