OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Wage Loss Compensation

Policy #:

CP-23-02

Code/Rule Reference:

R.C. 4123.56; R.C. 4123.68; O.A.C. 4125-1-01; O.A.C. 4123-17-30

Effective Date:

02/03/2022

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-23-02, effective 09/15/2020 and Procedure # CP-23-02.PR1, effective 09/15/2020

History:

Previous versions of this policy are available upon request


 

Table of Contents

 

II. APPLICABILITY

III. DEFINITIONS

Closed Period

Good Faith Job Offer

Good Faith Job Search

Initial Request

Present Earnings

Public Work Relief Employee

Separation of Employment

Subsequent New Request

Subsequent Ongoing Request

Suitable Employment

Wage Loss

Wage Replacement Compensation

IV. POLICY

A.          General Policy for Wage Loss Compensation

B.          Eligibility for Wage Loss Compensation

C.          Evidentiary Requirements for Wage Loss Compensation

D.          Subsequent Ongoing Request(s) for Wage Loss Compensation

E.          Job Search Requirements for Wage Loss Compensation

F.          Good Faith Job Offer for Suitable Employment

G.         Other Wage Loss Compensation Circumstances

H.          Other Receipt of Benefits and Impact to Wage Loss Compensation

I.            BWC Determination or Notice of Referral to the Industrial Commission

J.           Calculation of Wage Loss Compensation Benefits

K.          Maximum Number of Weeks

L.           Concurrency of Wage Loss Compensation

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Expectations for Wage Loss Compensation

C.          Reviewing Wage Loss Compensation Request

D.          Evaluating Job Searches for Suitable Employment

E.          Verification of Job Searches for Suitable Employment

F.          Issuing Order or Notice of Referral and Payment

 

 

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC evaluates the evidence and makes an appropriate determination regarding payment of wage loss compensation to an injured worker who experiences a reduction in earnings as a direct result of physical and/or psychiatric restrictions caused by the allowed condition(s) in the claim.

 

II. APPLICABILITY

 

This policy applies to claims services staff.

 

III. DEFINITIONS

 

Closed Period: A request for wage loss compensation for a definitive period that includes a start and end date in the past.

 

Good Faith Job Offer: A written offer of work within the injured workers restrictions made by the employer of record or another employer. The offer should have similar hours, commute time, shifts and accommodate scheduling needs that were at issue with the employer of record.

 

Good Faith Job Search: An injured worker’s consistent, sincere, and best attempts to obtain suitable employment that will eliminate a loss in earnings. This includes an injured worker’s devotion of time to job search consistent with restrictions, former position of employment and hours able to work.

 

Initial Request: An injured worker’s first request for wage loss compensation in their claim.

 

Present Earnings: An injured worker’s actual weekly gross earnings which are generated by gainful employment; or if self-employed, the injured worker’s gross income minus business-related expenses. It is a rebuttable presumption that:

  • Earnings from paid leave (e.g., vacation, sick, etc.) provided by the employer will be included in present earnings.
  • Injured workers engaged in self-employment have a gross income of at least fifty percent of the statewide average weekly wage.

 

Public Work Relief Employee: A person engaged in any service or labor, under the supervision and control of a government body, either directly or through agencies, in exchange for some form of public funds or goods, on the basis of the budgetary needs of the work-relief employee and his or her dependents.

 

Separation of Employment: The end of the employment relationship between the employer of record or another employer and the injured worker.

 

Subsequent New Request: A period of wage loss after there has been an interruption in wage loss payments due to ineligibility (including extended periods when the injured worker failed to submit a request).

 

Subsequent Ongoing Request: A continual request, without a break, for wage loss compensation after an award, whether an initial or subsequent new request, is granted.

 

Suitable Employment: Work which is within the injured worker’s restrictions, and which may be performed by the injured worker subject to all physical, psychiatric, mental and vocational limitations to which the injured worker was subject on the date of the injury, or on the date of disability in occupational disease claims.

