Claim process -- Rehabilitation benefits
If you are a worker injured on the job, you may be eligible for rehabilitation benefits, depending on the extent of your injuries. The following paragraphs briefly explain the services that may be available to you.
You may be eligible for vocational rehabilitation services if you need help returning to work because of your injury and your employer is unable to offer you suitable gainful employment within your work restrictions. At any time, you may request a rehabilitation consultation to determine if you are eligible for rehabilitation services. Submit your request for a rehabilitation consultation in writing to your insurer.
If you are eligible for services, vocational rehabilitation services are planned by you, the employer/insurer and a qualified rehabilitation consultant (QRC). These services may include modifying job duties to fit abilities, finding work with a different employer if yours does not have suitable work available or training for a new job.
This benefit is a formal course of study designed to return an injured worker to suitable gainful employment.
Before 80 weeks of wage-loss benefits have been paid, the insurer must notify you or your right to request retraining.
If your date of injury is from Oct. 1, 1995, through Sept. 30, 2000, you must file your request for retraining benefits before 104 weeks of wage-loss benefits have been paid to you.
If your date of injury is from Oct. 1, 2000, through Sept. 30, 2008, you must file your request for retraining benefits before 156 weeks of wage-loss benefits have been paid to you.
If you were injured on or after Oct. 1, 2008, you must file your request for retraining before 208 weeks of wage-loss benefits have been paid to you.
Qualified rehabilitation consultant
A QRC will assist you with planning vocational rehabilitation services. The insurer may refer you to a QRC for a rehabilitation consultation, but you may also choose your own QRC.
If you do not choose the QRC for the consultation, you may select one to provide the services. You have up to 60 days after a rehabilitation plan is filed to request a different QRC. Under certain circumstances, you may be entitled to a different QRC after the 60-day period.
Disability case management; vocational rehabilitation services
If an insurer has been granted a waiver for vocational rehabilitation services or if you are not qualified for statutory rehabilitation services, your employer or insurer may assign a disability case manager (DCM) – sometimes just referred to as a case manager – to work with you instead of a QRC. The employer or insurer might ask the DCM to communicate with you, your health care provider(s), your employer and the insurer to help you successfully return to work and/or to coordinate medical treatment.
Understanding the DCMs role
A disability case manager is not a rehabilitation provider, as defined by rule, and is not necessarily bound by all of the statutes and rules pertaining to QRCs. To avoid confusion and understand the role of the individual you are working with, clarify whether you are working with a QRC or a DCM.
Although there is no law that requires you to work with a DCM, a DCM can be a helpful resource in coordinating medical treatment or assisting your return to work. As previously noted, you may ask for a vocational rehabilitation consultation with a QRC at any time, even if you are working with a DCM. A person who worked with you as a DCM may not be your QRC. If you disagree about your eligibility for rehabilitation services or have questions about a DCM, call DLI's Alternative Dispute Resolution unit for additional information and assistance at 651-284-5032 or 800-342-5354.