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Policy and Procedure Name:
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Wage Loss Compensation
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Policy #:
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CP-23-02
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Code/Rule Reference:
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R.C. 4123.56;
R.C. 4123.68;
O.A.C. 4125-1-01;
O.A.C. 4123-17-30
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Effective Date:
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02/03/2022
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Approved:
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Ann M. Shannon, Chief of Claims Policy and Support
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-23-02, effective 09/15/2020 and Procedure #
CP-23-02.PR1, effective 09/15/2020
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History:
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Previous versions of this policy are available upon
request
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Table of Contents
II. APPLICABILITY
III. DEFINITIONS
Closed Period
Good Faith Job Offer
Good Faith Job Search
Initial Request
Present Earnings
Public Work Relief Employee
Separation of Employment
Subsequent New Request
Subsequent Ongoing Request
Suitable Employment
Wage Loss
Wage Replacement Compensation
IV. POLICY
A. General Policy for Wage
Loss Compensation
B. Eligibility for Wage
Loss Compensation
C. Evidentiary
Requirements for Wage Loss Compensation
D. Subsequent Ongoing
Request(s) for Wage Loss Compensation
E. Job Search Requirements
for Wage Loss Compensation
F. Good Faith Job Offer
for Suitable Employment
G. Other Wage Loss
Compensation Circumstances
H. Other Receipt of
Benefits and Impact to Wage Loss Compensation
I. BWC Determination or
Notice of Referral to the Industrial Commission
J. Calculation of Wage
Loss Compensation Benefits
K. Maximum Number of Weeks
L. Concurrency of Wage
Loss Compensation
V. PROCEDURE
A. General Claim Note and
Documentation Requirements
B. Expectations for Wage
Loss Compensation
C. Reviewing Wage Loss
Compensation Request
D. Evaluating Job Searches
for Suitable Employment
E. Verification of Job
Searches for Suitable Employment
F. Issuing Order or Notice
of Referral and Payment
I. POLICY PURPOSE
The purpose of this policy is to
ensure that BWC evaluates the evidence and makes an appropriate determination
regarding payment of wage loss compensation to an injured worker who experiences
a reduction in earnings as a direct result of physical and/or psychiatric
restrictions caused by the allowed condition(s) in the claim.
This policy applies to claims services staff.
Closed Period: A request for wage loss compensation
for a definitive period that includes a start and end date in the past.
Good Faith
Job Offer: A written offer of work within the injured workers
restrictions made by the employer of record or another employer. The offer
should have similar hours, commute time, shifts and accommodate scheduling
needs that were at issue with the employer of record.
Good Faith Job Search: An injured worker’s
consistent, sincere, and best attempts to obtain suitable employment that will
eliminate a loss in earnings. This includes an injured worker’s devotion of
time to job search consistent with restrictions, former position of employment
and hours able to work.
Initial Request: An injured worker’s first request
for wage loss compensation in their claim.
Present Earnings: An injured worker’s actual weekly gross
earnings which are generated by gainful employment; or if self-employed, the injured
worker’s gross income minus business-related expenses. It is a rebuttable
presumption that:
- Earnings from paid leave (e.g., vacation, sick, etc.) provided
by the employer will be included in present earnings.
- Injured workers engaged in self-employment have a gross
income of at least fifty percent of the statewide average weekly wage.
Public Work Relief Employee: A person engaged in any
service or labor, under the supervision and control of a government body,
either directly or through agencies, in exchange for some form of public funds
or goods, on the basis of the budgetary needs of the work-relief employee and
his or her dependents.
Separation of Employment: The
end of the employment relationship between the employer of record or another
employer and the injured worker.
Subsequent
New Request: A period of wage loss after there has been an
interruption in wage loss payments due to ineligibility (including extended
periods when the injured worker failed to submit a request).
Subsequent Ongoing Request: A continual request,
without a break, for wage loss compensation after an award, whether an initial
or subsequent new request, is granted.
Suitable Employment: Work
which is within the injured worker’s restrictions, and which may be performed
by the injured worker subject to all physical, psychiatric, mental and
vocational limitations to which the injured worker was subject on the date of
the injury, or on the date of disability in occupational disease claims.
