Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out wc r1catee with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
Click ‘Get Form’ to open the wc r1catee in the editor.
Begin by filling out Section 1, which includes your identifying information. Enter your last name, first name, middle initial, Social Security Number or Board Tracking Number, date of injury, occupation, county of injury, birthdate, treating physician's specialty, and diagnosis.
In Section 2, specify the catastrophic rehabilitation supplier you are requesting. Ensure that you provide the name clearly as this will be crucial for the Board's Administrative Decision.
Complete Section 3 by detailing your education level and work history for the past 15 years. Include physical requirements for each job such as lifting weights and hours spent standing or sitting.
Attach a statement from your authorized treating physician regarding your work ability. This must be dated within one year prior to mailing the form.
Fill out Section 4 with your Certificate of Service details to confirm that copies have been sent to all relevant parties.
Finally, review all sections for accuracy before submitting your request through our platform.
Start using our platform today to fill out your wc r1catee easily and efficiently!
(1) The objection must be filed on the WC-Rehab Objection Form with attached arguments and sent to all parties and to any/all involved rehabilitation suppliers.Read more
In April 2006 the employee filed a WC-R1CATEE requesting the designation of his condition as catastrophic. Because the catastrophic designation requestRead more
Cookie consent notice
This site uses cookies to enhance site navigation and personalize your experience.
By using this site you agree to our use of cookies as described in our Privacy Notice.
You can modify your selections by visiting our Cookie and Advertising Notice.