Ohio Administrative Code › Title 4121 - Industrial Commission › Chapter 4121-3 - Claims Procedures › Section 4121-3-34 - Permanent total disability

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to ensure that applications for
				compensation for permanent total disability are processed and adjudicated in a
				fair and timely manner. This rule applies to the adjudication of all
				applications for compensation for permanent total disability filed on or after
				the effective date of this rule.
(B) Definitions
The following definitions shall apply to the adjudication of
				all applications for compensation for permanent
				total disability:
(1) "Permanent total
			 disability" means the inability to perform sustained remunerative employment
			 due to the allowed condition(s) in the claim(s).
The purpose of permanent total disability benefits is to
				compensate an injured worker for impairment of earning capacity.
The term "permanent" as applied to disability under the
				workers' compensation law does not mean that such disability must necessarily
				continue for the life of the injured worker but that it will, within reasonable
				probability, continue for an indefinite period of time without any present
				indication of recovery therefrom.
(2) Classification of physical demands of
			 work:
(a) "Sedentary work" means exerting up
			 to ten pounds of force occasionally (occasionally: activity or condition exists
			 up to one-third of the time) and/or a negligible amount of force frequently
			 (frequently: activity or condition exists from one-third to two-thirds of the
			 time) to lift, carry, push, pull, or otherwise move objects. Sedentary work
			 involves sitting most of the time, but may involve walking or standing for
			 brief periods of time. Jobs are sedentary if walking and standing are required
			 only occasionally and all other sedentary criteria are met.
(b) "Light work" means exerting up to twenty
			 pounds of force occasionally, and/or up to ten pounds of force frequently,
			 and/or a negligible amount of force constantly (constantly: activity or
			 condition exists two-thirds or more of the time) to move objects. Physical
			 demand may be only a negligible amount, a job should be rated light work:
(i) when it requires walking or standing to a
			 significant degree; or
(ii) when it
			 requires sitting most of the time but entails pushing and/or pulling or arm or
			 leg controls; and/or
(iii)  when the
			 job requires working at a production rate pace entailing the constant pushing
			 and/or pulling of materials even though the weight of those materials is
			 negligible.
(c) "Medium
			 work" means exerting twenty to fifty pounds of force occasionally, and/or ten
			 to twenty-five pounds of force frequently, and/ or greater than negligible up
			 to ten pounds of force constantly to move objects. Physical demand requirements
			 are in excess of those for light work.
(d) "Heavy work" means exerting fifty to one
			 hundred pounds of force occasionally, and/or twenty to fifty pounds of force
			 frequently and/or ten to twenty pounds of force constantly to move objects.
			 Physical demand requirements are in excess of those for medium work.
(e) "Very heavy work" means exerting in
			 excess of one hundred pounds of force occasionally, and/or in excess of fifty
			 pounds of force frequently, and/or in excess of twenty pounds of force
			 constantly to move objects. Physical demand requirements are in excess of those
			 for heavy work.
(3)
			 Vocational factors:
(a) "Age" shall be
			 determined at time of the adjudication of the application for permanent total
			 disability. In general, age refers to one's chronological age and the extent to
			 which one's age affects the ability to adapt to a new work situation and to do
			 work in competition with others.
(b) "Education" is primarily used to mean
			 formal schooling or other training which contributes to the ability to meet
			 vocational requirements. The numerical grade level may not represent one's
			 actual educational abilities. If there is no other evidence to contradict it,
			 the numerical grade level will be used to determine educational abilities.
(i) "Illiteracy" is the inability to read or
			 write. An injured worker is considered illiterate if the injured worker cannot
			 read or write a simple message, such as instructions or an inventory list, even
			 though the person can sign his or her name.
(ii) "Marginal education" means sixth grade
			 level or less. An injured worker will have ability in reasoning, arithmetic,
			 and language skills which are needed to do simple unskilled types of work.
			 Generally, formal schooling at sixth grade level or less is marginal
			 education.
(iii) "Limited
			 education" means seventh grade level through eleventh grade level. Limited
			 education means ability in reasoning, arithmetic and language skills but not
			 enough to allow an injured worker with these educational qualifications to do
			 most of the more complex job duties needed in semi-skilled or skilled jobs.
			 Generally, seventh grade through eleventh grade formal education is limited
			 education.
(iv) "High school
			 education or above" means twelfth grade level or above. The G.E.D. is
			 equivalent to high school education. High school education or above means
			 ability in reasoning, arithmetic, and language skills acquired through formal
			 schooling at twelfth grade education or above. Generally an individual with
			 these educational abilities can perform semi-skilled through skilled
			 work.
(c) "Work
			 experience":
(i) "Unskilled work" is work that
			 needs little or no judgment to do simple duties that can be learned on the job
			 in a short period of time. The job may or may not require considerable
			 strength. Jobs are unskilled if the primary work duties are handling, feeding,
			 and off bearing (placing or removing materials from machines which are
			 automatic or operated by others), or machine tending and a person can usually
			 learn to do the job in thirty days and little specific vocational preparation
			 and judgment are needed.
(ii)
			 "Semi-skilled work" is work that needs some skills but does not require doing
			 the more complex work duties. Semi-skilled jobs may require close attention to
			 watching machine processes or inspecting, testing, or otherwise looking for
			 irregularities or tending or guarding equipment, property, material, or persons
			 against loss, damage, or injury and other types of activities which are
			 similarly less complex than skilled work but more complex than unskilled work.
			 A job may be classified as semi-skilled where coordination and dexterity are
			 necessary, as when hands or feet must be moved quickly in a repetitive
			 task.
(iii) "Skilled work" is work
			 that requires qualifications in which a person uses judgment or involves
			 dealing with people, factors or figures or substantial ideas at a high level of
			 complexity. Skilled work may require qualifications in which a person uses
			 judgment to determine the machine and manual operations to be performed in
			 order to obtain the proper form, quality, or quantity to be produced. Skilled
			 work may require laying out work, estimating quality, determine the suitability
			 and needed quantities of materials, making precise measurements, reading blue
			 prints or other specifications, or making necessary computations or mechanical
			 adjustments or control or regulate the work.
(iv) "Transferability of skills" are skills
			 that can be used in other work activities. Transferability will depend upon the
			 similarity of occupational work activities that have been performed by the
			 injured worker. Skills which an individual has obtained through working at past
			 relevant work may qualify individuals for some other type of
			 employment.
(v) "Previous work
			 experience" is to include the injured worker's usual occupation, other past
			 occupations, and the skills and abilities acquired through past employment
			 which demonstrate the type of work the injured worker may be able to perform.
			 Evidence may show that an injured worker has the training or past work
			 experience which enables the injured worker to engage in sustained remunerative
			 employment in another occupation. The relevance and transferability of previous
			 work skills are to be addressed by the adjudicator.
(4) "Residual functional capacity"
			 means the maximum degree to which the injured worker has the capacity for
			 sustained performance of the physical-mental requirements of jobs as these
			 relate to the allowed conditions in the claim(s).
(5) "Maximum medical improvement" is a
			 treatment plateau (static or well-stabilized)at which no fundamental functional
			 or physiological change can be expected within reasonable medical probability
			 in spite of continuing medical or rehabilitative procedures. An injured worker
			 may need supportive treatment to maintain this level of function.