Wage Loss:
The dollar amount of the diminishment of wages sustained by an injured worker
as a direct result of physical and/or psychiatric restriction(s) caused by the
allowed condition(s) in the claim, including:
- Non-working wage loss (NWWL) – when the injured
worker has not returned to work because he or she has been unable to find
suitable employment;
- Working wage loss (WWL) – when the injured worker
has returned to employment which is not his or her former position of
employment.
Wage Replacement Compensation: Compensation intended
to replace an injured worker’s earnings. This includes temporary total, living
maintenance, living maintenance wage loss, wage loss (working and non-working),
permanent total disability and salary continuation.
1. It is the policy
of BWC to provide an injured worker:
a. Working Wage
Loss (WWL): when an injured worker returns to employment or has remained at
work following an injury but suffers a loss in wages due to different job
duties, less hours, have to miss work to get approved medical treatment that is
only available during work hours or other circumstances as a direct result of
physical and/or psychiatric restriction(s) caused by the allowed condition(s)
in the claim; or
b. Non-Working
Wage Loss (NWWL): when the injured worker is released to return to work
with physical and/or psychiatric restriction(s) caused by the allowed condition(s)
in the claim, but is unable to find suitable employment; or
c. Living
Maintenance Wage Loss (LMWL): See the Living
Maintenance Wage Loss policy for information on this compensation. LMWL
is not addressed in this policy.
2. BWC may pay wage
loss compensation benefits beginning the day after an injury when eligibility and evidentiary requirements are met in
this policy and procedure.
3.
BWC may perform an independent medical examination to further evaluate an
injured worker’s application and work restrictions submitted by their physician.
4. It is the policy
of BWC to establish expectations for an
injured worker requesting an initial request or subsequent new request, and for subsequent ongoing requests for wage loss
compensation.
B.
Eligibility for Wage Loss Compensation
1. To be eligible
for wage loss compensation benefits, an injured worker must:
a. Have a date of
injury on or after 08/22/1986;
b. Have returned to
employment other than the former position of employment or has been unable to
find employment consistent with the physical and/or psychiatric restriction(s) caused
by the allowed condition(s) in the claim;
c. Experience
a reduction of earnings; and
d. The reduction in earnings is a direct result of physical and/or
psychiatric restriction(s) caused by the allowed condition(s) in the claim.
2. Claims allowed
for the following occupational diseases are not eligible for wage loss
compensation, but may be eligible for a change of occupation benefit:
a. Silicosis;
b. Coal miners’
pneumoconiosis (black lung);
c. Asbestosis;
d. Any other
occupational disease of the respiratory tract resulting from injurious exposure
to dust; or
e. Firefighters (paid
or volunteer) and police officers whose claims are allowed for:
i. Cardiovascular;
ii. Pulmonary;
or
iii. Respiratory
conditions.
f. See
the Change
of Occupation policy for more information.
3. A firefighter
with cancer occupational disease claim allowed pursuant to R.C. 4123.68(X) is only
eligible for working wage loss compensation.
C.
Evidentiary Requirements for Wage Loss Compensation
1. It is the policy
of BWC that an injured worker must meet evidentiary requirements in order to
receive wage loss compensation benefits.
2. Evidentiary
requirements are dependent upon the type of request and may include a
combination of the following:
a. For an initial request only, an injured worker shall seek
employment with the employer of record before going to Ohio Department of Job and Family Services and
doing a job search and seeking alternate employment. Written proof is
required.
b. A C-140
form or its equivalent.
c. A C-141
form(s) or its equivalent.
d. A C-142
form(s) or its equivalent.
e. Medical report of
physical and/or psychiatric restriction(s) caused by the allowed condition(s)
in the claim.
f. Payroll
or pay stubs showing gross earnings.
g. Self-employment
weekly or quarterly profit (i.e., gross income minus business-related expenses).
h. Documentation necessary
to support a good faith job search for suitable employment.
i. Additional
information requested by BWC to support the wage loss compensation request.
