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How to use or fill out catastrophic designation with our platform
- Click ‘Get Form’ to open the Employee’s Request for Catastrophic Designation in the editor.
- Begin by filling out Section 1, which includes your identifying information. Enter your last name, first name, occupation, treating physician's name, date of injury, and other relevant details.
- In Section 2, specify the catastrophic rehabilitation supplier you are requesting. Ensure that this supplier is authorized to provide services once the Board issues an Administrative Decision.
- Complete Section 3 by detailing your education level and work history for the past 15 years. Include physical requirements for each job held during this period.
- Attach a statement from your authorized treating physician regarding your work ability, ensuring it is dated within one year of submission.
- In Section 4, certify that you have sent copies of this request to all relevant parties and complete the Certificate of Service section.
- Finally, review all sections for accuracy before submitting your form through our platform.
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