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

§10133.13. Form RU-102 “Vocational Rehabilitation Plan” and Form Filing Instructions.

Rehabilitation Unit

California Division of Workers' Compensation

Form RU-102

VOCATIONAL REHABILITATION PLAN*

PLANS FOR REPRESENTED EMPLOYEES INJURED ON OR AFTER 1/1/94

Purpose:

To document objectives and methods to be used to implement a proposed rehabilitation plan.

Submitted by:

Claims Administrator

When submitted:

The Claims Administrator submits the form with a RU-105 at the completion of the plan.

Where submitted:

With the applicable Rehabilitation Unit district office. The Rehabilitation Unit's venue is the same as the WCAB. If no WCAB case exists, file with a Rehabilitation Unit within the county where the injured employee resides.

Form completion:

See the following page for information on properly completing the form. Please note: This form must be completed using type no smaller than 10 point. All information must be contained within the section provided.

Accompanying documents:

Within 10 days of plan completion, submit the RU-102 along with a RU-105 Notice of Termination. Medical and vocational reports should not be attached.

Rehabilitation Unit action:

Statistical recording.

Copy:

All parties

PLANS FOR UNREPRESENTED EMPLOYEE OR WITH A QRR WAIVER

AND ALL PLANS FOR EMPLOYEES INJURED BEFORE 1/1/94

Purpose:

To document objectives and methods to be used to implement a proposed rehabilitation plan.

Submitted by:

Claims Administrator

When submitted:

Immediately upon development of a rehabilitation plan which has been agreed to by the parties. If a waiver of Qualified Rehabilitation Representative is requested, whether represented or not, the plan must be submitted for approval.

Where submitted:

With the applicable Rehabilitation Unit district office. The Rehabilitation Unit's venue is the same as the WCAB's. If no WCAB case exists, file with a Rehabilitation Unit within the county where the injured employee resides.

Form completion:

See the following page for information on properly completing the form. Please note: This form must be completed using type no smaller than 10 point. All information must be contained within the section provided.

Accompanying documents:

Include all supporting medical and vocational reports not previously submitted.

Rehabilitation Unit action:

If disapproval is not made within 30 days of a properly documented plan, the plan is deemed approved. A notice of approval will issue in instances where disapproval previously issued.

Copy:

All parties.

INFORMATION ON HOW TO PROPERLY COMPLETE THE FORM RU-102

Form completion:

Submit only if the employee is a Qualified Injured Worker. The RU-102 is prepared by a Qualified Rehabilitation Representative (QRR). In filing out the form, avoid continuation of information to additional sheets. An extension of the information requested on the RU-102 to additional sheets should be limited to only the situation where there is an OJT agreement which describes the responsibilities of the parties and details of training.

Page 1;

The QRR completes the required information. The box in the lower left hand corner are for the parties to initial to show their agreement with the plan. Employee level of participation must be described.

Page 2:

The QRR completes the information and the parties initial the page. The RU-102 is used for modified or alternative work plans when the offer of modified or alternate work is made subsequent to the initiation of rehab services. The box in the lower left hand corner is for the parties to initial to show agreement. If training, education, or tutoring is a part of the plan, the counselor must select a facility or program approved by the council for Private Post Secondary and Vocational Education.

Page 3:

For injuries before 1/1/94--This page describes expected costs of the plan. There is not a legislatively required limit of $16,000 on total costs.

For injuries on or after 1/1/94--The purpose of the budget is to plan the estimated expenditures. The total budget for rehabilitation services may not exceed $16,000 including QRR fees. For QRR's fees, please refer to the fee schedule in the administrative rules.

This page may be helpful as a counseling tool to show the injured worker that greater expenditures in one area must be balanced with savings in others areas or the development of additional monetary resources.

Description of specific items on Page 3

VRMA/VRTD to date - refers to the rate and sum of VRMA payments made since the claims administrator sent the notice of potential eligibility and the injured worker requested rehabilitation services.

VRMA/VRTD to be paid - refers to the rate and sum of VRMA payments during the plan.

If the claims administrator is withholding for attorney fees, the should be calculated along with the actual weekly benefit payment so the worker will know how much he or she actually receives.

Any allocation for TRANSPORTATION EXPENSES such as gas money or public transit tickets must be calculated.

Any TRAINING/TUITION FEES and the training provider must be listed.

OTHER COSTS - such as clothing, tools, books, babysitting, relocation costs, or any other plan costs not itemized above on the form should be listed.

FEES FOR EVALUATION, PLAN DEVELOPMENT AND PLACEMENT and other expenditures from the fee schedule must be listed.

To insure that total plan costs do not exceed $16,000 add the following:

1) VRMA/VRTD paid to date -- total

2) VRMA/VRTD to be paid -- total

3) Transportation expenses -- total

4) Total of plan expenditures

5) Total of fees for evaluation, plan development, and placement

The injured worker must insure that he can meet his living expenses during the plan by adding the total weekly benefit payment to employee to the permanent disability supplement to be paid and any other confirmed financial resources which are listed. In addition, the injured worker can calculate expenditures for legal and rehabilitation fees by adding the total of amount withheld for attorney fees and the total of fees for evaluation, plan development and placement.

Regarding section C-2, labor market surveys are not required. Labor market assessment should include information from the California Occupational Information System if it is available.

The box in the lower left hand corner is for the parties to initial to show agreements.

Page 4:

This is the signature page. Please note: The claims administrator is expected to sign space in Section D as well as Section F.

Please note: Any plan, whether the employee is represented or not, which provides funds to the employee to be disbursed at the employee's discretion or on a non-specific basis must be submitted for review to the Rehabilitation Unit to determine whether the plan is in conflict with Labor Code Section 4646 as required by AD 10126(b)(4).

NOTE

Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4635, 4636 and 4638, Labor Code.

HISTORY

1. New section, relocation and amendment of Form RU-102 from section 10133 to section 10133.13, and new form filing instructions filed 1-29-2003; operative 1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 5).