 

Wage Loss: The dollar amount of the diminishment of wages sustained by an injured worker as a direct result of physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim, including:

  • Non-working wage loss (NWWL) – when the injured worker has not returned to work because he or she has been unable to find suitable employment;
  • Working wage loss (WWL) – when the injured worker has returned to employment which is not his or her former position of employment.

 

Wage Replacement Compensation: Compensation intended to replace an injured worker’s earnings. This includes temporary total, living maintenance, living maintenance wage loss, wage loss (working and non-working), permanent total disability and salary continuation.

 

 

IV. POLICY

 

A.    General Policy for Wage Loss Compensation

1.    It is the policy of BWC to provide an injured worker:

a.    Working Wage Loss (WWL): when an injured worker returns to employment or has remained at work following an injury but suffers a loss in wages due to different job duties, less hours, have to miss work to get approved medical treatment that is only available during work hours or other circumstances as a direct result of physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim; or

b.    Non-Working Wage Loss (NWWL): when the injured worker is released to return to work with physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim, but is unable to find suitable employment; or

c.     Living Maintenance Wage Loss (LMWL): See the Living Maintenance Wage Loss policy for information on this compensation. LMWL is not addressed in this policy.

2.    BWC may pay wage loss compensation benefits beginning the day after an injury when eligibility and evidentiary requirements are met in this policy and procedure.

3.    BWC may perform an independent medical examination to further evaluate an injured worker’s application and work restrictions submitted by their physician.

4.    It is the policy of BWC to establish expectations for an injured worker requesting an initial request or subsequent new request, and for subsequent ongoing requests for wage loss compensation.

 

B.    Eligibility for Wage Loss Compensation

1.    To be eligible for wage loss compensation benefits, an injured worker must:

a.    Have a date of injury on or after 08/22/1986;

b.    Have returned to employment other than the former position of employment or has been unable to find employment consistent with the physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim;

c.     Experience a reduction of earnings; and

d.    The reduction in earnings is a direct result of physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim.

2.    Claims allowed for the following occupational diseases are not eligible for wage loss compensation, but may be eligible for a change of occupation benefit:

a.    Silicosis;

b.    Coal miners’ pneumoconiosis (black lung);

c.     Asbestosis;

d.    Any other occupational disease of the respiratory tract resulting from injurious exposure to dust; or

e.    Firefighters (paid or volunteer) and police officers whose claims are allowed for:

i.      Cardiovascular;

ii.     Pulmonary; or

iii.    Respiratory conditions.

f.      See the Change of Occupation policy for more information.

3.    A firefighter with cancer occupational disease claim allowed pursuant to R.C. 4123.68(X) is only eligible for working wage loss compensation.

 

C.   Evidentiary Requirements for Wage Loss Compensation

1.    It is the policy of BWC that an injured worker must meet evidentiary requirements in order to receive wage loss compensation benefits.

2.    Evidentiary requirements are dependent upon the type of request and may include a combination of the following:

a.    For an initial request only, an injured worker shall seek employment with the employer of record before going to Ohio Department of Job and Family Services and doing a job search and seeking alternate employment.  Written proof is required.

b.    A C-140 form or its equivalent.

c.     A C-141 form(s) or its equivalent.

d.    A C-142 form(s) or its equivalent.

e.    Medical report of physical and/or psychiatric restriction(s) caused by the allowed condition(s) in the claim.

f.      Payroll or pay stubs showing gross earnings.

g.    Self-employment weekly or quarterly profit (i.e., gross income minus business-related expenses).

h.    Documentation necessary to support a good faith job search for suitable employment.

i.      Additional information requested by BWC to support the wage loss compensation request.

 

D.   Subsequent Ongoing Request(s) for Wage Loss Compensation

1.    When an injured worker’s wage loss is periodically equal to zero dollars ($0) for a specific week because the injured worker’s earnings were equal to or higher than the average weekly wage or full weekly wage, it is the policy of BWC to continue to consider the wage loss award as a subsequent ongoing request. However, weeks where earnings result in no wage loss will not be included in the calculation for total weeks of eligibility.

