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The document is a Modified Duty Assignment Form that outlines the process for an employee returning to work after an injury with specific medical restrictions. It details the responsibilities of both the employee and supervisor, including communication about progress and adherence to physical limitations. The assignment is temporary, not exceeding 90 days, and emphasizes the importance of safety and compliance with medical guidelines.

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What is a DWC 1 form used for?

Form DWC 1 is the official form that California businesses and employees use to file a workers compensation claim. The employee fills out a portion of the form, and the employer fills out the remainder. The employer then sends the completed form to their workers comp insurance company in order to file a claim.

What is a CA 7 form used for?

This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

What is a modified job offer?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

What is a c11 form for workers comp?

C-11: Employers Report of Injured Employees Change in Status. Report any change in a claimants work status as soon as it occurs to NYSIF by submitting Form C-11, including return to work, discontinuance of work, decrease in regular working hours or reduction of wages.

What not to say to a workers comp doctor?

A modified schedule may involve adjusting arrival or departure times, providing periodic breaks, altering when certain functions are performed, allowing an employee to use accrued paid leave, or providing additional unpaid leave.

What does modified duty mean?

To put it simply, a modified job involves duties that have been altered to accommodate an injured employee. If a worker has a sprained ankle, for example, they may not be able to operate heavy machinery and will have to return to the office until their ankle has healed completely.

What is an offer of modified duty?

Light or modified duty is a temporary work modification given to an injured worker in order to accommodate their physical restrictions while recovering from the injury. Upon filing a workers compensation case, injured worker is expected to continue working if it is determined they can safely perform the modified duty.

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