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(continued)
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4638 and 4644, Labor Code.
s 10127. Dispute Resolution.
When there is a dispute regarding the provision of vocational rehabilitation services, either the employee or claims administrator may request the Rehabilitation Unit to resolve the dispute. All requests for dispute resolution shall be submitted as follows:
(a) If the request for dispute resolution results from an employee's objection to the claims administrator's intention to withhold maintenance payment pursuant to section 4643:
(1) The employee shall forward to the Rehabilitation Unit request for Dispute Resolution DWC Form RU 103 to the correct Rehabilitation Unit district office with copy to all parties;
(2) The employee shall state his/her position with full explanation of his/her objection, and attach the same to the request for Rehabilitation Unit dispute resolution; copies shall be served on all parties;
(3) The Rehabilitation Unit shall schedule and hold a conference and issue a determination within ten (10) days of the date of receipt of the employee's objection.
(b) If a dispute exists regarding identification of a vocational goal for injuries occurring on or after 1/1/94, the parties may contact the Rehabilitation Unit for a telephone conference discussion. The Rehabilitation Unit Consultant will provide direction, issue a determination or schedule a conference to be held on an expedited basis within 10 days.
(c) Excluding (a) above, all other requests for Rehabilitation Unit dispute resolution shall be submitted by completing a Request For Dispute Resolution, DWC Form RU-103, and attaching all medical and vocational reports not previously submitted to the Rehabilitation Unit, along with a format summary of the Informal Conference. The format summary identifies the disputed issues and the positions of the parties, including supporting information which shall be attached. The request for dispute resolution and all attached documentation shall be served on the parties.
(d) Excluding (a) above, and in instances where an informal conference is either impossible or impractical:
(1) The requesting party shall:
(a) Complete the request form;
(bb) Attach all pertinent medical and vocational reports not previously submitted to the Rehabilitation Unit;
(cc) Clearly identify why an informal conference is inappropriate.
(dd) Clearly state the issue(s) and identify supporting information for each issue and position;
(ee) Serve copies on all parties.
(2) Upon receipt of the request above, the opposing party shall have twenty (20) days to forward their position with supporting information to the Rehabilitation Unit with copies to all parties.
(3) Upon receipt of all information, the Rehabilitation Unit shall either issue its determination based on the record, will ask for additional information, set the matter for formal conference, or direct the parties to meet informally.
(e) Pursuant to (b), (c) and (d) above, the Rehabilitation Unit shall issue a determination within fifty (50) days of the receipt of the original request. Where a determination denying a request issues, any further requests for dispute resolution must be accompanied with a new or updated DWC Form RU-103.
(f) When a dispute arises concerning the cost-effectiveness of providing vocational rehabilitation services outside of California, the Rehabilitation Unit may assign an Independent Vocational Evaluator (IVE) or Qualified Rehabilitation Representative (QRR), at the expense of the employer and subject to the maximum vocational rehabilitation expenditure contained in Labor Code Section 139.5, to assist the Unit in issuing a determination pursuant to Labor Code Section 4644(g).
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4639, 4644 and 4645, Labor Code.
s 10127.1. Conferences.
(a) Upon receipt of "Request for Dispute Resolution," DWC Form RU-103, the Rehabilitation Unit shall determine if a formal conference is necessary. Notices shall be served by the Rehabilitation Unit on all parties, identifying the time, date, and location of any conference. Where the request is initiated by an unrepresented employee, the Rehabilitation Unit or an Information & Assistance Officer may assist the employee in completing and serving the form.
(b) Rehabilitation Unit Conferences shall be held on the date and time scheduled. Any party unable to attend the conference, may submit his/her position, on the issue(s) in writing, to the Rehabilitation Unit district office holding the conference. Following the conference, the Rehabilitation Unit shall issue a determination based on its file, information provided during the conference, and any written positions submitted prior to or at the time of the conference.
(c) If the dispute is resolved by the parties before the conference has been held, the party who requested the conference shall contact the Rehabilitation Unit for permission to cancel the conference. If permission to cancel is given, the requesting party shall notify all parties of the cancellation, and forward, in writing to the Rehabilitation Unit, with copies to all parties, notification that the conference has been cancelled. The requesting party shall include in the notification the issue(s) in dispute and the resolution reached by the parties.
(d) Except where the conference is held pursuant to Labor Code section 4643, a determination shall be issued within thirty (30) days of the date of conference unless additional information is requested by the Rehabilitation Unit, in which case, determination shall be issued thirty (30) days from the date of receipt of all further requested information.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4638 and 4639, Labor Code.
s 10127.2. Independent Vocational Evaluator.
(a) The Rehabilitation Unit Headquarters shall maintain a list of Qualified Rehabilitation Representatives (QRR) who meet the requirements of an Independent Vocational Evaluator (IVE) pursuant to Labor Code section 4635(c). A QRR who meets the qualifications specified in Labor Code Section 4635(c) may apply to be included on the IVE list throughout the year. The IVE list shall be reviewed and revised on a yearly basis, and shall be made available upon request.
