Determining Eligibility

During the initial contact with the injured worker, the CSS will determine if the injured worker is eligible for temporary total compensation according to RC 4123.56.  Payment of TT compensation will not be made:

 

·         for the period when an injured worker has returned to work;

·         when an injured worker’s POR/treating physician states that the injured worker is capable of returning to his/her former position of employment;

·         when work within the physical capabilities of the injured worker is made available by the employer or another employer;

·         when the injured worker has reached maximum medical improvement (MMI).

 

Additionally, an injured worker cannot be paid TT compensation if:

 

·         The injured worker was working (full or part-time) for any employer during the disability period.

·         The injured worker is incarcerated.

·         The injured worker has returned to work and is requesting TT compensation for a doctor’s appointment and/or medical treatment/services.  Wage Loss may be appropriate.

·         The injured worker voluntarily abandoned his/her employment.  Additional information on voluntary abandonment can be found in the following memos located on COR under Temporary Total Disability Legal References. Voluntary Abandonment Memo 1-22-02 and Voluntary Abandonment Memo updated 11-7-08.

 

The CSS will determine if the injured worker has multiple employers.  If an employee works for different employers during the same period of time and is injured at one of the jobs:

 

·         TT compensation can be paid if the injured worker cannot work at any job.  The TT compensation weekly rate is based upon the earnings from all jobs. 

·         TT compensation cannot be paid if the injured worker continues to work full or part-time at any job.  In this situation, the injured worker may be entitled to other types of compensation such as Wage Loss (WL).

·         TT compensation may be paid if the injured worker is receiving passive income from sources such as rental properties, investments without performing work for that business or investment.  When these situations arise, the CSS should staff with their assigned Claims Policy Field Technical Specialist and/or local BWC attorney to determine eligibility to TT compensation.

 

 

Additional Conditions and TT Compensation

A request for TT compensation cannot be considered until a final decision is reached on a previously filed request for an additional condition when the requested condition is the sole basis for the period of disability covered by the TT compensation.  The request for TT compensation is placed in “suspend” status until the additional condition is determined.  These situations should be staffed with the Claims Field Technical Specialist to determine if suspending is appropriate.

 

The Application/Request Pending letter is sent to notify the parties to the claim that the request for TT compensation is suspended.  This letter is located on COR under Subsequent Decisions Correspondence. 

 

 

Vacation Pay and TT Compensation

Rule 4123-5-20 states that an injured worker can receive both vacation pay and TT compensation over the same period.  Vacation pay in lieu of sick leave, holiday pay, or comp time and TT compensation can also be paid over the same period.   

 

 

Wages in Lieu of TT Compensation/Salary Continuation

The injured worker cannot receive payment of TT compensation if he/she is receiving wages or full sick leave benefits from the employer of record with no wage agreement in the claim file during the disability period.  Additional information can be found on COR in the Salary Continuation policy.