2.    When an injured worker ceases to be eligible for wage loss compensation or there is an extended period of time between requests for wage loss compensation, BWC will not consider an injured worker’s subsequent wage loss request to be a subsequent ongoing request. When the injured worker seeks wage loss compensation again, it is the policy of BWC to consider the request a subsequent new request.

 

E.    Job Search Requirements for Wage Loss Compensation

1.    It is the policy of BWC that for every week of wage loss compensation requested, the injured worker must submit proof of a good faith job search for suitable employment, unless otherwise required, on Wage Loss Statement for Job Search (C-141) forms or equivalent forms.

2.    Job search form(s) (C-141 or equivalent forms) shall be submitted at least every four weeks.  

3.    It is the policy of BWC that a good faith job search may not be required when the injured worker:

a.    Returns to alternative employment with the employer of record;

b.    Returns to alternative employment with another employer at the direction of the employer of record;

c.     Is receiving public relief pursuant to R.C. 4127.05; or

d.    Is working and BWC or the Industrial Commission (IC) determines, due to the totality of the circumstances, that a job search is not required.

 

F.    Good Faith Job Offer for Suitable Employment

1.    The failure of an injured worker to accept a good faith job offer for suitable employment may be considered as a reason to deny, reduce, or terminate wage loss compensation.

2.    In determining if the injured worker was offered suitable employment in good faith, BWC may consider whether:

a.    The employment offer has been made in writing.

b.    The employment offer contains a detailed description of the job duties, hours, and rate of pay.

c.     The employment offer meets the  injured worker’s restrictions noted by the physician of record.

d.    If the employment offer:

i.      Requires the injured worker to work significantly more hours per week than the former position of employment;

ii.     Requires the injured worker to work a shift(s) different from the shift(s) the injured worker was working at the time of injury; or

iii.    Requires the injured worker to relocate.

e.    Any other factors related to the suitability of the job offer.

 

G.   Other Wage Loss Compensation Circumstances

1.    Eligibility for working wage loss compensation may be established when the injured worker suffers a work-related injury and misses work to receive prescribed, approved medical treatment(s) for the injury, the injured worker may recover wage-loss compensation for the time absent from work when wage loss eligibility and evidentiary requirements are otherwise met. To recover for a wage loss, an injured worker must prove:

a.    The treatment was medically necessary for the injured worker to perform his or her job.

b.    That without the treatment he or she could not continue to work full time;  and

c.     That treatment was available only during the injured worker’s hours of employment.

2.    Separation of Employment or Limiting Income

a.    When an injured worker separates from employment by choice or for violation of some work rule, wage loss compensation may no longer be payable.

b.    When an injured worker separates from employment due to forces outside of the injured worker’s control, wage loss compensation may still be payable.

c.     When an injured worker voluntarily limits their income for reasons unrelated to the restrictions of their claim or is refusing to do a good faith job search wage loss compensation may no longer be payable or reduce their benefits.

 

H.   Other Receipt of Benefits and Impact to Wage Loss Compensation

1.    If an injured worker is receiving non-occupational accident and sickness insurance payments pursuant to an insurance policy or program fully funded by the employer of record, those payments will be considered present earnings and will offset/reduce wage loss compensation benefits.

2.    Social security benefits (disability or retirement) are not considered earnings and do not reduce wage loss compensation benefits.

3.    Unemployment benefits are not considered earnings and do not reduce wage loss compensation benefits.

a.    BWC does not reimburse Ohio Job and Family Services when wage loss compensation and unemployment benefits are paid over the same period.

b.    See the Ohio Department of Job and Family Services (ODJFS) Reimbursement and Claim Adjustment policy for additional information.

4.    Public Work Relief money received by an injured worker does not reduce wage loss compensation benefits.

5.    It is the responsibility of the injured worker, not BWC, to accurately report wage loss compensation benefits to other entities the injured worker is receiving benefits from.

