California DWC Posts Non-Substantive Changes to the Supplemental Job Displacement Benefit Voucher Forms By Press Release - February 19, 2014
The Office of Administrative Law (OAL) approved on February 5 the Division of Workers’ Compensation’s proposed changes to the Supplemental Job Displacement Forms removing the agency logo. Effective February 5, the following forms may be produced without a logo and may be produced on the claims administrator’s letterhead:
Section 10133.32 – Supplemental Job Displacement Nontransferable Voucher for Injuries Occurring on or After 1/1/13
Section 10133.33 – Description of Employee’s Job Duties
Section 10133.35 – Notice of Offer of Regular, Modified or Alterative Work for Injuries Occurring on Or After 1/1/13
Section 10133.36 – Physician’s Return-to-Work & Voucher Report for Injuries Occurring on or After 1/1/13
California Department of Industrial Relations, P.O. Box 420603 · San Francisco, CA · 94142-0603 · www.dir.ca.gov
Adjuster / Examiner Claims Examiner Santa Ana Unified School District Santa Ana, CA
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