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,
shall be
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 must not
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 shall continue to
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 shall
will not exceed
two thousand dollars for each claim.
(2) The MCO shall
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
shall
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 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 three 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
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