Chapter 4.5. Division of Workers' Compensation Subchapter 1.5. Injuries on or After January 1, 1990 Article 7. Vocational Rehabilitation

§10133. Forms & Notices. Rehabilations forms.

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.

HISTORY

1. Change without regulatory effect renumbering and amending former section 10133 to section 10131 and new section 10133 filed 1-22-91; operative 1-22-91 (Register 91, No. 10). For prior history, see Register 90, No. 4.

2. New Form RU-94, repealer and new Forms RU-102, RU-105 and RU-107, and repealer of Forms RU-104, RU-105-W, RU-500-W.1, RU-500-X, RU-500-Y and RU-500-Z filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).

3. Amendment of forms RU-91 and RU-103 filed 2-21-95; operative 2-21-95. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 95, No. 8).

4. Amendment of Forms RU-102 and RU-105 filed 8-26-98; operative 9-25-98 (Register 98, No. 35).

5. Repealer and new forms RU-94 and RU-103 filed 2-25-99; operative 2-25-99 pursuant to Government Code section 11343.3(d) (Register 99, No. 9).

6. Relocation of Forms RU-90, RU-91, RU-94, RU-102, RU-103, RU-105 and RU-107A to sections 10133.10, 10133.11, 10133.12, 10133.13, 10133.14, 10133.16 and 10133.19 filed 1-29-2003; operative 1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 5).

7. Amendment of section heading, new section text, and amendment of NOTE filed 1-29-2003; operative 1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 13.)