We are happy to provide you with this informative summarized booklet of the important changes and updates to both of these funds. Please feel free to contact us at anytime to get a hard copy of this booklet or answer questions you may have. We are always here to help in any way we can.

Laura M. Wilson & Associates, Inc. SB863: Supplemental Job Displacement benefit (SJDB Voucher) What you need to know CHANGES THAT APPLY TO ALL to the voucher unless the You will note the distinction that for DATES OF INJURY: employer makes an offer or dates of injuries prior to January 1, Pursuant to Labor Code section regular, modified, or alternative 2013, the time period required for 4658.5(d), a time limit is now work, as defined by Labor Code the offer of work pursuant to Labor imposed on an applicant’s use of the section 4658.1, that meets this Code section 4658.6, is 30 days. It voucher. For all vouchers issued criteria: is important to refer to the date of injury to ensure that the proper after January 1, 2013, a statutory time limit of two years after the 1. The offer is made no later than 60 date the voucher is furnished to days after receipt of the first report the employee or five years after received from either the primary If the employer does not make the the date of injury, whichever is treating physician, an agreed medical offer for regular, modified, or later. Note that there is no time limit evaluator or a qualified medical alternative work, the supplemental on vouchers issued before January evaluator finding that the disability job displacement benefit shall be 1, 2013. from all conditions for which offered to the employee within 20 compensation is claimed has days after the expiration of the 60 CHANGES FOR DATES OF INJURY become permanent and stationary, day period. (Labor Code ON OR AFTER JANUARY 1, 2013: and that the injury has caused §4658.7(c)). Labor Code section 4658.7(b) sets permanent partial disability. forth the eligibility criteria for the supplemental job displacement 2. The offer is for regular, modified or benefit for dates of injury after alternative work lasting at least 12 January 1, 2013. A permanently months. partially disabled worker is entitled www.lauramwilson.com deadlines are met.
Laura M. Wilson   Associates, Inc.  SB863  Supplemental Job Displacement benefit  SJDB Voucher  What you need to know CHAN...
Laura M. Wilson & Associates, Inc. ALL CASES WILL WITH PERMANENT PARTIAL DISABILTY=$6,000 VOUCHER All permanently partially disabled workers who are not returned to work are entitled to receive the same $6,000.00 voucher. (Labor Code §4658.7(d)). There are no longer varying amounts for the voucher based upon the level of permanent partial disability. THE VOUCHER CAN NO LONGER BE "CASHED OUT" Section 4658(g) does not permit settlement or commutation of a claim for the supplemental job displacement benefit. Therefore, the voucher may only be used as outlined in the statute. THE USES FOR THE VOUCHER HAVE BEEN EXPANDED TO THE FOLLOWING: 1. 2. 3. 4. 5. 6. Payment for education-related retraining or skill enhancement, or both, at a California public school or with a provider that is certified and on the state's Eligible Training Provider List (EPTL), as authorized by the federal Workforce Investment Act (P.L. 105-220), including payment of tuition, fees, books, and other expenses required by the school for retraining or skill enhancement. Payment for occupational licensing or professional certification fees, related examination fees, and examination preparation course fees. Payment for the services of licensed placement agencies, vocational or return-to-work counseling, and résumé preparation, all up to a combined limit of 10 percent of the amount of the voucher. Purchase of tools required by a training or educational program in which the employee is enrolled. Purchase of computer equipment, up to one thousand dollars ($1,000). Up to five hundred dollars ($500) as a miscellaneous expense reimbursement or advance, payable upon request and without need for itemized documentation or accounting. 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. (Labor Code §4658.7(e)). 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 employer prior to the expiration date (two years after the date the voucher is furnished or five years after the date of injury, whichever is later). (Labor Code §4658.7(f))).
Laura M. Wilson   Associates, Inc.  ALL CASES WILL WITH PERMANENT PARTIAL DISABILTY  6,000 VOUCHER All permanently partial...
Laura M. Wilson & Associates, Inc. NEW REQUIRED PHYSICIAN FORM The medical report that invokes the time period must be made on a specific form that is created by the administrative director. Pursuant to Labor Code section 4658.7(h)(2), the form must fully inform “the employer of work capacities and of activity restrictions resulting from the injury that are relevant to the potential regular work, modified work, or alternative work.” Physician’s Return-to-work & Voucher Report Labor Code section 4658.7(b)(1)(A) permits the employer to send the medical evaluator a job description for the applicant’s regular work, proposed modified or alternative work. The physician is then to “evaluate and describe in the form whether the work capacities and activity restrictions are compatible with the physical requirements set forth in that job description.” The form that is completed by the physician shall be forwarded by the carrier to the employer in order to fully inform the employer “of work capacities and activity restrictions resulting from the injury that are relevant to potential regular, modified, or alternative work.” (Labor Code §4658.7(b)(1)(B)). www.lauramwilson.com
Laura M. Wilson   Associates, Inc.  NEW REQUIRED PHYSICIAN FORM The medical report that invokes the time period must be ma...