(b) The parties are encouraged to select a QRR whenever a dispute is raised regarding the assignment of a QRR.If the parties cannot agree on the selection of a QRR within fifteen (15) days, either party may request the Rehabilitation Unit to appoint an IVE. To request an IVE either party must file a Request for Dispute Resolution, DWC Form RU-103, with the correct Rehabilitation Unit district office.
(c) Within fifteen (15) days of receipt of the request, the Rehabilitation Unit shall appoint an IVE with notice served simultaneously on the IVE and all parties. The assignment shall be made in rotation from a panel of all independent vocational evaluators in the geographic area included within the venue of the correct rehabilitation unit district office and who meet the language and specialty requirements, if any, of the employee.
(d) Upon receipt of notification of the IVE appointment, the claims administrator shall forward all medical and vocational reports to the IVE within ten (10) days. If the IVE is unable to meet with the employee within ten (10) days of receipt of the medical and vocational reports, upon notification from either party, the Rehabilitation Unit shall appoint another IVE.
(e) The IVE shall communicate with the injured worker throughout the provision of rehabilitation services. Except as specified in Administrative Rule 10127.2(d) above, no party shall communicate with the IVE regarding the evaluation unless otherwise directed by the Rehabilitation Unit except for communications initiated by the IVE. All such communications shall be confirmed in writing by the IVE.
(f) The Rehabilitation Unit may order that vocational rehabilitation services be provided by an Independent Vocational Evaluator at the expense of the employer, subject to the maximum expenditure for counseling fees set forth in Labor Code Section 139.5 for injuries occurring on or after 1/1/94, upon a finding of any of the following:
(1) The claims administrator failed to provide vocational rehabilitation services in a timely manner subsequent to the employee requesting vocational rehabilitation services;
(2) An independent vocational evaluation is necessary for the rehabilitation unit to determine if an employee is vocationally feasible;
(3) An independent vocational evaluation is necessary for the Rehabilitation Unit to determine if a vocational rehabilitation plan meets the requirements of this article; or
(4) The employee and qualified rehabilitation representative cannot agree on a vocational goal.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4635 and 4639, Labor Code.
s 10127.3. Qualified Rehabilitation Representative (QRR).
(a) The provision of vocational rehabilitation services shall be provided by individuals who meet the definition of a QRR as defined in Labor Code Section 4635(b), except where a QRR Waiver has been granted.
(b) When an employee is determined to be medically eligible and chooses to participate in a vocational rehabilitation program he/she is to be referred immediately to a QRR selected in agreement between the employee and claims administrator, pursuant to Labor Code Section 4637.
(c) If the agreement on a QRR cannot be reached within 15 days either party may request the Unit appoint an Independent Vocational Evaluator (IVE).
(d) The referral to the QRR shall include all pertinent and narrative medical and vocational reports to assist the QRR in the evaluation process.
Note: Authority cited: Sections 133, 138.4, 139.5 and 5307.3, Labor Code. Reference: Sections 4635, 4637 and 4640, Labor Code.
s 10128. Request for Order of Rehabilitation Services.
If the claims administrator fails to voluntarily provide services, subsequent to the employee's written demand with substantiation of eligibility for services upon the claims administrator, the employee may, on DWC Form RU-103 "Request for Dispute Resolution", request the Rehabilitation Unit to order the provisions of vocational rehabilitation services at the expense of the employer. A copy of the demand and copies of all medical and vocational reports including a listing of documents shall be attached with a completed Case Initiation Document, DWC form RU-101. Medical reports filed by the parties will be returned upon request.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5 and 4639, Labor Code.
s 10129. Interruption/Deferral of Services for Injuries Occurring Prior to 1/1/94.
(a) The provision of vocational rehabilitation services may be interrupted or deferred upon the request of the employee and agreement by the claims administrator, or if the agreement cannot be reached, upon a finding of good cause by the Rehabilitation Unit.
The claims administrator shall within 10 days of the agreement, confirm the deferral or interruption in writing to the employee including advice concerning procedures to be followed by the employee to commence or continue vocational rehabilitation services.
(b) The period of deferral or interruption may be extended upon agreement of the employee and claims administrator. If the employee and claims administrator are unable to agree to an extension of the deferral or interruption period, the Rehabilitation Unit may order an extension of the deferral or interruption period upon a finding that the extension is in the best interests of the employee.
(c) If the claims administrator fails to commence or continue vocational rehabilitation services after receipt of a timely request from the employee, the employee may request the Rehabilitation Unit to order the provision of vocational rehabilitation services pursuant to section 10128.