 

I.      BWC Determination or Notice of Referral to the Industrial Commission

1.    BWC shall make a determination on an initial request or a subsequent new request for wage loss compensation in all state fund claims no later than 30 calendar days from receipt of the application.

a.    When approving the wage loss compensation request, BWC shall issue an order;

b.    When recommending denying or reduce wage loss compensation, BWC shall issue a notice of referral to the Industrial Commission.

2.    BWC shall process subsequent ongoing requests within seven (7) calendar days and either:

a.    Pay wage loss compensation; or

b.    Refer the period requested on a notice of referral to the Industrial Commission with BWC’s recommendation to deny, reduce, or terminate wage loss compensation.

3.    BWC shall complete a notice of referral to the Industrial Commission with BWC’s recommendation for a determination when an injured worker files for wage loss compensation in multiple claims.

 

J.     Calculation of Wage Loss Compensation Benefits

1.    It is the policy of BWC to calculate wage loss compensation on a weekly basis.

2.    It is the policy of BWC to include commission sales, bonuses, gratuities, and all other forms of compensation (e.g., paid leave) for personal services customarily received by an injured worker in the course of his or her employment as present earnings.

3.    When earnings are not paid on a weekly or biweekly basis, the receipt of earnings will be apportioned over the number of weeks it is determined were required to initiate and consummate the commission sale or earn the bonus, gratuity, or other compensation.

4.    For self-employed injured workers, it is the policy of BWC that:

a.    The actual weekly present earnings are considered the gross income, less any business expenses not already accounted for in the gross income.

b.    A self-employed injured worker has a gross income of at least fifty percent (50%) of the current statewide average weekly wage.

5.    BWC shall calculate and pay wage loss compensation at sixty-six and two-thirds percent (66 2/3%) of the difference between the injured worker’s average weekly wage or full weekly wage, whichever applies based on date of injury or disease, and the injured worker’s actual weekly present earnings.

a.    For claims with a date of injury or disease before 05/15/97, the wage loss calculation is based on the greater of the injured worker’s average weekly wage or full weekly wage.

b.    For claims with a date of injury or disease on or after 05/15/97, the wage loss calculation is based on the injured worker’s average weekly wage.

6.    When the Industrial Commission determines that the injured worker voluntarily failed to accept a good faith job offer of suitable employment when requesting wage loss compensation, it is the policy of BWC to calculate the wage loss compensation benefits at 66 2/3% of the difference between the injured worker’s average weekly wage or full weekly wage, whichever is applicable, and the weekly wage the injured worker would have earned in the employment the injured worker failed to accept, unless otherwise ordered by the Industrial Commission.

7.    When the Industrial Commission determines that the injured worker is voluntarily limiting their income when requesting wage loss compensation, it is the policy of BWC to calculate wage loss compensation benefits at 66 2/3% of the difference between the injured worker’s average weekly wage or full weekly wage, whichever is applicable, and the weekly wage the injured worker would have earned if the injured worker had not voluntarily limited their income, unless otherwise ordered by the Industrial Commission.

 

K.    Maximum Number of Weeks

1.    It is the policy of BWC that for claims with a date of injury on or after 08/25/2006:

a.    An injured worker may receive up to a maximum of 200 weeks of wage loss compensation (subject to the provision for non-working wage loss) in a claim.

b.    Non-working wage loss is limited to a maximum of 52 weeks; however, 26 weeks of non-working wage loss are excluded from the 200-week wage loss compensation limitation.

c.     Living maintenance wage loss compensation is included when calculating the total number of weeks of wage loss compensation.

d.    Only weeks the injured worker receives a wage loss payment will be counted towards the maximum number of weeks the injured worker may receive wage loss compensation. For example, one week the injured worker’s earnings may be enough that there is no calculable wage loss. That week would not count towards the maximum number of weeks wage loss compensation is payable.

2.    It is the policy of BWC that for claims with a date of injury prior to 08/25/2006:

a.    An injured worker may receive up to a maximum of 200 weeks of wage loss compensation.

b.    The total number of weeks paid in living maintenance wage loss compensation will not count towards the 200 week-maximum for wage loss compensation.

c.     The total number of weeks paid in wage loss compensation will be deducted from the 200 week-maximum for living maintenance wage loss.

