4123-6-19 Remain at work program.

 

 

 

4123-6-19                    Remain at work program services.

 

 

 

(A)   The bureau shall take measures and make expenditures, as it deems necessary, to aid injured workers who have sustained compensable injuries or contracted occupational diseases to remain at work.

 

(B)  Remain at work services.

 

(1)   An injured worker is eligible to participate in a receive remain at work program services when:

 

(a)     The injury results in a medical only claim which is certified by the employer or is allowed pursuant to a bureau or industrial commission order or a lost time claim with eight or more days of lost time due to a work related injury which is certified by the employer or is allowed pursuant to a bureau or industrial commission order, but the injured worker is not receiving and has not been awarded temporary total compensation or salary continuation in the claim; and,

 

(b)   It is documented by the employer, the injured worker, or the physician of record that the injured worker is experiencing problems that are work-related and result from the allowed conditions in the claim.

 

(2)   Services provided shall be charged to the employer's risk.

 

(3)   The MCO shall determine the need for remain at work services.

 

(4)Within five business days of completion of services, the MCO shall submit a final report to the bureau.

 

(5) The bureau may audit the MCO's utilization of remain at work services.

 

(C)  Scope of remain at work services.

 

(1) Services provided in a remain at work program.

 

(a) The MCO shall submit to the bureau a final report at the completion of services within five business days of final services.

 

(b)(1) Remain at work services may include ergonomic study, functional capacity evaluation, job analysis, physical therapy (on site), occupational therapy (on site), physical reconditioning, transitional work, gradual return to work, on the job training, short term training, job modification, tools and equipment, and remain at work case management.

 

 

(c)(2) The bureau will not reimburse an employer for remain at work services that are provided by the employer (e.g., transitional work, on the job training, gradual return to work).

(2)(3) Remain at work services shall cease upon the occurrence of any of the following:

(a)   A bureau, industrial commission or court order subsequently disallowing the claim.

(b)    The claim changes to a lost time claim with eight or more days of lost time due to a work related injury and the injured worker receives temporary total compensation or salary continuation in the claim.

A claim that changes to a lost time claim with eight or more days of lost time due to a work related injury may be referred for vocational rehabilitation services as provided under Chapter 4123-18 of the Administrative Code.

(c)   The effective date of lump sum settlement.

(3) The bureau may audit the MCO's remain at work program.

(4) A claim that changes to a lost time claim with eight or more days of lost time due to a work related injury may be referred for vocational rehabilitation services as provided under Chapter 4123-18 of the Administrative Code if the injured worker is receiving or has been awarded temporary total compensation or salary continuation in the claim.

Effective:                                                             11/13/2015

Five Year Review (FYR) Dates:                         08/26/2015 and 08/25/2020

CERTIFIED ELECTRONICALLY

Certification

11/02/2015

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4121.44,

4121.441, 4123.05, 4123.66

Rule Amplifies:                                  4121.12, 4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates:                         10/26/04, 3/1/09, 1/1/01, 2/14/05, 7/1/12