Laura M. Wilson & Associates, Inc. SJDB Voucher Flow Chart (PC: LC 4658, SJDB: LC 4658.5 & 4658.6) 658 5 & LC 4658 6) DOI ≥ 01/01/2004 TX/No TD but EE has PD Send Mod/Alt Offer DWC-AD 10133.53 within 30 days from TD end (File copy with AD ≤ 30 days) P & S, Released to Regular Duties No PD Issue PD denial No voucher due PD TX/No TD No PD TD Paid Send Regular Work Offer DWCAD 10118 (EEs ≥ 50, DOI ≥ 01/01/05 only) TD Ends (PD or No PD) No Notice or Voucher Required Send Notice of Rights 10133.52 within 10 days from TD end certified mail (required once only) Released to Mod/Alt Work Reduce weekly PD 15% as of date of offer but within 60 days after P&S [LC 4658(d)(3)(A)] (DOI ≥ 01/01/05 only) Mod/Alt Available No voucher due Send Mod/Alt Offer DWC-AD 10133.53 within 30 days from TD end (File copy with AD ≤ 30 days) If not P&S yet, send Mod/Alt offer again within 60 days after P&S [LC 4658(d)(3)(A)] Reduce weekly PD 15% as of date of offer but within 60 days after P&S [LC 4658(d)(3)(A)] (DOI ≥ 01/01/05 only) No voucher due www.lauramwilson.com Mod/Alt/Reg Not Available Increase weekly PD 15% 60 days after P&S (EEs ≥ 50, DOI ≥ 01/01/05 only) Send Voucher 10133.57 within 25 days of approved award (unless settled) Pay voucher expenses within 45 days of invoice [10133.56(h)]
Laura M. Wilson   Associates, Inc.  SJDB Voucher Flow Chart  PC  LC 4658, SJDB  LC 4658.5   4658.6  658 5   LC 4658 6   DO...
Laura M. Wilson & Associates, Inc. 60 Days Form 10133.33 Description of Employee’s Job Duties P&S by treater with PD. Mandatory for 1st P&S report. Form 10133.36 – Physician’s Return to Work & Voucher Report 20 Days 2 years after furnished=S.O.L 10133.34 (b) Notice of Offer; Form 10133.35: Regular - 10117: Modified  Meet restrictions Alternative  Last 12 months Reasonable commute at time of DOI   85% Pay 10133.54 – Request for Dispute Resolution; Form 10133.55 10133.31 Voucher Form 10133.32 Eligible for $5000 Return to Work Fund Benefit – MUST BE SUBMITTED WITHIN 12 MONTHS FROM ISSUANCE OF SJDB VOUCHER. NOTE: THE RETURN TO WORK FUND BENEFIT WILL EXPIRE 12 MONTHS AFTER DATE OF ISSUANCE OF THE SJDB VOUCHER OR APRIL 13, 2015, WHICHEVER IS LATER. www.lauramwilson.com
Laura M. Wilson   Associates, Inc.  60 Days  Form 10133.33 Description of Employee   s Job Duties  P S by treater with PD....
Laura M. Wilson & Associates, Inc. (all information below provided by the DIR) Make sure you have all the following necessary documents and information:  Your DWC-AD 10133.32, SJDB Form: o Proof of Service Page (page 6) Or o Entire SJDB Voucher     Full Name Date of Birth SSN/ITIN Address, City, State, Zip     Date of Injury Claim Number ADJ Number Previous RTWSP Benefit Payment Information (if applicable) • Scan & save your SJDB voucher (you can do this yourself with any scanner or if you don't have access to one, there is one located at the kiosks within the DIR offices). •Make sure you scan one of the following: •Proof of Service of the SJDB voucher form (page 6) OR the entire SJDB voucher form (10133.32) • fill out the individual information: •* First Name, Middile Initial, Last Name; * Date of Birth; * SSN/ITIN; * Address, City, State, Zip; Email; Phone Number • fill out the injury history •* Date of Injury; * Claim Injury; * SJDB Proof Of Service Date; * ADJ Number; Previous RTWSP Benefit Payment (RTWSP#; Date) • Upload sjdb voucher • Click Upload; Click Browse; Click on your SJDB scanned file; Click Open; Click Add. • check boxes for certification •* Residency Certification; * Penalty of Perjury • Review & Submit •Review all your information for accuracy •If any changes are needed, click on Edit. •Click the Submit button to complete your application. An RTW number will be assigned to you on the last page. • Print a copy of your application for with rtw number •Click on "Click here to print this page" •On the Print menu, click on Print button •Collect your copy from the printer. •Keep your RTW number for your records • finally click on logout and close your application www.lauramwilson.com
Laura M. Wilson   Associates, Inc.   all information below provided by the DIR   Make sure you have all the following nece...
Laura M. Wilson & Associates, Inc. Corporate Office: 10350 Heritage Park Drive Santa Fe Springs, CA 90607 Satellite Offices: 12800 Center Court Drive, Ste 500 Cerritos, California 90703 11721 Whittier Blvd, Suite 413 Whittier, California 90601 7801 Mission Center Court, Ste 400
 San Diego, CA 92108
 Phone Numbers: Toll-Free: (800) 531-5608 Direct: (818) 359-SJDB (7532) (562) 458-SJDB (7532) (619) 325-0969 Fax: (562) 309-8142 or (888) 389-SJDB (7532) www.lauramwilson.com
Laura M. Wilson   Associates, Inc.  Corporate Office  10350 Heritage Park Drive Santa Fe Springs, CA 90607 Satellite Offic...
Laura M. Wilson & Associates, Inc. Notes: www.lauramwilson.com
Laura M. Wilson   Associates, Inc.  Notes   www.lauramwilson.com