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OhioBWC - Basics:  OAC 4123-18-04

4123-18-04 LIVING MAINTENANCE ALLOWANCE

The rehabilitation division shall order living maintenance to be paid from the surplus fund, established by section 4123.34 of the Revised Code, to each claimant in accordance with the guidelines listed below. Living maintenance payments are compensation under Chapters 4121. and 4123. of the Revised Code.

(A) A claimant is eligible for living maintenance payments in accordance with the following guidelines:

Living maintenance payments shall begin at the time that the claimant actually begins to participate in the rehabilitation plan. This means when the claimant actually starts counseling, training or other rehabilitation services under the plan; that date may or may not coincide with the division's approval of a rehabilitation plan or the agreement of the claimant to participate in the plan.

(B) The division shall order suspension of living maintenance payments at such time as it becomes evident that the claimant will not be able to participate actively in his/her rehabilitation plan for a period of thirty days or longer due to the medical instability of the claimant. Concurrently, the division shall, with adequate explanation and reason for the order, direct that the bureau of workers' compensation or the appropriate self-insuring employer commence the payment of workers' compensation benefits to which the claimant would normally be entitled absent involvement in a rehabilitation program immediately upon the cessation of living maintenance payments. If such aforementioned period of medical instability continues for a significant length of time, e.g., for sixty days, and it does not appear that the claimant will be able to resume active participation in his/her plan in the near future, then the claimant's rehabilitation file should be identified as inactive and placed in a medical monitor status. The rehabilitation division shall thereafter monitor the claimant's medical status with the attending physician on a monthly basis for the first six months following such a deactivation, and on a bimonthly basis thereafter, to continue for the remainder of a two-year period following such a deactivation. When the division becomes aware of the restabilization of the claimant's medical condition the claimant shall be reactivated into the division, absent any extenuating circumstances, and appropriate rehabilitation services should begin as soon as possible.

(C) The division shall order termination of living maintenance payments at such time as:

(1) The claimant has returned to work; or

(2) The claimant has failed, without good cause, to cooperate in the completion of his/her rehabilitation plan; or

(3) The claimant is unable to attain the goals of his/her rehabilitation plan; or

(4) The claimant has failed, without good cause, to cooperate in seeking out available employment; or

(5) The claimant is no longer living. The termination of living maintenance shall not affect a claimant's right to compensation or benefits under the Revised Code for which the claimant otherwise qualifies.

(D) The division may, within its discretion and pursuant to the agreement signed by the claimant, agreeing to accept rehabilitation, order deduction from any living maintenance payment an amount equal to:

(1) One-seventh of the weekly payment to which a claimant is entitled for each full day during which claimant fails, without good cause, to participate in his/her rehabilitation plan.

(2) Any wages or other remuneration received by the claimant for participation in substantial gainful activity, provided that during any period when wages or other remuneration equals or exceeds the living maintenance allowance, living maintenance payments shall be ordered suspended.

(E) Living maintenance payments shall be disbursed in the same manner as awards for temporary total disability compensation.

(F) Living maintenance payments shall not be ordered by the division for a period or periods exceeding six months in the aggregate, unless review by the division reveals that the claimant will be benefited by an extension of such payments.

(G) A claimant participating in a lessening disability plan shall not receive living maintenance payments, but will continue to receive the compensation payments to which the claimant is entitled.



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