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

§10133.20. Form RU-120 “Initial Evaluation Summary” and Form Filing Instructions.

Rehabilitation Unit

California Division of Workers' Compensation

Form RU-120

INITIAL EVALUATION SUMMARY

Purpose:

To document the findings and recommendations of the Qualified Rehabilitation Representative who conducts the initial evaluation. Per AR §10132.1, such assessment is to include an initial assessment of the worker's ability to benefit from VR services.

Submitted by:

Qualified Rehabilitation Representative (QRR).

When submitted:

The Rehabilitation Unit encourages an expeditious assessment of employee skills and vocational feasibility. The RU-120 should be submitted not later than 30 days from completion of the initial interview unless otherwise agreed to.

Where submitted:

To the claims administrator with copies to all parties. If the QRR is functioning as an Independent Vocational Evaluator (IVE), the RU-120 would be filed directly with the Rehabilitation Unit with copies to all parties.

Form completion:

This form is to be completed by the QRR. The purpose of the form is to obtain comprehensive, yet concise, information which is critical for assessing vocational feasibility and developing an appropriate plan per the California Standards Governing Timeliness and Quality of Vocational Rehabilitation Services. Information gathered for each section must fit within the section designated for that category and the typeface must be no smaller than 10 point. The cost of additional or more detailed reports shall be borne by the party requesting them.

Accompanying documents:

None

Rehabilitation Unit action:

None.

Copy:

All parties.

NOTE

Authority cited: Sections 133, 138.4, 139.5 and 5307.3, Labor Code. Reference: Section 139.5, Labor Code.

HISTORY

1. New section, relocation and amendment of Form RU-120 from section 10133 to section 10133.20, and new form filing instructions filed 1-29-2003; operative 1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 5).