Current through all regulations passed and filed through September 16, 2024
(A) For purposes of
this rule:
(1) "Successful return to work" as
a result of an approved vocational rehabilitation plan means that the injured
worker has obtained employment no later than sixty days from the date of
closure of the injured worker's approved comprehensive vocational
rehabilitation plan or has retained employment following the closure of the
injured worker's job retention plan, and the employment:
(a) Is within the physical or psychiatric
limitations caused by the impairments resulting from the allowed conditions in
the claim in which the injured worker completed the comprehensive vocational
rehabilitation plan or job retention plan; and
(b) Is reasonable in comparison with the
return to work goals of the comprehensive vocational rehabilitation plan or job
retention plan completed by the injured worker.
(2) "Suitable employment," "comparably paying
work," and "present earnings," have the same meaning as in rule
4125-1-01 of the Administrative
Code.
(B) In claims with
a date of injury on or after August 22, 1986, the bureau will make living
maintenance wage loss payments to injured workers who complete an approved
comprehensive vocational rehabilitation plan or job retention plan,
successfully return to work as defined in paragraph (A)(1) of this rule, and
experience a wage loss while employed as a consequence of the physical and/or
psychiatric limitation caused by the impairments resulting from the allowed
conditions in the claim.
(1) An injured worker
may request living maintenance wage loss payments by submitting an application
for living maintenance wage loss (on form RH-18 or equivalent) and medical
documentation of their physical or psychiatric limitations, or
both.
(2) Subsequent
applications for living maintenance wage loss payments must be submitted by the
injured worker before the specified end date of the documented restrictions or
every six months, whichever occurs first.
(a)
If the physical or psychiatric limitations are temporary, medical documentation
regarding the ongoing status of the restrictions must be submitted with any
subsequent application for living maintenance wage loss payments.
(b) If the physical or psychiatric
limitations are permanent, the bureau may request supplemental medical
documentation be submitted with subsequent applications.
(3) If an injured worker voluntarily limits
their income by choosing to work fewer hours or by accepting a job which does
not constitute suitable employment which is comparably paying work, the injured
worker's living maintenance wage loss benefits will be calculated as sixty-six
and two-thirds per cent of the difference between the greater of the injured
worker's full weekly wage or average weekly wage on the claim for which the
injured worker underwent a rehabilitation plan and the weekly wage the injured
worker would have earned had the injured worker not voluntarily limited their
income.
(a) In determining whether an injured
worker has voluntarily limited their income, the bureau may review all relevant
factors set forth in rule
4125-1-01 of the Administrative
Code in determining whether the injured worker has returned to suitable
employment which is comparably paying work.
(b) An injured worker who wishes to change
jobs after the initial receipt of living maintenance wage loss payments must
notify the bureau. The bureau will review the criteria set forth in paragraph
(A)(3)(a) of this rule to ensure that the job the injured worker wishes to
change to constitutes suitable employment which is comparably paying
work.
(4) If the injured
worker accepts employment below the reasonable expectations of the return to
work goals of the vocational rehabilitation plan, or if the injured worker can
reasonably be expected to obtain different employment for which earnings are
more comparable to those prior to the injury, the injured worker may be
required to make a good faith effort to search for suitable employment which is
comparably paying work. The bureau will consider factors such as the goals of
the vocational rehabilitation plan, the labor market, the skills and work
history of the injured worker, and any other factors that would assist in
making such determination.
(5) To
receive living maintenance wage loss payments under this rule after approval of
these benefits by the bureau, an injured worker must provide proof of
present earnings at least every four weeks, or on
a quarterly basis if the injured worker has a substantial variation in income,
in the form of pay stubs, payroll reports from the injured worker's current
employer, or a wage statement on form RH-94(A) or equivalent.
(6) Living maintenance wage loss payments are
charged to the surplus fund established by section
4123.34 of the Revised
Code.
(C) The bureau
will calculate living maintenance wage loss payment amounts based upon the
information submitted by the injured worker pursuant to paragraph (B)(4) of
this rule. Payments will be sixty-six and two-thirds per cent of the difference
between the greater of the injured worker's full weekly wage or average weekly
wage on the claim for which the injured worker underwent a rehabilitation plan
and the weekly wage received while employed up to a maximum per week equal to
the statewide average weekly wage.
(D) Payments may continue for up to a maximum
of two hundred weeks but will be reduced by the corresponding number of weeks
in which an injured worker receives payments pursuant to division (B) of
section 4123.56 of the Revised
Code.
(E) Facts supporting a
decision concerning the eligibility or non-eligibility of an injured worker for
living maintenance wage loss will be documented in the bureau's order approving
or denying the living maintenance wage loss. The bureau's order approving or
denying living maintenance wage loss may be appealed to the industrial
commission pursuant to section
4123.511 of the Revised
Code.