 

L.    Concurrency of Wage Loss Compensation

1.    Wage Replacement Compensation:

a.    An injured worker may only receive one type of wage replacement compensation at a time. Wage replacement compensation is not payable concurrently in the same claim or across claims.

b.    Once a claim is allowed for statutory permanent total disability, the injured worker is not entitled to receive wage loss compensation in the same claim.

c.     Wage loss compensation may be paid concurrently in two different claims only if ordered by the Industrial Commission for split payment in two different claims.

2.    Awards:

a.    Wage loss compensation and Scheduled Loss Compensation are payable concurrently in one or more claims.

b.    Wage loss compensation and Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability Compensation (%PP) are payable concurrently:

i.      In different claims; or

ii.     In the same claim, if the %PP award is granted first and then subsequently wage loss compensation is requested and awarded.

 

 

V. PROCEDURE

 

A.    General Claim Note and Documentation Requirements

1.    BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note and documentation requirements; and

2.    Shall follow any other specific instructions for claim notes and documentation included in this procedure.

 

B.    Expectations for Wage Loss Compensation

1.    Claims services staff shall review eligibility requirements as well as expectations for submission of supporting evidence with an injured worker who is considering or requesting wage loss compensation.

2.    Claims services staff shall make at least two attempts by telephone to the injured worker to review eligibility and discuss expectations. In addition, staff shall:

a.    Enter a detailed note summarizing the discussion with the injured worker.

b.    Prepare the working or non-working wage loss expectations letter in the claims management system documenting the telephone conversation and review this letter with an injury management supervisor prior to sending.

c.     Once the injury management supervisor approves the working or non-working wage loss expectations letter, send it to the injured worker.

3.    If claims services staff is unable to reach the injured worker by telephone, claims services staff shall prepare the working or non-working wage loss expectations letter, review it with an injury management supervisor, and send it to the injured worker after obtaining the injury management supervisor’s approval.

4.    Claims services staff shall reevaluate and reestablish expectations with the injured worker as may be necessary due to changing circumstances or problems with submission of documentation.

 

C.   Reviewing Wage Loss Compensation Request

1.    Initial Request or Subsequent New Request - Claims services staff shall evaluate an initial request or a subsequent new request for wage loss compensation to ensure the injured worker meets eligibility and evidentiary requirements.

a.    Claims services staff shall evaluate the injured worker’s wage loss compensation application (C-140) to ensure that:

i.      The application is completed in its entirety.

ii.     There is an indication of the type of wage loss compensation being requested and the beginning date of the wage loss and if a closed period, an end date.

iii.    When requesting non-working wage loss compensation, there is proof showing registration with the Ohio Department of Job and Family Services, or when an injured worker lives out of state, an equivalent agency in the injured worker’s state of residence;

iv.   There is a detailed employment history, including job titles and description of each position held;

v.     There is written proof the injured worker sought suitable employment with the employer of record at the onset of the initial request for wage loss compensation unless the injured worker establishes that seeking such employment would be futile (e.g., the injured worker was discharged, the employer is out of business, employer states work is not available within restrictions, IW was laid off and, where applicable, subject to recall). This is a onetime requirement and is not required for a subsequent new request for wage loss compensation;

vi.   There is an injured worker’s signature certifying that all the information being provided to BWC is true and accurate to the best of the injured worker’s knowledge, and that the injured worker served a copy of the wage loss compensation application and supporting documentation to the employer of record.

b.    Claims services staff shall review to verify that a medical report (i.e., C-140 page 2 or its equivalent) accompanies the injured worker’s application for wage loss. The medical report shall contain:

i.      Documentation of work restrictions caused by the physical and/or psychiatric condition(s) allowed in the claim;

ii.     A statement of whether those work restrictions are temporary or permanent;

a)    When the restrictions are temporary, the expected duration of those restrictions (temporary restrictions cannot be certified for a period to exceed 90 days without a new examination of the injured worker).

b)    When the restrictions are permanent, affirmation that the report is based on an examination or treatment conducted within 90 days prior to the initial request or subsequent new request for wage loss compensation.

