The following information is only applicable to injuries on or after 01/01/2103.
Recently, California Applicants’ Attorneys Association (CAAA) issued a bulletin and practice tip about the Return to Work Supplement Program (RTWSP).
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Claim administrators can expect to see an increase in voucher demands during settlement negotiations so that injured workers can obtain an additional $5,000 from the RTWSP and Supplemental Job Displacement Benefits (SJDB) program. However, it is not necessarily a bad thing, since the SJDB voucher and RTWSP can be valuable tools during settlement negotiations.
The RTWSP is a $120 million fund for the purpose of making supplemental payments to workers whose permanent disability benefits are disproportionately low in in comparison to their earning losses. (Labor Code § 139.48). The RTWSP provides eligible injured workers an additional one-time $5,000 payment.
Applicants are eligible for the RTWSP if they are injured on or after 01/01/2013 AND have applied for the RTWSP within one year of the date of service of the Supplemental Job Displacement Benefits (SJDB) Voucher.
Once a treating doctor, agreed medical evaluator or qualified medical evaluator declares the applicant permanent and stationary, finds permanent disability and issues a Physicians’ Return-to-Work & Voucher Report (Form DWC-AD 10133.36), the claims administrator has 60 days from receipt of the form to make a qualified modified job offer to the injured worker. If no qualified modified job offer is made within those 60 days (expiration date), then the claims administrator must issue the SJDB voucher within 20 days of the expiration date. The SJDB voucher expires within 2 years of being issued or 5 years from the date of injury, whichever come later.
The SJDB voucher is $6,000 regardless of the PD rating and can be used for training at a CA public school or other provider listed on the state’s eligible training provider list. The voucher provides up to $1,000 for reimbursement of licensing or certification and testing fees, to purchase tools required by a training course, to purchase computer equipment of up to $1,000, with receipts and documentation. Up to 10% or $600 may be used to pay for the services of a licensed placement agency or Vocational Return to Work Counselor (VRTWC). In addition, injured workers can also request an advance and/or reimbursement on for miscellaneous expenses up to $500 without providing itemized documentation or accounting.
If an applicant decides to enroll in a training program, then the claims administrator must issue direct payments to the VRTWC and training provider within 45 calendar days from the receipt of the completed voucher, receipts and documentation.
For voucher eligibility disputes, parties can file a Dispute Resolution form with the DWC, and the Administrative Director reviews the form and issues a decision. Claim administrators can avoid issuing vouchers if no PD is found or if a timely qualified job offer is made to the injured worker.
Once the SJDB voucher is served onto the injured worker, he or she has up to 1 year from the date of service of the SJDB Voucher to apply for the RTWSP. For SJDB vouchers issued before 04/13/2015
(RTWSP Launch Date), injured workers have until 04/13/2016 to apply for the RTWSP.
In order to apply, injured workers need only their ADJ number, claim number, and SJDB voucher or proof of service of SJDB voucher. The RTWSP application can only be completed online.
Eligibility for the RTWSP can be disputed by filing a Petition for Reconsideration within 20 days of service of the eligibility decision.
In essence, eligible applicants are entitled to an additional easy one-time payment of $5,000 through the RTWSP, and not the insurance carrier. Eligibility for the program is easy since it only requires that the date of injury be on or after 01/01/2013 and that the application be electronically filed within 1 year of the service date of the SJDB voucher. Further, injured workers can request an additional $500 without documentation from the claim administrator through the SJDB voucher.
However, if the claim is settled before a permanent & stationary report indicating permanent disability is issued, the injured worker would not be eligible for the SJDB voucher, and therefore would not be eligible for funds from the RTWSP.
Based on the above, claims administrators should expect to issue more vouchers based increased demands from applicant’s attorney, but are unlikely to see increased enrollment in training programs.
Since the vouchers are necessary to obtain the additional $5,000 payment from the RTWSP. But once a SJDB voucher is served, injured workers only have 1 year to apply for the RTWSP.
The SJDB Voucher and the RTWSP can be especially valuable during settlement negotiations even if the claim needs to be open for an additional two years after a SJDB voucher is issued. Offering the injured worker the voucher in the C&R, even without a P&S report, may help the settlement be done since the voucher would entitle the injured worker to obtain an additional $5,000 from the RTWSP.