The bureau will make living maintenance payments from the
surplus fund to an injured worker approved to participate in vocational
rehabilitation pursuant to rule
4123-18-03 of the Administrative
Code, in accordance with the criteria set forth in this rule. Living
maintenance payments are compensation under Chapters 4121.. and 4123.. of the Revised
Code.
(A) Living maintenance payments
begin on the date that the injured worker actually begins to participate in an
approved vocational rehabilitation assessment plan or comprehensive vocational
rehabilitation plan as defined in rule
4123-18-05 of the Administrative
Code. Living maintenance is not payable on the date of referral for vocational
rehabilitation services, nor the date the injured worker signed the
rehabilitation agreement. Activities performed prior to the injured worker's
active participation in the approved vocational rehabilitation assessment plan
and/or
or
comprehensive vocational rehabilitation plan are considered pre-plan activities
for which living maintenance is not paid.
If salary continuation is offered and
continues to be offered by the employer of record during participation in an approved vocational
rehabilitation plan assessment or comprehensive vocational rehabilitation
plan, an injured worker maintains the right
to
may choose to receive either salary
continuation or living maintenance during vocational
rehabilitation. However, if
unless
temporary total or living maintenance has been paid in the claim,
. In those cases,
the injured worker will be paid living maintenance when participating in an approved vocational rehabilitation
assessment plan or comprehensive vocational rehabilitation plan.
Whenever salary continuation is paid by the employer, it must be paid at the
injured worker's regular (full) salary level.
(B) The bureau will order suspension of
living maintenance payments at such time as it becomes evident that the injured
worker will not be able to participate actively in their vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation plan
for a period of thirty days or more due to the medical instability of the
injured worker. The suspension of living maintenance does not affect an injured
worker's right to compensation or benefits under the Revised Code for which the
injured worker otherwise qualifies.
(1) The
bureau will assist the injured worker in obtaining the payment of other
workers' compensation benefits to which the injured worker would
normally
otherwise be entitled,
absent involvement in a vocational rehabilitation assessment plan or
comprehensive vocational rehabilitation plan upon
the cessation of living maintenance payments.
(2) Medical hold and eligibility.
The injured worker, the employer, or their representatives may
make a request to the MCO for a medical hold. The MCO will forward the request,
along with any necessary information, to the bureau. The bureau will determine
whether, based on adequate medical documentation, the injured worker's
vocational rehabilitation plan should be closed with a medical hold.
(a) A medical hold will retain the injured
worker's eligibility
approval to participate
for
in
vocational rehabilitation services for up to a maximum of
two years
six
months from the date of vocational rehabilitation assessment plan or
comprehensive vocational rehabilitation plan file closure.
The bureau and the MCO will thereafter monitor the
injured worker's medical status with the attending
physician.
(b)
Upon request of the injured worker and with medical
documentation indicating the stabilization
When the bureau becomes aware of the
re-stabilization of the injured worker's medical condition, the
injured worker's vocational rehabilitation assessment plan or comprehensive
vocational rehabilitation plan will be reactivated and, absent any extenuating
circumstances, appropriate rehabilitation services will begin as soon as
possible.
(C)
The bureau will not pay living maintenance
benefits for any period during which an injured
worker has returned to work while the injured worker's vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation plan
remains open, other than as part of a gradual return to work plan.
However, the bureau may resume living maintenance payments if
the injured worker subsequently stops working while the vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation plan
is still open and the injured worker resumes services in said plan.
(D) The bureau will terminate
living maintenance payments upon the closure of the injured worker's vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation plan
pursuant to paragraph (F) of rule
4123-18-05 of the Administrative
Code.
The termination of living maintenance does not affect an
injured worker's right to compensation or benefits under the Revised Code for
which the injured worker otherwise qualifies.
(E) The bureau may order deduction from any
living maintenance payment an amount equal to:
(1) One-seventh of the weekly payment to
which an injured worker is entitled for each full day during which the injured
worker fails, without good cause, to participate in their approved vocational
rehabilitation assessment plan or comprehensive vocational rehabilitation
plan.
(2) Any wages or other
remuneration received by the injured worker while participating in an approved
vocational rehabilitation assessment plan or comprehensive vocational
rehabilitation plan and receiving living maintenance.
In the alternative, the inujured worker may
must either be endorsed
endorse the wages or other remuneration over to the
bureau, or will be deducted from the injured
worker's living maintenance payments or the
bureau may deduct the amount from future awards of
compensation.
(F) Living
maintenance payments will not be paid by the bureau for a period or periods
exceeding six months in the aggregate, unless the bureau determines that the
injured worker will benefit from an extension of vocational rehabilitation
services.
(G) Bureau orders
regarding suspension of, or deduction from an injured worker's living
maintenance payments or future awards of
compensation may be appealed to the industrial commission pursuant to
section 4123.511 of the Revised
Code.
Notes
Ohio Admin. Code
4123-18-04
Effective:
10/1/2024
Five Year Review (FYR) Dates:
7/9/2024 and
10/01/2029
Promulgated
Under: 119.03
Statutory
Authority: 4121.12,
4121.121,
4121.30,
4121.31,
4123.05
Rule
Amplifies: 4121.61,
4121.62,
4121.63,
4121.66
Prior
Effective Dates: 07/10/1980, 12/07/1982, 12/03/1992, 01/01/2001, 11/05/2009,
09/01/2014, 10/07/2019, 09/01/2020,
05/15/2023