1. When an injured
worker’s wage loss is periodically equal to zero dollars ($0) for a specific
week because the injured worker’s earnings were equal to or higher than the average
weekly wage or full weekly wage, it is the policy of BWC to continue to
consider the wage loss award as a subsequent ongoing request. However, weeks
where earnings result in no wage loss will not be included in the calculation
for total weeks of eligibility.
2. When an injured
worker ceases to be eligible for wage loss compensation or there is an extended
period of time between requests for wage loss compensation, BWC will not
consider an injured worker’s subsequent wage loss request to be a subsequent ongoing
request. When the injured worker seeks wage loss compensation again, it is the
policy of BWC to consider the request a subsequent new request.
1. It is the policy
of BWC that for every week of wage loss compensation requested, the injured
worker must submit proof of a good faith job search for suitable employment, unless
otherwise required, on Wage Loss Statement for Job Search (C-141)
forms or equivalent forms.
2. Job search
form(s) (C-141 or
equivalent forms) shall be submitted at least every four weeks.
3.
It is the policy of BWC that a good faith job search may not be required
when the injured worker:
a. Returns to
alternative employment with the employer of record;
b. Returns to
alternative employment with another employer at the direction of the employer
of record;
c. Is
receiving public relief pursuant to R.C. 4127.05; or
d. Is working and
BWC or the Industrial Commission (IC) determines, due to the totality of the
circumstances, that a job search is not required.
F.
Good Faith Job Offer for Suitable Employment
1. The failure of
an injured worker to accept a good
faith job offer for suitable employment may be
considered as a reason to deny, reduce, or terminate wage loss compensation.
2. In determining
if the injured worker was offered suitable employment in good faith, BWC may
consider whether:
a. The employment
offer has been made in writing.
b. The employment
offer contains a detailed description of the job duties, hours, and rate of pay.
c. The
employment offer meets the injured worker’s restrictions noted by the
physician of record.
d. If the
employment offer:
i. Requires
the injured worker to work significantly more hours per week than the former
position of employment;
ii. Requires
the injured worker to work a shift(s) different from the shift(s) the injured
worker was working at the time of injury; or
iii. Requires the injured
worker to relocate.
e. Any other
factors related to the suitability of the job offer.
1. Eligibility for
working wage loss compensation may be established when the injured worker suffers a work-related injury and misses
work to receive prescribed, approved medical treatment(s) for the injury, the
injured worker may recover wage-loss compensation for the time absent from work
when wage loss eligibility and evidentiary requirements are otherwise met. To recover
for a wage loss, an injured worker must prove:
a. The treatment was medically necessary for
the injured worker to perform his or her job.
b. That without the treatment he or she could
not continue to work full time; and
c. That
treatment was available only during the injured worker’s hours of employment.
2.
Separation of Employment or Limiting
Income
a. When an injured
worker separates from employment by choice or for violation of some work rule,
wage loss compensation may no longer be payable.
b. When an injured
worker separates from employment due to forces outside of the injured worker’s
control, wage loss compensation may still be payable.
c. When an
injured worker voluntarily limits their income for reasons unrelated to the restrictions
of their claim or is refusing to do a good faith job
search wage loss compensation may no longer be payable or reduce their
benefits.
1. If an injured
worker is receiving non-occupational accident and sickness insurance payments
pursuant to an insurance policy or program fully funded by the employer of
record, those payments will be considered present
earnings and will offset/reduce wage loss compensation benefits.
2. Social security
benefits (disability or retirement) are not considered earnings and do not
reduce wage loss compensation benefits.
3. Unemployment
benefits are not considered earnings and do not reduce wage loss compensation
benefits.
a. BWC does not
reimburse Ohio Job and Family Services when wage loss compensation and
unemployment benefits are paid over the same period.
b. See the Ohio
Department of Job and Family Services (ODJFS) Reimbursement and Claim
Adjustment policy for additional information.
4. Public Work Relief money received by an injured worker
does not reduce wage loss compensation benefits.
5. It is the
responsibility of the injured worker, not BWC, to accurately report wage loss
compensation benefits to other entities the injured worker is receiving
benefits from.