iii.    A separate statement of any other restrictions not related to the allowed condition(s) in the claim;

iv.   The date of the last medical examination;

v.     The date of the report; and

vi.   The name and signature of the physician who authored the report.

c.     Claims services staff shall review to verify that evidence of a good faith job search for suitable employment (i.e. Wage Loss Statement for Job Search (C-141) form or its equivalent) accompanies the injured worker’s application for wage loss. The injured worker shall provide:

i.      Documentation of job searches for suitable employment performed for the weeks wage loss compensation is requested;

ii.     Documentation of job search(es) performed such as copy of job ad applied for, confirmation of submission for online job application, and other proof as may be determined by BWC as necessary to support job searches;

iii.    For working wage loss compensation, proof of earnings (e.g., copies of payroll reports, pay stubs or a C-142 or its equivalent).

d.    Claims services staff shall create a legal case in the claims management system for the initial request or a subsequent new request for wage loss compensation.

2.    Incomplete Wage Loss Compensation Application

a.    When the application for wage loss compensation (C-140 or its equivalent) is incomplete, claims services staff shall contact the injured worker by telephone to secure the missing information.

i.      If the application contains missing information, claims services staff may obtain the missing information on the application verbally.

ii.     If the application is missing supporting documentation, claims services staff shall request the documentation that is missing to support the request from the injured worker and/or MCO.

iii.    If the missing information is a medical report describing the restrictions, or the medical report provided indicates that the restrictions are for conditions not allowed in the claim, claims services staff shall contact the MCO and request additional information to clarify the report received.

b.    Claims services staff may send (by fax, email or mail) the “WL-Incomplete C-140” letter to the injured worker and, if applicable, to the injured worker’s representative when unsuccessful in contacting the injured worker by telephone.

c.     Claims services staff shall continue processing the request when the requested missing information is received.

d.    If requested missing information is not received, claims services staff shall complete a notice of referral to the Industrial Commission when the injured worker and/or physician does not provide the required information within thirty (30) days from BWC’s receipt of the wage loss compensation application.

e.    If the requested missing information is received after a referral but before a hearing is scheduled, claims services staff may attempt to withdraw the notice of referral and continue processing the application. (See the Notice of Referral to the Industrial Commission policy for more information on withdrawing a referral).

f.      If the condition(s) causing the restrictions appear to be related to the claim and those conditions have been requested but not yet adjudicated, claims services staff shall contact the injured worker to determine if the injured worker wants to:

i.      Move forward with the wage loss compensation application; or

ii.     Dismiss the wage loss compensation application until the conditions are adjudicated.

3.    Claims services staff shall evaluate subsequent ongoing wage loss compensation requests to ensure the injured worker has submitted documentation to support an ongoing loss of earnings. Claims services staff shall evaluate each subsequent ongoing wage loss compensation request to:

a.    Verify the injured worker still meets eligibility and evidentiary requirements; and

b.    BWC may request additional documentation, as necessary, to support a subsequent ongoing wage loss compensation request.

4.    Wage Loss Compensation payments stop and request to resume payments is submitted

a.    When there is a break in wage loss compensation payments and the injured worker subsequently requests wage loss compensation, claims services staff shall investigate by contacting the injured worker to obtain information regarding the timing and reasons for the break.

b.    Upon gathering information from the injured worker, claims services staff shall staff the claim with their supervisor and if necessary a BWC attorney to determine whether there is evidence to support subsequent ongoing wage loss, or whether a subsequent new request must be made.

i.      Subsequent ongoing wage loss compensation may continue if there is a minimal time period where the evidence does not support wage loss compensation, but the remaining time periods of wage loss requested are supported by the evidence.

ii.     A subsequent new request must be filed if there is an excessive time period where the evidence does not support wage loss compensation, even if the remaining time periods are supported by the evidence (e.g., there is a 30-day break in the supporting evidence with the injured worker transitioning from working to non-working wage loss).

c.     Claims services staff shall notify the injured worker if the wage loss request will be treated as a subsequent new request and if any additional information must be provided by the injured worker.

