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.
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.
Decisions issued by order may be appealed to the Industrial Commission
of Ohio (IC). The types of decisions that are appealable to the IC are:
a.
Participation in vocational rehabilitation (including eligibility,
feasibility, and living maintenance (LM) compensation);
b.
Overpayment, deduction, suspension, and resumption of LM; and
c.
Issues related to living maintenance wage loss compensation (LMWL).
2.
MCO vocational rehabilitation case closure decisions are appealable through
the alternative dispute resolution (ADR) process contained in OAC 4123-6-16.
Upon issuance of a final order by BWC, any party may appeal the ADR order to
the IC. An appeal or dispute to a BWC vocational rehabilitation decision must
be filed within 14 calendar days of receipt of the decision.
3.
Appeals to BWC
a.
The following vocational rehabilitation decisions are appealable to BWC:
i.
Medical hold; and
ii.
Injured worker travel reimbursement related to vocational rehabilitation
services.
b.
Upon issuance of a final order by BWC, any party may appeal to the IC.
V. PROCEDURE
A.
Upon receipt of an appeal to the MCO, the MCO shall follow the ADR procedures
for processing an appeal, as provided in OAC
4123-6-16.
B.
Upon receipt of an appeal to BWC:
1.
The BWC Return to Work Services Unit shall:
a.
Review, investigate and respond to any appeal received regarding any BWC
vocational rehabilitation decisions outlined in section IV.B.3 above; and
b.
Notify the DMC of appeals resulting in overturned or amended decisions.
2.
When the DMC receives the abovementioned notification, the DMC shall
then address any resulting issues, following all policies and procedures
relevant to those issues.