(d) If the employer offers the employee modified or alternate employment, the claims administrator may request the Rehabilitation Unit to determine whether the employer's offer provides the employee with suitable gainful employment. If the Rehabilitation Unit finds the employer's offer reasonable and appropriate, the employee shall not be entitled to the development or implementation of an additional plan.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5 and 4644, Labor Code.
s 10129.1. Interruption/Deferral of Services for Injuries Occurring on or After 1/1/94.
(a) An employee may defer rehabilitation services subsequent tobeing advised of medical eligibility for services, but prior to accepting services, only if the employer has not offered to provide alternative or modified work not exceeding the medical restrictions.
(b) An employee may interrupt rehabilitation services subsequent to accepting services. The interruption shall be for an agreed upon period of time. If the employee had previously agreed to a plan at the time of interruption, the claims administrator shall provide the notice specified in Section 9813(a)(4).
(c) If a dispute arises concerning an employee's request to defer or interrupt rehabilitation services, the employee may be granted a deferral or interruption upon a finding of good cause by the Rehabilitation Unit.
NOTICE OF OFFER OF MODIFIED OR ALTERNATIVE WORK
THIS SECTION COMPLETED BY EMPLOYER OR CLAIMS ADMINISTRATOR:
Employer (name of firm) _________________________________ is offering you the position of a (name of job) _____________________.
Attach a list of the duties required of the position.
You may contact ____________________________ concerning this offer. Phone No.: _____________
Date of offer: _______________. Date job starts: _____________.
Claims Administrator: ___________________Claim Number: _______.
NOTICE TO EMPLOYEE
Name of employee: ___________________________
Date offer received: ________________________
You have 30 calendar days from receipt to accept or reject this offer of modified or alternative work. If you reject this job offer, you will not be entitled to rehabilitation services unless:
Modified Work
A. The proposed modification(s) to accommodate required work restrictions are inadequate.
B. The modified job will not last 12 months.
Alternative Work
A. You cannot perform the essential functions of the job; or
B. The job is not a regular position lasting at least 12 months; or
C. Wages offered were less than 85% of the wages paid at the time of injury; or
D. The job is beyond a reasonable commuting distance from residence at time of injury.
THIS SECTION TO BE COMPLETED BY EMPLOYEE
__ I accept this offer of Modified or Alternative work.
__ I reject this offer of Modified or Alternative work and understand that I am not entitled to vocational rehabilitation services.
______________________________ Date _____________
Signature
I feel I cannot accept this offer because:
NOTICE TO THE PARTIES
If the offer is not accepted or rejected within 30 days of the offer, the offer is deemed to be rejected by the employee.
The employer or claims administrator must forward a completed copy of this agreement to the Rehabilitation Unit with a Case Initiation Document (DWC Form RU-101) and Notice of Termination (DWC Form RU-105) within 30 days of acceptance or rejection.
If a dispute occurs regarding the above offer or agreement, either party may request the Rehabilitation Unit to resolve the dispute by filing a Request for Dispute Resolution (DWC Form RU-103) at the nearest office of the State of California, Division of Workers' Compensation, Rehabilitation Unit.
MANDATORY FORMAT
STATE OF CALIFORNIA
DWC-RU-94 (3/99)
REQUEST FOR DISPUTE RESOLUTION ___ Original ___ Response
DO NOT USE THIS FORM WHEN LIABILITY FOR THE INJURY IS DISPUTED
INSTRUCTIONS: This is to be used when the parties are unable to resolve disputed rehabilitation issues and a determination by the Rehabilitation Unit is required. The completed form must be accompanied by all medical and vocational reports, including an indexed listing, and any other pertinent information not previously submitted to the Rehabilitation Unit. The parties are expected to meet prior to filing this request in an effort to informally resolve disputed issues. This request must be sent to the appropriate Rehabilitation Unit office. If a case number has not been assigned, attach a completed Case Initiation Document (DWC Form RU-101). Please note: An expedited conference is a procedure designed to resolve single issues as identified below. Other issues will be resolved either by a separate conference or a determination on the submitted record.
EMPLOYEE NAME (LAST) (FIRST) (M.I.) CLAIM #: RU CASE #:
ADDRESS: (STREET) (CITY) (STATE & ZIP) DATE OF INJURY:
The Rehabilitation Unit is requested to resolve the following dispute on an expedited basis because the parties disagree on : (Check the single issue which applies)
__ The description of the employee's job duties at the time of injury (for injuries after 1/1/94)
__ The selection of an Independent Vocational Evaluator
__ The employee objects to the attached Notice of Intent to Withhold Maintenance Allowance
__ The identification of a vocational goal (for injuries after 1/1/94)
Non-Expedited Issues: (Check the issue(s) that apply)