1. BWC shall make a
determination on an initial request or a subsequent new request for wage loss compensation in
all state fund claims no later than 30 calendar days from receipt of the
application.
a. When approving
the wage loss compensation request, BWC shall issue an order;
b. When
recommending denying or reduce wage loss compensation, BWC shall issue a notice
of referral to the Industrial Commission.
2. BWC shall
process subsequent ongoing requests within seven (7) calendar days and either:
a. Pay wage loss
compensation; or
b. Refer the period
requested on a notice of referral to the Industrial Commission with BWC’s
recommendation to deny, reduce, or terminate wage loss compensation.
3. BWC shall complete
a notice of referral to the Industrial Commission with BWC’s recommendation for
a determination when an injured worker files for wage loss compensation in
multiple claims.
1. It is the policy
of BWC to calculate wage loss compensation on a weekly basis.
2. It is the policy
of BWC to include commission sales, bonuses, gratuities, and all other forms of
compensation (e.g., paid leave) for personal services customarily received by
an injured worker in the course of his or her employment as present earnings.
3. When earnings
are not paid on a weekly or biweekly basis, the receipt of earnings will be
apportioned over the number of weeks it is determined were required to initiate
and consummate the commission sale or earn the bonus, gratuity, or other
compensation.
4. For
self-employed injured workers, it is the policy of BWC that:
a. The actual weekly
present earnings are considered the gross
income, less any business expenses not already accounted for in the gross
income.
b. A self-employed injured
worker has a gross income of at least fifty percent (50%) of the current
statewide average weekly wage.
5. BWC shall
calculate and pay wage loss compensation at sixty-six and two-thirds percent
(66 2/3%) of the difference between the injured worker’s average weekly wage or
full weekly wage, whichever applies based on date of injury or disease, and the
injured worker’s actual weekly present earnings.
a. For claims with
a date of injury or disease before 05/15/97, the wage loss calculation is based
on the greater of the injured worker’s average weekly wage or full weekly wage.
b. For claims with
a date of injury or disease on or after 05/15/97, the wage loss calculation is
based on the injured worker’s average weekly wage.
6. When the
Industrial Commission determines that the injured worker voluntarily failed to
accept a good faith job offer of suitable employment when requesting wage loss
compensation, it is the policy of BWC to calculate the wage loss compensation
benefits at 66 2/3% of the difference between the injured worker’s average
weekly wage or full weekly wage, whichever is applicable, and the weekly wage
the injured worker would have earned in the employment the injured worker
failed to accept, unless otherwise ordered by the Industrial Commission.
7. When the Industrial
Commission determines that the injured worker is voluntarily limiting their
income when requesting wage loss compensation, it is the policy of BWC to
calculate wage loss compensation benefits at 66 2/3% of the difference between
the injured worker’s average weekly wage or full weekly wage, whichever is
applicable, and the weekly wage the injured worker would have earned if the
injured worker had not voluntarily limited their income, unless otherwise
ordered by the Industrial Commission.
1. It is the policy
of BWC that for claims with a date of injury on or after 08/25/2006:
a. An injured
worker may receive up to a maximum of 200 weeks of wage loss compensation
(subject to the provision for non-working wage loss) in a claim.
b. Non-working wage
loss is limited to a maximum of 52 weeks; however, 26 weeks of non-working wage
loss are excluded from the 200-week wage loss compensation limitation.
c. Living
maintenance wage loss compensation is included when calculating the total
number of weeks of wage loss compensation.
d. Only weeks the injured
worker receives a wage loss payment will be counted towards the maximum number
of weeks the injured worker may receive wage loss compensation. For example,
one week the injured worker’s earnings may be enough that there is no
calculable wage loss. That week would not count towards the maximum number of
weeks wage loss compensation is payable.
2. It is the policy
of BWC that for claims with a date of injury prior to 08/25/2006:
a. An injured
worker may receive up to a maximum of 200 weeks of wage loss compensation.
b. The total number
of weeks paid in living maintenance wage loss compensation will not count
towards the 200 week-maximum for wage loss compensation.
c. The total
number of weeks paid in wage loss compensation will be deducted from the 200
week-maximum for living maintenance wage loss.
