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California Division of Workers' Compensation
REQUEST FOR CONCLUSION OF REHABILITATION BENEFITS
Purpose:
To request the Rehabilitation Unit's approval of conclusion of rehabilitation services for injuries before 1-1-90. For injuries on or after 1-1-90, use the Notice of Termination of Rehabilitation Services (RU-105).
Submitted by:
Claims Administrator.
When submitted:
Within ten (10) days of the circumstances as described on the form.
Where submitted:
To 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:
Please note this form will be returned or the request denied if:
r The box was not checked for the reason of the request.
r The request lacks substantiation as required.
r Copies have not been sent to the employee and his/her representative, if represented.
r The copy of service section is incomplete.
Accompanying documents:
Relevant medical and vocational reports.
Rehabilitation Unit action:
When the employee objects to the RB-105, the rehabilitation unit will hold a conference or otherwise obtain the reason for objection and issue its decision. If the employee objects, a RU-103 (Request For Dispute Resolution) must be filed. Check the box “the requesting party objects to the request for termination or conclusion of vocational rehabilitation benefits” and provide the reasons for the objection.
Copy:
All parties.
NOTE
Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4637, 4643 and 4644, Labor Code.
HISTORY
1. New section and new Form RB-105 and form filing instructions filed 1-29-2003; operative 1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 5).
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