(Not so new) NEW REQUIRED PHYSICIAN FORM

The Administrative Director has a required form that starts the time clock on Supplemental Job Displacement procedure, Physician Return-To-Work & Voucher Report DWC AD Form 10133.36:

This form is to be completed by the primary treating physician, an agreed medical evaluator or a qualified medical evaluator finding that the disability from conditions for which compensation is claimed has become permanent and stationary and that the injury has caused permanent partial disability. The voucher report shall be forwarded by the carrier to the employer in order to fully inform the employer “of work capacities and activity restrictions resulting from the injury that are relevant to potential regular, modified, or alternative work.”  Labor Code §4658.7(b)(1)(B).

The employer has no more than 60 days after receipt of the voucher report to make an offer for regular, modified or alternative work lasting at least 12 months. If no valid job offer is made, injured worker is entitled to the voucher. (Labor Code §4658.1)

Pain point: The physicians are not issuing required AD form. Whether it’s because they don’t know they must do this, are too busy and/or just avoiding more work, IT IS MANDATORY.  Adjusters will NOT issue the SJDB voucher form to an injured worker if they do not receive it... even after settlement!

Applicant attorneys are urged to speak to their Physician vendors and express the urgency to comply with AD requirements.

The voucher is the gateway to the RTWSF benefit of $5,000 and can help improve the quality of injured workers’ lives before they have serious, long lasting devastation. Your clients need the voucher now! Please do not wait...THEY CAN'T WAIT.

If you have any questions, please do not hesitate to contact me directly. As always, OCC is here to support you and your clients to access their fair share of the $120 Million Dollar Supplement Fund. We have sample demand letters you can use to streamline this process for your office, the doctors, and your clients.  Just contact us and we will send it right away.

Thank you.

Don't wait to refer your clients for their job loss benefits, they can't wait.