Supplemental

The criteria and eligibility requirements for a supplemental job displacement benefit voucher depend on various factors, most notably when your injury occurred.

You may qualify for a supplemental job displacement benefit voucher if you were injured on the job between January 1, 2004, and December 31, 2012, and you did not return to work within 60 days of the conclusion of your temporary disability benefits. Your injury also had to result in a permanent partial disability. Suppose your employer offers you modified or alternative work within 30 days of concluding your temporary disability payments, and you do not accept the job. In that case, you are not eligible for a supplemental job displacement benefit voucher.

You should receive the voucher within 25 days of verifying your permanent disability. The voucher expires unless issued before January 1, 2013. Your voucher amount depends on your level of permanent disability. The amount varies from $4,000 to $10,000.

• Up to $4,000 voucher for permanent partial disability of less than 15%
• Up to $6,000 voucher for permanent partial disability between 15% and 25%
• Up to $8,000 voucher for permanent partial disability between 26% and 49%
• Up to $10,000 voucher for permanent partial disability between 50% and 99%

Suppose you suffered permanent disability from a work-related incident on or after January 1. In that case, 2013, and your employer does not offer you modified or alternative work; you may be eligible to receive a supplemental job displacement benefit voucher. Suppose your employer provides modified or alternative work within 60 days of receiving the Physician’s Return-to-Work & Voucher Report, and you do not accept the job. In that case, you are not eligible for a supplemental job displacement benefit voucher.

You will generally hear if you qualify for the voucher within 20 days of not receiving an offer for modified or alternative work. If you are eligible for a supplemental job displacement benefit, you will receive a voucher for $6,000, no matter the level of your permanent disability. The voucher will expire within two years of issuance or five years from the date of injury. 

Employees should receive the voucher (Form DWC-AD 10133.57) if injured between January 1, 2004, and December 31, 2012. The claims administrator will complete the first page of the form, and you are responsible for the second page of the form. If you are using a vocational return to work counselor, you should include their information in the first half of the page. The second half of the page is where you have your training provider’s information. After completing the voucher, you must sign it and return it to the claims administrator. You will generally receive payment for the voucher within 45 days of completion.   

To receive an offer of supplemental job displacement benefits for an injury sustained on or after January 1, 2013, you must have the physician who determined your condition is permanent and stationary and has caused permanent partial disability fill out the Physician’s Return-to-Work & Voucher Report (Form DWC-AD 10133.36). Once you receive the voucher (Form DWC-AD 10133.32), complete the second page with the information for your vocational return-to-work counselor or training provider if you use these services. Complete the third page if you want to request an advance or reimbursement of miscellaneous expenses that do not exceed $500. You will complete the fourth page and provide receipts if you would like to request compensation for tuition, fees, books, and computer equipment. You will generally receive payment for the voucher within 45 days of completing the voucher. If you receive a supplemental job displacement benefit voucher, you may also be able to receive a one-time return-to-work supplement voucher of $5,000. 

For injuries between January 1, 2004, and December 31, 2012, a Supplemental Job Displacement Benefits voucher can be used for:

• Education-related retraining or skill enhancement at a state-approved or state-accredited school
• Payment of tuition, fees, books, and other expenses required for retraining or skill enhancement by the school
• Vocational and return-to-work counseling (combined limit cannot exceed 10% of the amount of the voucher)

For injuries on or after January 1, 2013, a Supplemental Job Displacement Benefits voucher can be used for: 

• Education-related retraining or skill enhancement at a California public school or with a provider on the Eligible Training Provider List
• Payment of tuition, fees, books, and other expenses required for retraining or skill enhancement by the school
• Computer equipment up to $1,000, submitted with appropriate documentation
• Occupational licensing or professional certification fees, including related examination fees or examination preparation course fees
• Services of licensed placement agencies, return-to-work counseling, and résumé preparation (combined limit cannot exceed $600 or 10% of the voucher)
• Miscellaneous expense reimbursement or advance up to $500

Employees are generally not allowed to use their Supplemental Job Displacement Benefit voucher for transportation, travel expenses, telephone or internet access, clothing or uniforms, or incidental expenses.

You may be eligible for the Return-to-Work Supplement Program if you received a supplemental job displacement benefit voucher and cannot return to your usual employment. The Return-to-Work Supplement Program is a $5000 voucher that can be used to subsidize lost wages from a work-related injury.  

To qualify for the Return-to-Work Supplement Program, you need a supplemental job displacement benefit voucher for your injury on or after January 1, 2013. You must apply online within one year from the date the voucher was served.