__ The employee objects to a Notice of Termination of Vocational Rehabilitation Services
__ The employee's medical eligibility for vocational rehabilitation services
Medical report relied upon by requester ____________________________
__ The employer has failed to provide vocational rehabilitation services and benefits.
On what date should the employer have provided vocational rehabilitation services? __/__/__ (Attach explanation)
My QRR preference is (if any): ___________________________________
Date last worked __/__/__ Date of last payment of temporary disability __/__/__ __
The employee requested reinstatement and the employer failed to respond:
On what date was request made to claims administrator? __/__/__
How does the employee substantiate this request? [Attach supporting document(s)]
__ This is in response to a previously submitted RU-103 dated __/__/__ (Attach position statement)
__ Other disputed issues (please describe the nature):
SUMMARY OF PARTIES' INFORMAL EFFORTS TO RESOLVE THIS DISPUTE:
An informal conference was held on _________________. A summary of the conference including a list of attendees, issues addressed, agreements reached, and unresolved issues is attached. If an informal conference was not held, attach explanation.
Copies of this request with copies of medical and vocational reports have been served on:
Has the employer/insurer accepted this claim? __ Yes __ No
Has liability for the injury been found by WCAB? __ Yes __ No
Has more than 90 days of TTD been paid? __ Yes __ No
Name of Requester:
Firm Name: _________________
Address: ___________________
____________________________
Signature: ______________________ Date:______________
REHABILITATION UNIT USE ONLY
MANDATORY FORMAT STATE OF CALIFORNIA DWC FORM RU-103 (3/99)
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5 and 4644, Labor Code.
s 10130. Request for Reinstatement of Vocational Rehabilitation Services.
Request for reinstatement of vocational rehabilitation services following an interruption or deferral shall be made in accordance with Labor Code section 4644(b).
All other requests for reinstatement of services shall initially be submitted to the claims administrator. If the claims administrator fails to reinstate services and the employee wishes a determination of entitlement to further rehabilitation services, all such requests shall be directed to the correct Rehabilitation Unit district office on DWC Form RU-103, "Request for Dispute Resolution".
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Section 4644, Labor Code.
s 10131. Termination of Vocational Rehabilitation Services.
(a) When the employer/claims administrator elects to terminate rehabilitation services of an employee injured before 1/1/90, prior to such termination, the claims administrator shall provide the employee with a "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105. For employees injured on or after 1/1/90, the claims administrator shall provide the employee with a "Notice of Termination of Rehabilitation Services," DWC RU-105. The notice must be sent within 10 days of the circumstances set forth in Labor Code section 4644(a) with copies sent to all parties, including the Rehabilitation Unit, with proof of service. The copy forwarded to the Rehabilitation Unit shall include the Rehabilitation Unit file number or a RU 101 attached.
(b) If the employee wishes to object to the "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105 or the "Notice of Termination of Vocational Rehabilitation Services", DWC Form RU-105, the objection must be filed with the Rehabilitation Unit within twenty days using the "Request for Dispute Resolution", DWC Form RU-103. The claims administrator shall provide the employee with a RU-103 with the "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105, or "Notice of Termination of Vocational Rehabilitation Services" DWC Form RU-105. Absent timely objection by the employee, the employer's liability for vocational rehabilitation services will be presumed terminated.
(c) When the employee objects to the claims administrator's "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105 or "Notice of Termination of Vocational Rehabilitation Services", DWC Form RU-105, the Rehabilitation Unit shall, within thirty (30) days of the employee's objection, hold a conference or otherwise obtain the employee's reasons for objection together with substantiating evidence and issue its decision.
(d) For injuries occurring on or after 1/1/94. When the employer offers modified or alternative work to the employee on the DWC Form RU-94 that meets the conditions of Labor Code Section 4644(a)(5), (6), or (7) and subsequently learns that the employee cannot lawfully perform modified or alternative work due to the employee's immigration status, the employer is not required to provide vocational rehabilitation services.
(e) An employer's obligation to provide modified or alternative work to a seasonal employee is terminated after 12 months if the following conditions apply:
(1) The employee was hired on a seasonal basis prior to injury;
(2) The offer or modified or alternative work is on a similar seasonal basis to the employee's previous employment; and
(3) The offer is made on the DWC Form RU-94 that meets the conditions of Labor Code Section 4644(a)(5), (6), or (7).
(f) For dates of injuries on or after 1/1/03, where the employee and employer have agreed to settle the employee's right to prospective vocational rehabilitation services for an amount not to exceed $10,000 for the employee's use in self-directed rehabilitation, the employer/claims administrator's liability for vocational rehabilitation services is terminated.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4644 and 4646, Labor Code.
s 10131.1. Declination of Rehabilitation.
(a) A request for conclusion of rehabilitation benefits, or a notice of termination of vocational rehabilitation services on the basis that the employee has declined rehabilitation services must be made in the form and manner set forth by the Administrative Director in section 10131 of these rules by using DWC Form RB-105 or DWC Form RU-105.