1. Wage Replacement Compensation:
a. An injured
worker may only receive one type of wage replacement
compensation at a time. Wage replacement
compensation is not payable concurrently in the same claim or across claims.
b. Once a claim is
allowed for statutory permanent total disability, the injured worker is not
entitled to receive wage loss compensation in the same claim.
c. Wage loss
compensation may be paid concurrently in two different claims only if ordered
by the Industrial Commission for split payment in two different claims.
2. Awards:
a. Wage loss compensation
and Scheduled
Loss Compensation are payable concurrently in one or more claims.
b. Wage loss compensation
and Percentage
of Permanent Partial Disability or Increase of Permanent Partial Disability Compensation
(%PP) are payable concurrently:
i. In
different claims; or
ii. In the
same claim, if the %PP award is granted first and then subsequently wage loss
compensation is requested and awarded.
1. BWC staff shall
refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
2. Shall follow any
other specific instructions for claim notes and documentation included in this
procedure.
B.
Expectations for Wage Loss Compensation
1. Claims services
staff shall review eligibility requirements as well
as expectations for submission of supporting evidence with an injured worker
who is considering or requesting wage loss compensation.
2. Claims services
staff shall make at least two attempts by telephone to the injured worker to
review eligibility and discuss expectations. In
addition, staff shall:
a. Enter a detailed
note summarizing the discussion with the injured worker.
b. Prepare the
working or non-working wage loss expectations letter in the claims management
system documenting the telephone conversation and review this letter with an
injury management supervisor prior to sending.
c. Once the
injury management supervisor approves the working or non-working wage loss expectations
letter, send it to the injured worker.
3. If claims
services staff is unable to reach the injured worker by telephone, claims
services staff shall prepare the working or non-working wage loss expectations
letter, review it with an injury management supervisor, and send it to the
injured worker after obtaining the injury management supervisor’s approval.
4. Claims services
staff shall reevaluate and reestablish expectations with the injured worker as
may be necessary due to changing circumstances or problems with submission of
documentation.
1. Initial Request or Subsequent
New Request - Claims services staff shall evaluate an initial request or a
subsequent new request for wage loss compensation to ensure the injured worker
meets eligibility and evidentiary
requirements.
a. Claims services
staff shall evaluate the injured worker’s wage loss compensation application (C-140)
to ensure that:
i. The
application is completed in its entirety.
ii. There is
an indication of the type of wage loss compensation being requested and the
beginning date of the wage loss and if a closed period,
an end date.
iii. When requesting non-working
wage loss compensation, there is proof showing registration with the Ohio
Department of Job and Family Services, or when an injured worker lives out of
state, an equivalent agency in the injured worker’s state of residence;
iv. There is a detailed
employment history, including job titles and description of each position held;
v. There is
written proof the injured worker sought suitable employment with the employer of
record at the onset of the initial request for wage loss compensation unless
the injured worker establishes that seeking such employment would be futile
(e.g., the injured worker was discharged, the employer is out of business, employer
states work is not available within restrictions, IW was laid off and, where
applicable, subject to recall). This is a onetime requirement and is not
required for a subsequent new request for wage loss compensation;
vi. There is an injured
worker’s signature certifying that all the information being provided to BWC is
true and accurate to the best of the injured worker’s knowledge, and
that the injured worker served a copy of the wage loss compensation application
and supporting documentation to the employer of record.
b. Claims services
staff shall review to verify that a medical report (i.e., C-140 page 2 or its
equivalent) accompanies the injured worker’s application for wage loss. The
medical report shall contain:
i. Documentation
of work restrictions caused by the physical and/or psychiatric condition(s)
allowed in the claim;
ii. A
statement of whether those work restrictions are temporary or permanent;
a) When the
restrictions are temporary, the expected duration of those restrictions
(temporary restrictions cannot be certified for a period to exceed 90 days
without a new examination of the injured worker).
b) When the
restrictions are permanent, affirmation that the report is based on an
examination or treatment conducted within 90 days prior to the initial request
or subsequent new request for wage loss compensation.
iii. A separate
statement of any other restrictions not related to the allowed condition(s) in
the claim;
iv. The date of the last
medical examination;
v. The date
of the report; and
vi. The name and signature
of the physician who authored the report.
c. Claims
services staff shall review to verify that evidence of a good faith job search
for suitable employment (i.e. Wage Loss Statement for Job Search (C-141)
form or its equivalent) accompanies the injured worker’s application for wage loss.