5.    Other wage loss compensation circumstances:

a.    When claims services staff identify that an injured worker may be self-limiting their income, the claim shall be staffed with the supervisor and BWC attorney to determine appropriate course of action.

b.    When an injured worker becomes separated from employment while receiving working wage loss compensation, claims services staff must contact the injured worker to find out the cause for the separation and then subsequently staff the claim with the supervisor and BWC attorney to determine possible impacts to wage loss compensation.

c.     Before excusing an injured worker from performing job searches pursuant to IV.E.2. of this policy, claims services staff must first consult with the supervisor and BWC attorney.

d.    Claims services staff may perform an independent medical examination to further evaluate an injured worker’s application and work restrictions submitted by their physician but only with a supervisor and BWC attorney approval.

 

D.   Evaluating Job Searches for Suitable Employment

1.    For every week that wage loss compensation is requested, an injured worker must submit a C-141 or equivalent form(s) documenting their search for suitable employment, unless exempt from conducting a job search under section IV.E.2.

2.    An injured must submit job search form(s) at least every four weeks.

3.    Claims services staff shall not set a specific number of job searches required by the injured worker. Instead, the reasonableness of the number of job searches performed each week should depend on factors such as the number of hours the injured is released to return to work, whether the injured worker is not working at all or working full or part time, and whether the job search is conducted on-line or in-person. Online job searches should include documented time preparing resume, reviewing jobs, uploading resume, and applying for jobs.

4.    Claims services staff shall evaluate job search statements and ensure the following information is included:

a.    The name and address of each employer contacted;

b.    The employer’s telephone number;

c.     The position sought;

d.    A reasonable identification by name or position of the person contacted;

e.    The date and method of contact;

f.      For on-line job searches, a copy of the on-line posting and verification of the application submission;

g.    The result of the contact; and

h.    Any other information requested by BWC.

5.    The injured worker :

a.    For the first 60 days, may limit their search for suitable employment to jobs that are within the injured worker’s skills, prior employment history, and educational background.

b.    After 60 days of an unsuccessful job search, shall expand his or her job search to include entry level and/or unskilled employment.

6.    Claims services staff shall evaluate an injured worker’s job search for suitable employment to determine if it has been made in good faith by considering the following factors:

a.    The injured worker’s skills, prior employment history, and educational background;

b.    The number, quality and regularity of contacts made by the injured worker with prospective employers, and/or public and private employment services;

c.     The amount of time devoted to making prospective employer contacts;

d.    For an injured worker receiving WWL, the number of hours the injured worker is working;

e.    Any refusal of the injured worker without good cause to accept employment seeking assistance from BWC, or free of charge assistance from any public or private entity;

f.      Labor market conditions;

g.    The injured worker’s restrictions.

h.    Any recent activity of the injured worker to change his or her place of residence and the impact such a change would have on the reasonable probability of success in the search for employment;

i.      The injured worker’s economic status as it impacts his or her ability to search for employment, including such things as access to:

i.         public and private transportation;

ii.       Internet services;

iii.     telephone service; and

iv.     any other means of communication.

j.      The self-employed injured worker’s documentation of efforts undertaken on a weekly basis to produce self-employment income;

k.     Any part-time employment engaged in by the injured worker and whether that employment constitutes a voluntarily limitation on the injured worker’s present earnings;

l.      Whether the injured worker is only seeking employment that would require him or her to work fewer hours per week than worked in the former position of employment.

m.   Whether the injured worker, due to the restrictions from the allowed conditions in the claim, is enrolled in a rehabilitation program with the Opportunities for Ohioans with Disabilities (OOD) agency and is attending an education institution approved by OOD.

n.    Whether the injured worker has engaged in coursework or other time spent that will benefit the injured worker’s job search efforts. (e.g., updating resume, class on how to market oneself and write a better resume.)