(b) Absent timely objection by the employee to the "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105 or the "Notice of Termination of Vocational Rehabilitation Services", DWC Form RU-105, the employer's liability for vocational rehabilitation services will be presumed terminated when:
(1)(A) The employee, with a date of injury prior to 1/1/90, received a notice of potential entitlement to rehabilitation services, immediately following the claims administrator's knowledge of potential medical eligibility or immediately following 180 days of aggregate total disability, or
(B) The employee with a date of injury on or after 1/1/90 has received a notice of potential eligibility pursuant to Labor Code section 4637(a); and,
(2) If the injury occurred between 1/1/90 and 12/31/93, the employee has received a full explanation by a Qualified Rehabilitation Representative of his/her rights and obligations pertaining to vocational services pursuant to Labor Code section 4636(a); or
(3) If the injury occurred on or after 1/1/94, the employee has received a notice of his/her rights and obligations as required in Section 9813(d)(2).
(c) The employee and his/her representative, if any, must sign a declination of rehabilitation on the form prescribed by the Administrative Director.
(d) The claims administrator shall submit a "Request for Conclusion of Rehabilitation Benefits", DWC Form RB-105 for employees with a date of injury prior to 1/1/90, to the correct Rehabilitation Unit district office with copies to all parties. A "Notice of Termination of Vocational Rehabilitation Services", DWC Form RU-105, shall be submitted for employees with dates of injury on or after 1/1/90 to the correct Rehabilitation Unit district office with copies to all parties. The request shall be accompanied with the notice of potential eligibility and either (i) the signed "Statement of Decline of Rehabilitation Benefits", DWC Form RB-107, for employees with dates of injury prior to 1/1/90 or (ii) an "Employee Statement of Declination of Vocational Rehabilitation Services," DWC Form RU-107, for employees with dates of injury between 1/1/90 and 12/31/93 or (iii) an "Employee Statement of Declination of Vocational Rehabilitation Services", DWC Form RU-107A, for employees with dates of injury on or after 1/1/94.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Section 4641 and 4644, Labor Code.
s 10131.2. Settlement of Prospective Vocational Rehabilitation.
(a) A represented employee who was injured on or after January 1, 2003 can settle prospective vocational rehabilitation services for an amount not to exceed $10,000 in self directed vocational rehabilitation when the following conditions have been met;
(1) The settlement of the employee's rights to prospective vocational rehabilitation services shall be set forth on the DWC Form RU-122;
(2) Prior to entering into any settlement agreement, the attorney for the represented employee shall fully disclose and explain to the employee the nature and quality of the rights and privileges being waived; and
(3) The "Settlement of Prospective Vocational Rehabilitation Services" shall be submitted on the DWC Form RU-122 for employees with a date of injury on or after January 1, 2003 to the correct Rehabilitation Unit office with copies to all parties.
(b) The Rehabilitation Unit may only disapprove a settlement agreement upon a finding that receipt of rehabilitation services is necessary to return the employee to suitable gainful employment. If disapproval is not made within ten (10) days of the Rehabilitation Unit's receipt of a fully executed agreement, the agreement shall be deemed approved.
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4644 and 4646, Labor Code.
s 10132. Fee Schedule.
(a) The Fee Schedule promulgated by the Administrative Director shall be deemed reasonable for providers of vocational rehabilitation services pursuant to Labor Code section 139.5. For services provided to employees injured on or after 1/1/94, the maximum aggregate permissible fees paid for evaluation, plan development and job placement may not exceed $4500, nor may the maximum aggregate permissible fees in each phase of the fee schedule be exceeded.
(b) For injuries occurring prior to 1/1/94, the fee schedule promulgated by the Administrative Director effective 1/1/94 shall be presumed reasonable for services to employees who are determined medically eligible on or after 1/1/94.
(c) For employees who were determined medically eligible prior to 1/1/94, the fee schedule promulgated by the Administrative Director effective 1/23/91 shall apply.
(d) For employees injured on or after 1/1/94 who initiate rehabilitation benefits or services pursuant to Section 10125 on or after 1/1/98, the fee schedule promulgated by the Administrative Director effective 1/1/98 shall apply.
(e) Rehabilitation providers and claims administrators may enter into agreements with any party to provide services at rates less than those provided by the Fee Schedule. Any agreements, however, shall be made in writing prior to the provision of such rehabilitation services. Fees that are charged back to a file by an in-house QRR who is providing rehabilitation services shall not exceed this fee schedule and are subject to the maximum permissible fees for counseling for injuries occurring on or after 1/1/94.
(f) Charges by a claims administrator for the activities of an employee supervising outside rehabilitation providers shall not exceed this fee schedule and shall not be attributed to the maximum permissible fees for counseling. These charges shall be attributed as expenses and not losses for the purposes of insurance rating pursuant to Labor Code Section 139.5(i) for injuries occurring on or after 1/1/94.