The injured worker shall provide:
i. Documentation
of job searches for suitable employment performed for the weeks wage loss compensation
is requested;
ii. Documentation
of job search(es) performed such as copy of job ad applied for, confirmation of
submission for online job application, and other proof as may be determined by BWC
as necessary to support job searches;
iii. For working wage
loss compensation, proof of earnings (e.g., copies of payroll reports, pay
stubs or a C-142
or its equivalent).
d. Claims services
staff shall create a legal case in the claims management system for the initial
request or a subsequent new request for wage loss compensation.
2. Incomplete Wage
Loss Compensation Application
a. When the
application for wage loss compensation (C-140 or its equivalent) is incomplete,
claims services staff shall contact the injured worker by telephone to secure
the missing information.
i. If
the application contains missing information, claims services staff may obtain
the missing information on the application verbally.
ii. If the
application is missing supporting documentation, claims services staff shall
request the documentation that is missing to support the request from the
injured worker and/or MCO.
iii. If the missing
information is a medical report describing the restrictions, or the medical
report provided indicates that the restrictions are for conditions not allowed
in the claim, claims services staff shall contact the MCO and request
additional information to clarify the report received.
b. Claims services
staff may send (by fax, email or mail) the “WL-Incomplete C-140” letter to the injured
worker and, if applicable, to the injured worker’s representative when unsuccessful
in contacting the injured worker by telephone.
c. Claims
services staff shall continue processing the request when the requested missing
information is received.
d. If requested
missing information is not received, claims services staff shall complete a
notice of referral to the Industrial Commission when the injured worker and/or
physician does not provide the required information within thirty (30) days
from BWC’s receipt of the wage loss compensation application.
e. If the requested
missing information is received after a referral but before a hearing is
scheduled, claims services staff may attempt to withdraw the notice of referral
and continue processing the application. (See the Notice
of Referral to the Industrial Commission policy for more information on
withdrawing a referral).
f. If
the condition(s) causing the restrictions appear to be related to the claim and
those conditions have been requested but not yet adjudicated, claims services
staff shall contact the injured worker to determine if the injured worker wants
to:
i. Move
forward with the wage loss compensation application; or
ii. Dismiss
the wage loss compensation application until the conditions are adjudicated.
3. Claims services
staff shall evaluate subsequent ongoing wage
loss compensation requests to ensure the injured worker has submitted
documentation to support an ongoing loss of earnings. Claims services staff
shall evaluate each subsequent ongoing wage loss compensation request to:
a. Verify the
injured worker still meets eligibility and evidentiary requirements; and
b. BWC may request
additional documentation, as necessary, to support a subsequent ongoing wage
loss compensation request.
4.
Wage Loss Compensation payments stop and request to resume payments is
submitted
a. When there is a
break in wage loss compensation payments and the injured worker subsequently requests
wage loss compensation, claims services staff shall investigate by contacting
the injured worker to obtain information regarding the timing and reasons for
the break.
b. Upon gathering
information from the injured worker, claims services staff shall staff the
claim with their supervisor and if necessary a BWC attorney to determine
whether there is evidence to support subsequent ongoing
wage loss, or whether a subsequent new request
must be made.
i. Subsequent
ongoing wage loss compensation may continue if there is a minimal time period where
the evidence does not support wage loss compensation, but the remaining time
periods of wage loss requested are supported by the evidence.
ii. A
subsequent new request must be filed if there is an excessive time period where
the evidence does not support wage loss compensation, even if the remaining
time periods are supported by the evidence (e.g., there is a 30-day break in
the supporting evidence with the injured worker transitioning from working to
non-working wage loss).
c. Claims
services staff shall notify the injured worker if the wage loss request will be
treated as a subsequent new request and if any additional information must be
provided by the injured worker.
