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California Division of Workers' Compensation
NOTICE OF OFFER OF MODIFIED OR ALTERNATIVE WORK
Purpose:
To document an offer of modified or alternative work by the employer at the time of injury. The form also documents the acceptance or rejection of modified or alternate work by the injured employee. The RU-94 is to be used only for injuries which occur on or after 1-1-94.
Submitted by:
The claims administrator obtains the response of the injured worker and submits the form to the Rehabilitation Unit.
When prepared:
The form is prepared at the time of the offer of modified or alternative work by the employer or claims administrator. This form is not to be used to document a plan for modified or alternate work offered subsequent to advising the worker that modified or alternative work was not available.
Where submitted:
Initially to the injured worker within 30 days of the acceptance or rejection of the offer, then it is submitted to the Rehabilitation Unit, together with a RU-105.
Form completion:
The employer or claims administrator completes the information in the top box. The employee completes the section so marked.
Accompanying document:
The RU-94 is submitted with a RU-105 Notice of Termination. The submitted RU-94 must also include a list of duties required of the position and wages offered.
Rehabilitation Unit action:
The Rehabilitation Unit will not take action unless the employee objects by filing a RU-103, Request for Dispute Resolution, to the Notice of Termination.
Note: If the offer is not accepted or rejected within 30 days of the offer, the offer is deemed to be rejected by the employee. The employer has the option to file a RU-105, Notice of Termination, or extend the 30-day period by mutual agreement.
NOTE
Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 4636 and 4637, Labor Code.
HISTORY
1. New section, relocation and amendment of Form RU-94 from section 10133
to section 10133.12, and new form filing instructions filed 1-29-2003; operative
1-29-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 5).
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