Denial Of Vocational Rehabilitation Services Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Denial Of Vocational Rehabilitation Services Form. This is a California form and can be use in General Workers Comp.
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Tags: Denial Of Vocational Rehabilitation Services, RU-500P, California Workers Comp, General
DENIAL OF VOCATIONAL REHABILITATION SERVICES
Based on a review of your file, you are not eligible for vocational rehabilitation services
at this time. Our decision is based on a determination that you are:
Not Medically Eligible - See attached Physician's Report of Disability Status
or other supporting documentation.
Not Vocationally Feasible because:
Our action involved only vocational rehabilitation. It does not affect your right to other
workers' compensation benefits.
You have the right to disagree with our decision. If you disagree, within fifteen days
after receiving this letter, your or your representative must complete the two forms
enclosed and return them to the Rehabilitation Unit office closest to you. The addresses
and phone numbers of the Rehabilitation Unit of the Division of Workers' Compensation
are on the back of the Case Initiation Document (Form No. RU-101).
Under certain conditions you may have the right to reopen your case. Please refer to
the enclosed pamphlet for additional information. You have 5 years from the date of
injury to make this request.
Please call me if you have questions. If you need more information, you may contact the
California Division of Workers' Compensation by calling 1-800-736-7401, or you may
consult an attorney.
Attachments:
cc:
Request for Dispute Resolution
Case Initiation Document
Pamphlet
Name:
Signature:
Phone #:
MANDATORY FORMAT
NOTICE OF NON-ELIGIBILITY
STATE OF CALIFORNIA
DWC FORM RU 500-Y (12/90)
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