This information is provided free of charge by the Department of Industrial Relations from its web site at These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at

Division 1. Department of Industrial Relations
Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 7.5. Supplemental Job Displacement Benefit

New query

§10133.33. Form [DWC-AD 10133.31 Requirement to Issue Supplemental Job Displacement Nontransferable Voucher for Injuries Occurring on or After January 1, 2013.

(a) This section shall apply to all injuries occurring on or after January 1, 2013.

(b) If the injury causes partial permanent disability, the employee shall be entitled to a Supplemental Job Displacement Benefit unless the employer makes an offer of regular, modified, or alternative work that meets both the following criteria:

(1) The offer is made within 60 days after receipt by the claims administrator of the Physician's Return-to-Work & Voucher Report (Form DWC-AD 10133.36).

(A) Upon receipt of the Physician's Return-to-Work & Voucher Report (Form DWC-AD 10133.36), the claims administrator shall forward the form to the employer.

(B) If the claims administrator provides the physician with a job description of the employee's regular work, proposed modified work, or proposed alternative work, the physician shall complete the bottom portion of the Physician's Return-to-Work & Voucher Report (Form DWC-AD10133.36.)

(2) The offer is for regular work, modified work, or alternative work lasting at least 12 months.

(c) If no offer for regular, modified, or alternative work is made, pursuant to subdivision (b), the claims administrator shall furnish a “Supplemental Job Displacement Nontransferable Voucher For Injuries Occurring on or After 1/1/13” (Form DWC-AD 10133.32) within 20 calendar days from expiration of time for making an offer of regular, modified, or alternative work pursuant to paragraph (1) of subdivision (b).

(d) The voucher shall be redeemable up to an aggregate of six thousand dollars ($6,000)

(e) The voucher may be applied to any of the following expenses at the choice of the injured worker:

(1) Payment for education-related training or skill enhancement, or both, at a California public school or with a provider that is certified on the state's Eligible Training Provider List at, including payment of tuition, fees, books, and other expenses required by the school for retraining and skill enhancement.

(2) Payment for occupational licensing or professional certification fees, related examination fees, and examination preparation course fees.

(3) Payment for services of licensed placement agencies, vocational or return-to-work counseling, and resume preparation, all up to a combined limit of six hundred dollars ($600).

(4) Purchase of tools required by a training or educational program in which the employee is enrolled.

(5) Purchase of computer equipment including, but not limited to monitors, software, networking devices, input devices (such as keyboard and mouse), peripherals (such as printers), and tablet computers of up to one thousand dollars ($1,000) reimbursable after cost is incurred and submitted with appropriate documentation. The employee shall not be entitled to reimbursement for purchase of games or any entertainment media.

(6) Up to five hundred dollars ($500) as a miscellaneous expense reimbursement or advance, payable upon written request with a copy of the voucher and without need for itemized documentation or accounting. The claims examiner may provide an email address on Form [DWC-AD 10133.32 “Supplemental Job Displacement Nontransferable Voucher for Injuries Occurring on or After 1/1/13]; if an email address is provided, the employee can submit the request via email or regular mail. The employee shall not be entitled to any other voucher payment for transportation, travel expenses, telephone or internet access, clothing or uniforms or incidental expenses.

(f) The voucher will expire two years after the date it is furnished to the employee, or five years after the date of injury, whichever is later. The employee shall not be entitled to payment or reimbursement of any expenses that have not been incurred and submitted with appropriate documentation to the claims administrator prior to the expiration date.

(g) Settlement or commutation of a claim for the supplemental job displacement voucher is not permitted.

(h) An employer shall not be liable for compensation for injuries incurred by the employee while utilizing the voucher.

(i) The claims administrator shall issue the reimbursement payments to the employee or direct payments to the VRTWC and the training providers within 45 calendar days from receipt of the completed voucher, receipts, and documentation.

Note: Authority: Sections 133, 4658.1, 4658.7 and 5307.3, Labor Code. Reference: Sections 4658.6 and 4658.7, Labor Code.


1. New section filed 12-20-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346.1(d) (Register 2012, No. 51). A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day.

Go BackGo Back to Subchapter 1.5 Table of Contents