(g) Disputes pertaining to the application of the Fee Schedule shall be initially determined by the Rehabilitation Unit.
(h) Service provided by persons other than the firm in which the Qualified Rehabilitation Representative is employed must be clearly identified and billed separately.
(i) Qualified Rehabilitation Representatives appointed by the Rehabilitation Unit to act in the capacity of an independent Vocational Evaluator shall strictly adhere to the fee schedule.
(j) All billings from vocational rehabilitation service providers are due and payable within sixty (60) days of receipt by the claims administrator unless within the sixty (60) day period an objections filed contesting the billing or any portion thereof. Any portion of the billing not contested shall be paid within the sixty day period. Absent objection as described, billings not paid within sixty days from the date of receipt are subject to penalty under Labor Code sections 129 and 129.5. A copy of each billing shall be sent to the employee, and his or her representative, if any, at the time the bill is sent to the claims administrator.
Note: Authority cited: Sections 129, 129.5, 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4635, 4636, 4638 and 4639, Labor Code.
s 10132.1. Reasonable Fee Schedule.
VOCATIONAL REHABILITATION FEE SCHEDULE
All billings for casework provided are to be itemized in tenths of an hour, unless alternative agreements are made under Section 10132(c).
Non-billable costs include: postage, clerical services, photocopies, in-house waiting time, attempts telephone contacts, and in-house staffing. If detailed documentation of these activities is required, the activity is billable at the normal hourly rate of actual time spent.
Adjustments to the Fee Schedule will be reviewed by the Administrative Director of the Division of Worker's Compensation on an annual basis. Recommendations regarding adjustments to the Fee Schedule shall be reviewed by the Rehabilitation Advisory Committee prior to public hearings.
Professional Hourly Rate $65.00 Vocational Evaluation Modules: Work Sample Testing, Vocational Testing, Situational Assessment, or related activities in a group setting shall be subject to the following fee schedule. Includes report.
Service
Code Item Description Schedule
60 One Day $175
61 Three Day $375
62 Five Day $500
63 Eight Day $800
30 90 Day QRR Benefit Call Actual time at professional hourly
rate, not to exceed 5 Hours
Includes all contacts to schedule appointments, preparation of
RU90/91, visit verification, employer contact, first physician
contact. Subsequent contacts to be billed at professional hourly
rate.
31 Job Analysis of Position at Time Actual time at professional hourly
on Injury
rate, not to exceed 5 Hours
Includes contacts to schedule appointment, site visit, document
completion, document review with employee/attorney, securing
signatures and completed report.
PHASE A: EVALUATION OF VOCATIONAL FEASIBILITY AND PLAN DEVELOPMENT MAXIMUM
AGGREGATE PERMISSIBLE FEES NOT TO EXCEED $3000
32 Initial Evaluation Actual time, not to exceed 5 Hours
Includes initial file review, scheduling contact with employee,
contact with employee and representative, if any, interview,
assessment of vocational feasibility and completed Initial
Evaluation Summary, Form RU-120. Billing for the RU-120 shall
not exceed 1.2 hours. The QRR must review with the employee the
report and his or her initial recommendations regarding the
employee's likely ability to benefit from the provision of
rehabilitation services and regarding the nature, extent and
cost of any additional services.
60,61,62,63 Vocational/Work Evaluation Appropriate module
Services
To be used at most appropriate module if required to assist in the
evaluation of vocational feasibility.
34 Vocational Testing & Report. Actual time at Professional
Hourly Rate, not to exceed 5 Hours
or most appropriate module (and
related
service code) if testing is done
at a
vocational/work evaluation
facility.
Includes administration and scoring of a standard battery of
vocational tests.
35 Counseling & Research Service Actual Time at
Professional Hourly Rate
Includes professional time meeting with employee, assessment of
transferrable skills, guidance through vocational exploration,
test interpretation with employee, labor market assessment and
resource research, determination of physical appropriateness of
a proposed vocational goal.
43 DWC Form RU-102 Actual time at professional
hourly rate, not to exceed 1 Hour
All required documents and cover latter completion for plans
involving modified or alternative work.
44 DWC Form RU-102 Actual time, at professional
hourly
rate, not to exceed 2 Hours
All required documents and cover letter completion for plans
involving Direct placement, OJT, Training, Self-Employment.
45 Plan Monitoring Actual time, by report
Includes activities necessary
to oversee the employee's
successful completion of the
plan. May entail contacts
with employee, training
facility or OJT employer.
PHASE B: PLAN MONITORING AND JOB PLACEMENT MAXIMUM AGGREGATE PERMISSIBLE FEES
NOT TO EXCEED $3500.
Service
Code Item Description Schedule
46 Plan Monitoring Report Actual time, not to
exceed .5 hours
41 Job Seeking Skills Actual time, not to
exceed 4 hours at $65 hour
All activity directed to providing the employee with skills, recume
preparation, and personal presentation necessary to obtain
employment.
