Ohio Admin. Code 4123-18-08 - Payment for rehabilitation services and related expenses from the surplus fund
(A) General principles.
(1) Vocational rehabilitation services and
related expenses, as set forth in this rule, are paid from the surplus fund
established by section
4123.34 of the Revised Code, so
long as such costs are incurred in a lost time claim pursuant to an approved
vocational rehabilitation assessment plan, comprehensive vocational
rehabilitation plan, or job retention plan.
(2) Vocational rehabilitation services can
include but cannot be solely directed toward medical management and allied
medical treatment of the injured worker in an approved vocational
rehabilitation assessment plan, comprehensive vocational rehabilitation plan,
or job retention plan.
(3) Any
period of treatment relating to the allowed condition(s) of the claim which has
been prescribed and provided prior to the approval of the vocational
rehabilitation plan by the physician of record in the claim, by a specialist to
whom the injured worker has been referred by the physician of record, the
injured worker's employer, the managed care organization (MCO), or the bureau
of workers' compensation, and which extends into the calendar period of the
injured worker's approved vocational rehabilitation assessment plan,
comprehensive vocational rehabilitation plan, or job retention plan will be
charged to the risk of the employer.
(4) Vocational rehabilitation case management
costs incurred in the development and preparation of an approved vocational
rehabilitation assessment plan, comprehensive vocational rehabilitation plan,
or job retention plan, including costs for necessary medical, psychological,
and vocational evaluations, are vocational rehabilitation services and are paid
from the surplus fund. On-going vocational rehabilitation case management
professional services and travel are also paid from the surplus fund as part of
the approved vocational rehabilitation assessment plan, comprehensive
vocational rehabilitation plan, or job retention plan.
(B) Nonallowed conditions.
(1) The MCO may authorize payment for
treatment of a condition which is unrelated to the work related injury or
occupational disease as long as it is clearly evident that the unrelated
condition is impeding vocational rehabilitation or is a barrier to returning to
work. The payment for treatment of these conditions will not exceed
two
three
thousand dollars for each claim.
(2) The MCO will fully document the rationale
for these expenditures in both the approved vocational rehabilitation
assessment plan, comprehensive vocational rehabilitation plan, or job retention
plan and the MCO's rehabilitation case file.
(3) Payment for such treatment does not
constitute a recognition of the unrelated condition as a part of the
claim.
(4) As soon as the unrelated
condition is no longer affecting the work related injury or occupational
disease, or payment for treatment of the condition has reached the
two
three
thousand dollar maximum, payment for any subsequent treatment is the
responsibility of the injured worker.
(C) Expenses incurred by injured workers.
The following expenses may be paid when authorized as part of an approved vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan.
(1) Travel expenses may be reimbursed
consistent with the provisions of paragraph (B) of rule
4123-6-40 of the Administrative
Code.
(2) Reasonable and necessary
relocation expenses may be authorized up to a maximum
of
three
four thousand dollars per injured worker.
(a) Relocation expenses may be approved when,
as determined by the MCO, the following criteria are met:
(i) Job opportunities for which the injured
worker is qualified do not exist within a reasonable commute on a daily basis,
and
(ii) The injured worker has
secured a job at the new location.
(b) Relocation expenses may include temporary
lodging for up to sixty days.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.61, 4121.62, 4121.66, 4123.53
Prior Effective Dates: 07/10/1980, 12/07/1982, 03/16/1992, 01/01/2001, 11/05/2009, 01/09/2015, 03/01/2020, 05/15/2023
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