Current through all regulations passed and filed through September 16, 2024
(A) Scope of vocational rehabilitation.
(1) Vocational rehabilitation is the process
of restoring the vocational functioning of a worker who experiences a work
related injury and who voluntarily agrees to participate in vocational
rehabilitation. Vocational rehabilitation services are focused on return to
work and are not reimbursable from the surplus fund if solely directed toward
the medical management of a claim.
(2) The vocational rehabilitation rules of
Chapter 4123-18 of the Administrative Code aid in the development of procedures for
providing reimbursable vocational rehabilitation services.
(B) Participation in vocational
rehabilitation services.
(1) Anyone can refer
an injured worker for vocational rehabilitation services.
(2) The bureau
will determine
the injured worker's eligibility under paragraph (C) of this rule for
vocational rehabilitation services.
(3) The MCO
will make a
recommendation to the bureau regarding the injured worker's feasibility under
paragraph (G) of this rule for vocational rehabilitation services.
(4) An injured worker
cannot participate in a vocational rehabilitation
plan or receive vocational rehabilitation services until the injured worker has
been determined to be both eligible and feasible for vocational rehabilitation
services. The bureau
will issue an order approving or denying the
injured worker's participation in vocational rehabilitation services.
(5) Referrals for vocational rehabilitation
in inactive claims
will be processed in accordance with rule
4123-3-15 of the Administrative
Code.
(C) Eligibility for
vocational rehabilitation services.
The following criteria apply
to requests for vocational rehabilitation services:
(1) The injured worker
has
a claim that is
(a) Allowed by an order of the
bureau of workers' compensation or the industrial commission or of its hearing
officers with eight or more days of lost time due to a work related injury;
or
(b) Certified by a self-insuring
employer.
(2) The injured
worker
has a significant impediment to employment or the
maintenance of employment as a direct result of the allowed conditions in the
referred claim.
(3) The injured
worker
has at least one of the following present in the
referred claim:
(a) The injured worker is
receiving or has been awarded temporary total, nonworking wage loss, or
permanent total compensation for a period of time that
includes the date of referral. For purposes of this
rule, payments made in lieu of temporary total compensation (e.g. salary
continuation)
will be treated the same as temporary total
compensation; or
(b) The injured
worker was granted a scheduled loss award under division (B) of section
4123.57 of the Revised Code;
or
(c) The injured worker is not
currently receiving compensation and has job restrictions in the claim
documented by the physician of record and dated not more than one hundred
eighty days prior to the date of referral; or
(d) The injured worker is receiving job
retention services to maintain employment or satisfies the criteria set forth
in paragraph (E) of this rule on the date of referral; or
(e) The injured worker sustained a
catastrophic injury claim and a vocational goal can be established
(4) The injured worker
was not
working on the date of referral, with
the exception of referral for job retention services.
(D) Eligibility for rehabilitation services
for an employee of a state agency or state university employer.
Notwithstanding the eligibility
criteria of paragraph (C)(3) of this rule,
an employee
of a state
agency or state university is eligible for rehabilitation services where
the state agency or state university has certified the claim and the employee
and employer agree upon a program of rehabilitation services.
(E) Job retention services.
(1) Job retention may be furnished when an
injured worker is working and experiences a significant work related problem as
a direct result of the allowed conditions in the claim.
(2) Job retention services may be provided
if:
(a) The injured worker has received
temporary total compensation or salary continuation from an allowed claim with
eight or more days of lost time due to a work related injury; and
(b) The physician of record provides a
written statement in office notes or correspondence indicating that the injured
worker has work limitations related to the allowed conditions in the claim that
negatively impact the injured workers' ability to maintain the injured worker's
employment; and
(c) The injured
worker's employer describes the specific job task problems the injured worker
is experiencing to the MCO and the MCO documents these problems in the claim.
The MCO
will include a statement describing why the injured
worker needs job retention services to maintain employment.
(F) Non-eligibility for
vocational rehabilitation services.
The injured worker is not eligible for vocational
rehabilitation services and such services
will be
terminated:
(1) After the effective
date of a lump sum settlement (medical and/or indemnity); or
(2) If the claim is subsequently disallowed
by an order of the industrial commission, its district or staff hearing
officers, or by an order of the court; or
(3) When the injured worker, after
successfully completing a comprehensive vocational rehabilitation plan,
subsequently resigns from employment or is terminated for cause and the
resignation or termination is not due to the allowed conditions in the
claim.
(G) Determination
of feasibility for vocational rehabilitation services.
(1) Feasibility for vocational rehabilitation
services means, based upon all available information:
(a) The injured worker is willing to
participate in vocational rehabilitation services;
(b) The injured worker is able to participate
in vocational rehabilitation services; and
(c) There is a reasonable probability that
the injured worker will benefit from vocational rehabilitation services and
return to work as a result of the services.
(2) "All available information" means
records, documents, written and oral statements, and any and all medical,
psychological, vocational, social, and historical data, of any kind whatsoever,
developed in the claim through which vocational rehabilitation is sought or
otherwise, that is relevant to the determination of an injured worker's
feasibility for vocational rehabilitation services.
(H) Appeal process.
Facts supporting a decision concerning either the acceptance or
denial of an injured worker into vocational rehabilitation
will be
documented in the bureau's order approving or denying the injured worker's
participation in vocational rehabilitation services. The bureau's order
approving or denying participation in vocational rehabilitation services may be
appealed to the industrial commission pursuant to section
4123.511 of the Revised
Code.
(I) Injured worker's
right to compensation or benefits.
(1)
Approval of an injured worker to participate in vocational rehabilitation
services
makes the injured worker eligible to receive living
maintenance payments in accordance with section
4121.63 of the Revised Code and
rule 4123-18-04 of the Administrative
Code.
(2) Denial of an injured
worker to participate in vocational rehabilitation services
does not affect an injured worker's right to
compensation or benefits under Chapters 4123., 4127., and 4131. of the Revised
Code for which the injured worker otherwise qualifies.
