Supplemental Job Displacement Benefit Table
Saturday, October 9, 2004 | 0
The SJDB voucher process continues to be a source of confusion and frustration for claims departments charged with implementing the various notices and processes mandated by L.C. sections 4658.5 and 4658.6. It doesn't help that we still don't have AD Regulations to provide necessary guidance and structure and it now seems unlikely that we will have regulations before the end of the year. With the pressure on the AD to finalize and issue regulations on PD rating, medical treatment, and medical networks, it may be optimistic to expect voucher regulations until sometime next year.
This leaves claims administrators with no choice but to act in "good faith" consistent with the intent and plain language of the statute. Put simply, this means sending a Notice of Potential Rights within 10 days of the last TD payment, determining the availability of mod/alt work if needed for injured employees with PD and offering such work within 30 days of the last TD payment, advising the employee of entitlement to the voucher where mod/alt work is not available, and providing the employee with the voucher within a reasonable period (probably 20 days) from resolution of the case by F&A or C&R. There are all sorts of "exceptions" of course and there cannot be "answers" for these situations until we have regulations - and probably some case law.
In the interim, claims administrators need to deal with the usual or routine cases. The attached "SJDB Action Table" is intended to assist claims staff in responding to situations where the employee is P&S (and P&S coincides with the last payment of TD) and has (is likely to have) some degree of permanent disability. Claims managers and supervisors should note that use of this table requires some policy decisions so appropriate adjustments should be made to the table to insure that your examiners' responses are consistent with company policy.
| Trigger Event | Time Frame | Action Required | Cases Impacted |
| Last Payment of TTD | 10 days | Send Notice of Potential Rights* (Use SJDB-1 letter) | The Notice of Potential Rights is required by L.C. section 4658.5(c) for all cases where the employee has PD or is likely to have PD. |
| First Payment of PD (no TTD paid) | 10 days* | Send Notice of Potential Rights* (Use SJDB-1 letter) | The Notice of Potential Rights is required by L.C. section 4658.5(c) for all cases where the employee has PD or is likely to have PD. |
| NO TTD but PD known or expected | 10 days | Send Notice of Potential Rights* (Use SJDB-1 letter) | The Notice of Potential Rights is required by L.C. section 4658.5(c) for all cases where the employee has PD or is likely to have PD. |
| Medical indication that job accommodation needed | 30 days from last TD payment | Contact Employer ASAP to determine availability of modified or alternative work | Employee's who require job accommodation must be notified within 30 days per L.C. section 4658.6(a). |
| Offer of modified or alternative work* | 30 days from last TD payment | Complete and send RU-94a* with SJDB-2 cover letter to the claimant | Per L.C. sections 4658(a)(b), the employee must be sent an offer of modified or alternative work within 30 days of the last TD payment |
| Return to work date | 60 days from last TD payment | Enter date job starts on Page 1 of the RU-94a Offer Form | Per L.C. sections 4658(a)(b), the employee must be sent an offer of modified or alternative work within 30 days of the last TD payment |
| Trigger Event | Time Frame | Action Required | Cases Impacted |
| Employee released to/performing temporary light duty or regular duty. | 30 days | Advise employee that determination is premature (temp duty) or s/he is not eligible (regular duty). (Use SJDB-3 letter) | This is an optional letter |
| No modified or alternative work available | 30 days | Advise employee by letter (Use SJDB-3 letter) | This is an optional letter |
| PD Award or C&R | 20 days | Send SJDB voucher to the claimant (Use SJDB-4 vocuher); specify the face value of the voucher per L.C. section 4658.5(a) | The voucher must be provided to the employee per L. C. section 4658.5(c). |
| Request for reimbursement by claimant | 45 days | Reimburse claimant for education-related expenses incurred at an approved facility | Per L.C. section 4658.5(a)(b), the claimant can be reimbursed for training expenses incurred at a BPPVE or Western Association of Colleges and Universities up to the face value of the voucher. |
| Request for reimbursement by training facility | 45 days | Reimburse approved training facility for education-related expenses | Per L.C. section 4658.5(a)(b), a BPPVE or Western Association of Colleges and Universities training facility can be reimbursed for training expenses incurred up to the face value of the voucher. |
| Request for reimbursement by a vocation/RTW counselor | 45 days | Pay vocational/RTW counselor fees (not to exceed 10% of voucher) | Per L.C. section 4658.5(b), a vocational/RTW counselor may be paid up to 10% of the face value of the SJDB voucher. The counselor must provide evidence of an agreement with the claimant. |
Contributed by vocational rehabilitation expert Allan Leno, Leno & Associates, (818) 370-8859, allanleno@leno-assoc.com.
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