42 Job Placement Actual time at $65/hour
Job placement services, placement follow-up and placement counseling.
INTERPHASE SERVICES (pertains to all phases, to be charged during the phase in
which the activity occurs and included within the maximum aggregate
expenditure for each phase)
21 Travel Rate Not to exceed $32.50/hour
plus $0.24 per mile
51 Telephone Calls Actual time
52 File Review/New Document Review Actual Time at $65.00
After an initial review, file review is billable activity only for
re-opening or re-activation of a file, or for conference preparation
purposes. Review of new medical/legal reports, or work evaluation
reports, upon receipt, is billable activity.
35 Counseling & Research Services Actual Time at
Professional Hourly Rate
53 Reporting The fee for completion of
the Vocational Rehabilitation
Progress Report, Form RU-121,
is .5 hours at Professional Hourly
Rate.
For narrative reports at the request of a party unless otherwise
specified, three-tenths of an hour per page, up to one and one half
hour maximum.
54 Rehabilitation Unit Conference, Actual time at professional rate.
Informal Conference & Professional
Appearance
Preparation time up to one hour.
Education & Training:
As between schools of equal merit, preference will be given to those
schools who have reduced their tuition rates by 10% from published
1989 tuition rates, in accordance with the reduction required by
Labor Code section 139.5(a)(4). Documentation reflecting the tuition
reduction shall be available upon request. Private Vocational
schools may not charge a tuition rate for rehabilitation students
which is greater than the lowest rate than that given to the general
public.
90 Extraordinary Services/Expenses
For Dates of Injury prior to to
1/1/94:
It is recognized that there can occasionally be exceptional
circumstances which may require services and fees beyond those
listed. Billings above the recommended fee schedule shall require
additional documentation prior authorization for excess billings
should be obtained before service delivery.
TABULAR OR GRAPHIC MATERIAL SET AT THIS POINT IS NOT DISPLAYABLE
Note: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4635, 4636, 4638 and 4639, Labor Code.
s 10133. Forms, Form Filing Instructions & Notices.
The forms and form filing instructions govern the procedures for the use and completion of the forms required by the Rehabilitation Unit. Unless otherwise specified each form may be used for all dates of injuries.
Form RU-90 "Treating Physician's Report of Disability Status" Form Filing Instructions
Form RU-91 "Description of Employee's Job Duties" Form Filing Instructions
Form RU-94 "Notice of Offer of Modified or Alternative Work" Form Filing Instructions
Form RU-102 "Vocational Rehabilitation Plan" Form Filing Instructions
Form RU-103 "Request for Dispute Resolution" Form Filing Instructions
Form RB-105 "Request for Conclusion of Rehabilitation Benefits" Form Filing Instructions
Form RU-105 "Notice of Termination of Vocational Rehabilitation Services" Form Filing Instructions
Form RB-107 "Statement of Decline of Vocational Rehabilitation Benefits" Form Filing Instructions
Form RU-107 "Employee Statement of Declination of Vocational Rehabilitation Services" Form Filing Instructions
Form RU-107A "Statement of Declination of Vocational Rehabilitation Services" Form Filing Instructions
Form RU-120 "Initial Evaluation Summary" Form Filing Instructions
Form RU-121 "Vocational Rehabilitation Progress Report" Form Filing Instructions
Form RU-122 "Settlement of Prospective Vocational Rehabilitation Services" Form Filing Instructions
Note: Authority cited: Sections 133, 138.4, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4635, 4636, 4637, 4638, 4641, 4644 and 4646, Labor Code.
s 10133.1. Standardized Report Forms
Note: Authority cited: Sections 133, 138.4, 139.5 and 5307.3, Labor Code. Reference: Section 139.5, Labor Code..
s 10133.2. Pamphlets.
(a) "Help in Returning to Work"
Help In Returning To Work
Vocational Rehabilitation Benefits for Workers Injured after January 1, 1994
What is vocational rehabilitation?
Vocational rehabilitation is a workers' compensation benefit that helps injured workers return to work.
You generally qualify for vocational rehabilitation if you can no longer do your old job, and your employer does not offer you another.
If you qualify, a plan to return you to work will usually be developed by a vocational counselor - with assistance from you and your claims administrator, the person who is handling your claim for your employer or your employer's insurance company.
California law limits the amount of money for rehabilitation services.
How do I find out if I'm eligible for vocational rehabilitation services?
When you are off work for 90 days, your claims administrator will give the doctor who is treating you a job description that lists the exact duties you performed at work.
Your claims administrator will ask for your help in preparing this job description. This is to make sure that your doctor has an accurate picture of your job duties.
Your participation is very important, because if you do not assist, the claims administrator may send your doctor the employer's description of your job.