 

E.    Verification of Job Searches for Suitable Employment

1.    Claims services staff may do a job search verification when inconsistencies are identified. Some examples of inconsistencies:

a.    Requirements for positions listed on job search are inconsistent with the injured worker’s restrictions or injured worker’s job skills;

b.    The same employers are repeatedly listed;

c.     The job search documentation is not being completed as required;

d.    The injured worker is not providing proof of applications filed via the internet.

2.    When inconsistencies are identified and/or claims services staff has other reason to believe the job search information needs to be verified, claims services staff shall initially contact a random sample of the employers listed.

a.    Verifying job searches shall be conducted in such a way as to avoid hindering the injured worker’s employment opportunity and in compliance with BWC’s sensitive data policies.

b.    A sample script for claims services staff to use for verifying an employment contact is as follows: “Hi, my name is Martha Jones with the State of Ohio. I am working with Rose Tyler and want to verify that she has applied for a job with your company. Our records indicate that she applied for a cashier position and submitted an application to Amy Pond in Human Resources. Is this information correct?”

3.    Claims services staff shall document the random sample review on the “Wage Loss Job Search Verification Summary Worksheet” available on COR and summarize the review in claim notes.

4.    If the job search verification random sample review indicates that the IW is making a good faith job search, claims services staff shall image the “Wage Loss Job Search Verification Summary Worksheet” into the claims management system, enter a claim note and take no further action.

5.    If the job search verification of the random sample, indicates that the injured worker is not making a good faith job search, claims services staff shall verify every contact listed on the C-141, continuing to document the results on the “Wage Loss Job Search Verification Summary Worksheet.

6.    If the additional job search verification supports that the IW is not making a good faith job search, claims services staff shall review the claim with their supervisor and BWC attorney to determine the next appropriate step.

a.    A referral to the IC may be appropriate if the job search verification and documentation reflects a pattern of non-compliance.

i.      Claims services staff shall complete the “Wage Loss Job Search Verification Affidavit” and image it into the claim; and

ii.     Complete the notice of referral to the IC stating that the IW has failed to make a good faith job search for the period requested on the C-141 (or equivalent) and cite the supporting evidence (which includes the “Wage Loss Verification Summary Worksheet” and the “Wage Loss Job Search Verification Affidavit”).

iii.    Claims services staff shall withhold wage loss compensation for the disputed period until directed otherwise by the IC.

b.    If a referral to Special Investigations Unit is determined to be appropriate, claims services staff shall follow the Fraud/Special Investigations policy and procedure.

c.     If instead of referral to the IC or the Special Investigations Unit it is determined that the appropriate next step is to educate and establish additional expectations for the injured worker, claims services staff shall contact the injured worker, review any problems with previous job search submissions, and set expectations for future job search submissions. Claims services staff shall follow up with a letter to the injured worker outlining the expectations.

 

F.    Issuing Order or Notice of Referral and Payment

1.    Claims services staff shall only issue a BWC order for wage loss compensation when:

a.    It’s an initial request or a subsequent new request; and

b.    Allowing the request in its entirety.

2.    Claims services staff shall issue a notice of referral to the IC, in the following instances:

a.    Recommendation is to deny request in its entirety;

b.    Recommendation is to allow but alter the wage loss calculation.

3.    For subsequent ongoing requests for wage loss compensation that are supported and payable, claims services staff do not issue a BWC order.

4.    Once a decision is payable, claims services staff shall pay the wage loss award as outlined in the order.

a.    Claims services staff shall follow the Working Wage Loss-Initial/Ongoing job aid for paying working wage loss compensation.

i.      Claims services staff shall enter earnings for the entire period submitted but shall only release a full week and hold any remaining days until outstanding earnings are received to complete the next full week.

ii.     Claims services staff shall enter all earnings for multiple employers and irregular pay periods:

a)    Wages not earned on a weekly basis shall still be released as a weekly benefit; and

b)    Bi-monthly or Monthly pay periods shall only be paid in a weekly increment, which will result in a few days that will not be included and will be applied on the next wage loss period request.

b.    Claims services staff shall follow the Non-Working Wage Loss-Initial/Ongoing job aid to pay non-working wage loss compensation.