Section Lab 509.04 - Reporting Provision of Vocational Rehabilitation Services(a) Within 7 days of receiving a referral from a carrier or self-insured employer, the vocational rehabilitation provider shall report it to the department. This information shall be provided on the vocational rehabilitation provider's letterhead and shall reflect referrals for vocational rehabilitation services, not referrals exclusively for medical management services.(b) A copy of the "Employer's First Report of Injury", form 8WC (12/2014), contained in Appendix II shall be attached to the referral.(c) The vocational rehabilitation provider shall provide the following information in the following order: (1) Date referral received;(2) Date of employee's injury;(3) Employee's name at the time of the injury;(4) Employee's mailing address, including the street, RFD or box number, city, state, and zip code;(6) Carrier or self-insured employer's name;(7) Carrier or self-insured employer's mailing address;(8) Rehabilitation provider's name;(9) Rehabilitation company name;(10) Employee's attorney's name, if represented by an attorney; and(11) Employee's attorney's mailing address.(d) In cases that have been referred pursuant to Lab 509.04(a), an individual written rehabilitation plan (IWRP) shall be filed with the department within 120 days of the vocational rehabilitation referral.(e) (IWRP) amendments shall be written and consecutively numbered as long as vocational rehabilitation services continue to be provided. (f) (IWRP) and amendments shall be on the vocational rehabilitation provider's letterhead. (g) The vocational rehabilitation provider shall provide the following information in the order below on the (IWRP) and amendments: (3) Employee's date of injury;(4) Employee's date of birth;(5) Employee's average weekly wage;(6) Employee's disability;(7) Employee's pre-injury occupation;(8) Employee's education level;(9) Carrier or self-insured employer's name;(11) Medical justification for the vocational goals with the attached medical report;(12) Level of service as per Lab 509.02(c);(13) Vocational goal with rationale and estimated weekly earnings;(14) Detailed plan of vocational services including the nature and extent of services, and the projected dates of service;(15) Responsibilities of participants; and(16) Signature of the employee, rehabilitation provider, employer or representative, and department representative with dates.(h) The (IWRP) and amendments shall reflect all the vocational rehabilitation services anticipated.(i) If disputes arise over the (IWRP) or its amendments, the vocational rehabilitation coordinator or designee shall contact the party in dispute, discuss the problem areas, and identify resolutions.(j) The vocational rehabilitation coordinator or designee shall review the (IWRP) and its amendments within 14 days of receipt by the department. If the (IWRP) or its amendments are disallowed, per 281-A:25, VII, it shall be returned to the vocational rehabilitation provider for revisions.(k) If a dispute arises regarding the (IWRP) or its amendments which is not resolved through the administrative process outlined above, a hearing shall be scheduled pursuant to RSA 281-A:25, VII.(l) At case closure, the vocational rehabilitation provider shall file with the department a closure report which provides the following information: (2) Carrier or self-insured employer's name;(3) Employee's date of injury;(6) Reason for closure; and(7) Name of vocational rehabilitation provider.(m) The case closure shall be on the vocational rehabilitation provider's letterhead.N.H. Admin. Code § Lab 509.04
#6806, eff 7-18-98 (formerly Lab 508.04 ); ss by #8682, INTERIM, eff 7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07
Amended by, Volume XXXVI Number 14, Filed April 7, 2016, Proposed by #11067, Effective 4/1/2016, Expires 4/1/2026.