5. Other wage loss
compensation circumstances:
a. When claims
services staff identify that an injured worker may be self-limiting their
income, the claim shall be staffed with the supervisor and BWC attorney to
determine appropriate course of action.
b. When an injured
worker becomes separated from employment while receiving working wage loss
compensation, claims services staff must contact the injured worker to find out
the cause for the separation and then subsequently staff the claim with the
supervisor and BWC attorney to determine possible impacts to wage loss
compensation.
c. Before
excusing an injured worker from performing job searches pursuant to IV.E.2. of this policy, claims services staff must first
consult with the supervisor and BWC attorney.
d. Claims services
staff may perform an independent medical examination to further evaluate an
injured worker’s application and work restrictions submitted by their physician
but only with a supervisor and BWC attorney approval.
D. Evaluating Job Searches
for Suitable Employment
1. For every week
that wage loss compensation is requested, an injured worker must submit a C-141
or equivalent form(s) documenting their search for suitable employment, unless
exempt from conducting a job search under section IV.E.2.
2. An injured must
submit job search form(s) at least every four weeks.
3. Claims services
staff shall not set a specific number of job searches required by the injured
worker. Instead, the reasonableness of the number of job searches performed
each week should depend on factors such as the number of hours the injured is released
to return to work, whether the injured worker is not working at all or working
full or part time, and whether the job search is conducted on-line or
in-person. Online job searches should include documented time preparing resume,
reviewing jobs, uploading resume, and applying for jobs.
4. Claims services
staff shall evaluate job search statements and ensure the following information
is included:
a. The name and
address of each employer contacted;
b. The employer’s
telephone number;
c. The
position sought;
d. A reasonable
identification by name or position of the person contacted;
e. The date and
method of contact;
f. For
on-line job searches, a copy of the on-line posting and verification of the
application submission;
g. The result of
the contact; and
h. Any other information
requested by BWC.
5. The injured
worker :
a. For the first 60
days, may limit their search for suitable employment to jobs that are within
the injured worker’s skills, prior employment history, and educational
background.
b. After 60 days of
an unsuccessful job search, shall expand his or her job search to include entry
level and/or unskilled employment.
6. Claims services
staff shall evaluate an injured worker’s job search for suitable employment to
determine if it has been made in good faith by considering the following
factors:
a. The injured
worker’s skills, prior employment history, and educational background;
b. The number,
quality and regularity of contacts made by the injured worker with prospective
employers, and/or public and private employment services;
c. The amount
of time devoted to making prospective employer contacts;
d. For an injured
worker receiving WWL, the number of hours the injured worker is working;
e. Any refusal of
the injured worker without good cause to accept employment seeking assistance
from BWC, or free of charge assistance from any public or private entity;
f. Labor
market conditions;
g. The injured worker’s
restrictions.
h. Any recent
activity of the injured worker to change his or her place of residence and the
impact such a change would have on the reasonable probability of success in the
search for employment;
i. The injured
worker’s economic status as it impacts his or her ability to search for
employment, including such things as access to:
i.
public and private transportation;
ii.
Internet services;
iii.
telephone service; and
iv.
any other means of communication.
j. The
self-employed injured worker’s documentation of efforts undertaken on a weekly
basis to produce self-employment income;
k. Any
part-time employment engaged in by the injured worker and whether that
employment constitutes a voluntarily limitation on the injured worker’s present earnings;
l. Whether
the injured worker is only seeking employment that would require him or her to
work fewer hours per week than worked in the former position of employment.
m. Whether the injured
worker, due to the restrictions from the allowed conditions in the claim, is
enrolled in a rehabilitation program with the Opportunities for Ohioans
with Disabilities (OOD) agency and is attending an education institution
approved by OOD.
n. Whether the
injured worker has engaged in coursework or other time spent that will benefit
the injured worker’s job search efforts. (e.g., updating resume, class on how
to market oneself and write a better resume.)
1. Claims services
staff may do a job search verification when inconsistencies are identified.