If you need help filling out the job description form, you may contact the Division of Workers' Compensation (DWC) Information and Assistance office.
Once your doctor reports whether you can return to your job, you will receive a letter from the claims administrator and a copy of the doctor's report regarding medical eligibility.
If you are unable to return to your old job, your employer will decide whether you can return to other work with your disability. You should receive a notice in about a month from the date you receive the notice of potential eligibility from the claims administrator.
If your employer offers you work within your medical restrictions, and you reject or fail to accept the job within 30 days of the offer, you will not qualify for rehabilitation services.
What if the job my employer offered does not work out?
You may still be entitled to rehabilitation services if the job doesn't last for 12 months or your disability prevents you from performing the tasks.
If you have concerns, talk to your employer, claims administrator, or Information and Assistance officer.
What if my employer does not offer me a job?
You will receive an offer of vocational rehabilitation services. You have 90 days to accept. You may ask for an evaluation to help you decide.
If you want services but can't start immediately, you should let your claims administrator know and ask about the possibility of delaying services.
If you do not wish rehabilitation at all, you may decline these services by signing a form. This ends your employer's obligation to provide rehabilitation services at a later date.
Can I settle my vocational rehabilitation services?
No, for injuries which occurred prior to January 1, 2003. California law does not permit prospectivevocational rehabilitation services to be settled.
Yes, for injuries which occur on or after January 1, 2003. An employer and represented employee may agree to settle rights to prospective vocational rehabilitation services with a one-time payment not to exceed $10,000 for use in self directed vocational rehabilitation.
If I accept vocational rehabilitation, what should I expect?
You and your claims administrator can choose an agreed upon counselor who will develop a rehabilitation plan for you. This can include job modification, job placement assistance, short-term training, and self-employment possibilities - whatever is the best way to return to work.
You also have the right to request a change of counselor.
What income do I receive if I accept vocational rehabilitation?
If you are receiving temporary disability payments when you start vocational rehabilitation, you may continue receiving them until your doctor reports your condition is "permanent and stationary." When this occurs, you will then receive a maintenance allowance of up to $246 per week. There is a 52-week limit to the maintenance allowance that counts against the $16,000 cap. It is better for you to start your rehabilitation as soon as possible. You may also receive advance payments of permanent disability benefits to supplement the maintenance allowance.
What are the limits of vocational rehabilitation?
The California Legislature has placed very strict limits on rehabilitation plans:
w The plan must be completed within 18 months.
w Vocational rehabilitation maintenance allowance payments are limited to a total of 52 weeks.
w Once you agree to a plan, changes are limited.
w Total cost, including maintenance allowance, counseling fees, services and expenses, are generally limited to $16,000.
What if I'm already enrolled in a college or university?
If you are already enrolled and have made substantial progress toward a degree or certificate at a community college, California State University or the University of California, you may be able to waive the services of a rehabilitation counselor. Funds normally paid for counseling may then be used to help pay for the college or university program in which you are enrolled. Contact the DWC Rehabilitation Unit for details.
What other services or benefits could I receive as part of the vocational
rehabilitation benefit?
w Transportation allowance at a rate specified by the State of California.
w Specific costs required for your rehabilitation plan, such as the cost of retraining, supplies, tools and equipment, tuition and student fees.
w Reasonable additional living expenses, such as temporary relocation costs during evaluation or training. This consists of the costs of your food and lodging when you are required to be away from home.
w Reasonable relocation expenses if permanent relocation is required.
w Remember, total costs cannot be more than $16,000 except in very limited circumstances.
What are my responsibilities?
You are expected to:
w Take an active role in your rehabilitation.
w Complete assignments.
w Be on time for all appointments, classes, interviews, and scheduled meetings.
w Notify your rehabilitation counselor immediately if you are unable to keep appointments.
w Maintain an accurate, complete travel expense log.
w Stay in contact with and immediately notify your counselor of any problems.
w Keep your counselor and claims administrator advised of any change of your address or phone number.
w Be available for rehabilitation services Monday through Friday, during reasonable business hours.
You should be aware that if you do not participate fully, your maintenance allowance may be stopped.
What are the claims administrator responsibilities?
The claims administrator in a timely manner:
w assists you in returning to work with your employer.
w pays your benefits that are due.
w pays for rehabilitation services and expenses that are agreed upon.
w notifies you of changes in benefits.
w submits required paperwork to DWC.
w responds to your questions.
If your claims administrator causes a delay in the provision of services, you may be entitled to additional benefits that could extend beyond the $16,000 limitation. You must file aRequest for Dispute Resolution(DWC Form RU-103) if you wish a written determination as to whether there was a delay.
How do I request assistance from the DWC Rehabilitation Unit?
We hope that you can resolve problems informally with your claims administrator. However, the DWC Rehabilitation Unit is the agency responsible for resolving disputes in vocational rehabilitation. (continued)