and Procedure Name:
Vocational Rehabilitation Case Closure
Kroninger, Chief of Medical Operations (Signature on file)
vocational rehabilitation policies, procedures, directives and memos
regarding vocational rehabilitation case closure that predate the effective
date of this policy and procedure.
purpose of this policy is to ensure that vocational rehabilitation cases are
closed for consistent reasons in a consistent manner.
policy applies to the:
disability management coordinators (DMCs);
care organization (MCO) staff involved in the coordination and management of
the vocational rehabilitation program; and
rehabilitation case managers (VRCMs) assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy
A. It is the policy of
BWC to close a vocational rehabilitation case when vocational rehabilitation
services will not be provided or are no longer being provided.
B. Closure of a
1. Closure of a
vocational rehabilitation referral occurs after:
a. The injured worker (IW)
has been found not eligible;
b. The IW has been found
eligible but is not feasible for services; or
c. The IW has been found
eligible and feasible but the IW does not participate in services.
C. Closure After
Participation in a Vocational Rehabilitation Plan - After the IW has
participated in a vocational rehabilitation assessment plan, comprehensive
vocational rehabilitation plan, or job retention plan (“vocational
rehabilitation plan”), closure occurs when:
1. The IW has completed
an assessment plan and it is determined further vocational rehabilitation
services are not needed;
2. The IW has failed to
fulfill the responsibilities outlined in the vocational rehabilitation plan;
3. The IW is unable to attain
the goals of the vocational rehabilitation plan;
4. The IW has refused,
without good cause, to accept an offer of employment within the vocational goal
of the comprehensive vocational rehabilitation plan;
5. The IW dies;
6. The IW does not agree
with the decision of the MCO or BWC to approve or deny specific vocational
rehabilitation plan services;
7. The claim is
subsequently disallowed by an order of the Industrial Commission or by order of
8. The claim is settled
for medical and/or indemnity;
9. The IW has completed
a comprehensive vocational rehabilitation plan;
10. The IW has completed
a job retention plan;
11. The IW is determined
to be no longer feasible for vocational rehabilitation services; or
12. The IW has returned
to work and the case follow-up period has ended.
A. The MCO shall notify
the DMC by phone, fax or email of a return to work or other case closure event within
one business day.
B. Within ten (10)
business days of case closure:
1. For all cases in
which the IW has been determined eligible, whether or not assigned to a VRCM, the
MCO shall prepare and send a vocational rehabilitation closure letter to all
parties to the claim, including a copy to the DMC, which includes:
a. The specific reason
b. The IW’s appeal
c. The timeframes for
appeal using the established closure date.
2. For referrals that
have been assigned to a VRCM:
a. The VRCM shall
complete and provide to the MCO a Vocational Rehabilitation Closure Report
b. The MCO and VRCM
shall complete the Complexity Factor form; and
c. The MCO shall forward
the report and Complexity Factor form to the DMC.
DMC shall assign the closure code. If the MCO believes the closure code does
not correspond with the information submitted, the MCO shall contact the DMC to
1. A closure may be
rescinded during the closure appeal period if the MCO, employer and IW all
agree to keep the vocational rehabilitation case open.
2. If the employer is
out of business or no longer doing business in Ohio, the employer’s agreement
is not required, consistent with the Due Process policy.
3. The MCO shall send a
letter to all parties documenting the agreement to rescind a closure.
D. Lump Sum Settlement
(LSS) and Closure of a Case
1. When the DMC becomes
aware that a Settlement Agreement and Application for Approval of Settlement
Agreement (C-240) is filed in a claim where the IW is participating in a
vocational rehabilitation plan:
a. The DMC shall ensure
the MCO and VRCM are aware of the LSS application.
b. The DMC shall
communicate with the LSS CSS, monitor the status of the claim and keep the MCO
and VRCM apprised.
rehabilitation services may continue until the day before the claim enters
“Settled-Pending” status (i.e., the day the “Approval of Settlement Agreement”
letter is mailed).
d. Services provided on
or after the effective date of settlement shall not be reimbursed.
2. If settlement is
reached and no prior notice was given to the provider, a closure report shall
not be completed. BWC shall reimburse authorized services provided prior to the
effective date of the settlement.
3. Refer to the Lump
Sum Settlement policy and procedure for further information.