This information is provided free of charge by the Department of Industrial Relations
from its web site at www.dir.ca.gov. 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 http://www.dir.ca.gov/od_pub/disclaimer.html.
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
§10133.35 [DWC-AD 10133.36 Form [DWC-AD 10133.36 “Physician's Return-to-Work & Voucher Report.”]
This form may be produced without a logo and may be produced on the claim's administrator's letterhead.
Note: Authority cited: Sections 133, 4658.7 and 5307.3, Labor Code. Reference: Sections 4658 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 A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 6-26-2013 as an emergency; operative 7-1-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 26). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 7-1-2013 order, including amendment of form, transmitted to OAL 9-27-2013 and filed 11-8-2013; amendments operative 1-1-2014 (Register 2013, No. 45).
4. Change without regulatory effect amending section filed 2-5-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 6).
Back to Subchapter 1.5 Table of Contents