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; O.A.C. 4123-18-04; O.A.C. 4123-18-05; O.A.C. 4123-18-21
Effective Date:	07/01/21
Approved:	Deborah Kroninger, Chief of Medical Operations
Origin:	Vocational Rehabilitation Policy
Supersedes:	Policy # VR-04-01, effective 03/02/20
History:	Previous versions of this policy are available upon request

 

 

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.