Even More SJDB FAQs

Saturday, March 11, 2006 | 0

by Alan Leno

Once we know an applicant with a 2004 date of injury is entitled to a voucher, how long do we have to issue the voucher? There continues to be much confusion in claims departments regarding the time frame for issuing vouchers to eligible injured workers.

Per AD Reg. Section 10133.65(c), a voucher is due an eligible applicant within 25 calendar days from the issuance of a permanent partial disability award... by the WCAB. There are some stories circulating that a few applicant attorneys are pressuring claims examiners to issue a voucher immediately after it is determined that the injured worker will not be offered a modified/alternative position and threatening dire consequences if the examiner does not comply. There may be good claims management reasons for issuing a voucher immediately after modified/alternative work is ruled out but the requirement for issuing the voucher is incurred when the case in chief is resolved at the WCAB. As noted above.

Where can we get the voucher form? This question has been raised by both claims and rehabilitation professionals, although in somewhat different contexts. Claims examiners want the document so they can send it to eligible injured workers but counselors want to know where an injured worker can obtain the form.

Unlike rehab forms, the voucher and related documents are not available at the Unit. The voucher is actually a Regulation Section (Section 10133.57) and is available on line in PDF format. Go to http://www.dir.ca.gov/dwc/forms.html#1 and click on the DWC AD 10133.57 item under the heading "Supplemental Job Displacement Benefit." [WorkCompCentral subscribers can obtain the form both in Regulations and Forms.]

If we cannot obtain the necessary information to make a modified/alternative job offer within 30 days of the last TTD payment, is there any point in continuing the effort A sharp-eyed VR Coordinator has pointed out that there is an incentive to continue the effort.

L.C. Section 4658.5/4658.6 indicate that the offer of modified/alternative work must be sent to the applicant within 30 days of the last TTD payment or the applicant is entitled to a voucher. This is often an impossible task because the necessary information regarding work restrictions is not available from the treating doctor within 30 days and/or the employer does not provide an agreement to provide such work timely. It is therefore very tempting to discontinue the effort once the time frame has been exceeded.

However, L. C. Section 4658(d)(2) provides that the offer of modified or alternative work must be made within 60 days or weekly PD benefits must be increased by 15% (employers with more than 50 employees). L. C. Section 4658(d)(3) allows PD to be decreased by 15% where such an offer is made (acceptance by the injured employee is not required). The effort to offer modified/alternative work should therefore continue for the full 60 days from P&S or until the employer indicates it cannot provide such work, whichever occurs first. The employee will be entitled to a voucher BUT there is a 30% difference in the weekly PPD payment to the injured employee.

How long must a claim file be kept open to pay approved tuition costs? This question has been asked before but there is on-going concern among claim departments that it may be necessary to keep files open indefinitely. There is no L.C. Section 5410 limit on the use of the SJDB voucher. It may sound crude but the only limits on use of the voucher are the full expenditure of the face value of the voucher or the injured employee's death, whichever occurs first. It is entirely possible that a voucher issued today might not be redeemed for 20, 30, 40 years. Does this mean the insurer/employer must keep their claim file open that long?

Our experience with the vocational rehabilitation benefit tells us that an injured worker is unlikely to use the benefit at all when participation is deferred for more than one year. Our experience with the voucher is likely to be very similar. Those who are motivated to pursue a retraining program will most likely do so within a few months of receiving the voucher. If the eligible injured worker does not begin using the voucher within one year, it is unlikely the voucher will ever be used. Each insurer, TPA, and self-insured employer will have to make a policy decision about when a claim file should be closed, vis-