Some examples of inconsistencies:
a. Requirements for
positions listed on job search are inconsistent with the injured worker’s
restrictions or injured worker’s job skills;
b. The same
employers are repeatedly listed;
c. The job
search documentation is not being completed as required;
d. The injured
worker is not providing proof of applications filed via the internet.
2. When inconsistencies
are identified and/or claims services staff has other reason to believe the job
search information needs to be verified, claims services staff shall initially
contact a random sample of the employers listed.
a. Verifying job
searches shall be conducted in such a way as to avoid hindering the injured
worker’s employment opportunity and in compliance with BWC’s sensitive data
policies.
b. A sample script
for claims services staff to use for verifying an employment contact is as
follows: “Hi, my name is Martha Jones with the State of Ohio. I am working
with Rose Tyler and want to verify that she has applied for a job with your
company. Our records indicate that she applied for a cashier position and
submitted an application to Amy Pond in Human Resources. Is this information
correct?”
3. Claims services
staff shall document the random sample review on the “Wage Loss Job Search
Verification Summary Worksheet” available on COR and summarize the review
in claim notes.
4. If the job
search verification random sample review indicates that the IW is making a good
faith job search, claims services staff shall image the “Wage Loss Job
Search Verification Summary Worksheet” into the claims management system,
enter a claim note and take no further action.
5. If the job
search verification of the random sample, indicates that the injured worker is
not making a good faith job search, claims services staff shall verify every
contact listed on the C-141, continuing to document the results on the “Wage
Loss Job Search Verification Summary Worksheet.”
6. If the
additional job search verification supports that the IW is not making a good
faith job search, claims services staff shall review the claim with their
supervisor and BWC attorney to determine the next appropriate step.
a. A referral to
the IC may be appropriate if the job search verification and documentation
reflects a pattern of non-compliance.
i. Claims
services staff shall complete the “Wage Loss Job Search Verification
Affidavit” and image it into the claim; and
ii. Complete
the notice of referral to the IC stating that the IW has failed to make a good
faith job search for the period requested on the C-141 (or equivalent) and cite
the supporting evidence (which includes the “Wage Loss Verification Summary
Worksheet” and the “Wage Loss Job Search Verification Affidavit”).
iii. Claims services
staff shall withhold wage loss compensation for the disputed period until
directed otherwise by the IC.
b. If a referral to
Special Investigations Unit is determined to be appropriate, claims services
staff shall follow the Fraud/Special
Investigations policy and procedure.
c. If instead
of referral to the IC or the Special Investigations Unit it is determined that the
appropriate next step is to educate and establish additional expectations for
the injured worker, claims services staff shall contact the injured worker,
review any problems with previous job search submissions, and set expectations
for future job search submissions. Claims services staff shall follow up with a
letter to the injured worker outlining the expectations.
1. Claims services
staff shall only issue a BWC order for wage loss compensation when:
a. It’s an initial
request or a subsequent new request; and
b. Allowing the
request in its entirety.
2. Claims services
staff shall issue a notice of referral to the IC, in the following instances:
a. Recommendation
is to deny request in its entirety;
b. Recommendation
is to allow but alter the wage loss calculation.
3. For subsequent
ongoing requests for wage loss compensation that are supported and payable, claims
services staff do not issue a BWC order.
4. Once a decision
is payable, claims services staff shall pay the wage loss award as outlined in
the order.
a. Claims services
staff shall follow the Working Wage Loss-Initial/Ongoing job aid for paying working
wage loss compensation.
i. Claims
services staff shall enter earnings for the entire period submitted but shall
only release a full week and hold any remaining days until outstanding earnings
are received to complete the next full week.
ii. Claims
services staff shall enter all earnings for multiple employers and irregular
pay periods:
a) Wages not earned
on a weekly basis shall still be released as a weekly benefit; and
b) Bi-monthly or
Monthly pay periods shall only be paid in a weekly increment, which will result
in a few days that will not be included and will be applied on the next wage
loss period request.
b. Claims services
staff shall follow the Non-Working Wage Loss-Initial/Ongoing job aid to pay
non-working wage loss compensation.