Tip for VR Referral (state-specific)

Vocational rehabilitation is designed to help you return to work in some capacity

Tip for VR Referral (state-specific)

Cooperate with the vocational counselor — refusal to participate can affect your benefits

Tip for VR Referral (state-specific)

You may be entitled to maintenance benefits during rehabilitation/retraining

Workers' Compensationmoderate

Vocational Rehabilitation Referral

VR Referral (state-specific) · State Workers' Compensation Agencies

Referral for vocational rehabilitation services when an injured worker cannot return to previous employment. May include job retraining, education, or job placement services.

Form Details

Total fields: 35
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Filled by: both
Frequency: as needed
State-specific: Yes — form may vary by state

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Where to Submit This Form

📬

Submit to the workers' comp insurance carrier or your state's vocational rehabilitation program

Your claims adjuster, attorney, or treating physician can make the referral.

🌐

Some state programs accept online referrals

https://www.dol.gov/agencies/owcp/regs/compliance/owcp_vocrehab

For federal employees, OWCP manages vocational rehabilitation.

Required Attachments

📎 Medical documentation of disability and work restrictions
📎 Vocational rehabilitation referral form
📎 Employment history and education background
📎 Current functional capacity evaluation (if available)

Processing Time

Initial assessment typically within 2-4 weeks of referral. Full rehabilitation plan development takes 30-60 days.

What Happens Next

A vocational rehabilitation counselor will conduct an assessment and develop a return-to-work or retraining plan. Services may include job placement, retraining, resume assistance, and job modification.

Tips for This Form

✓ Vocational rehabilitation is designed to help you return to work in some capacity
✓ Cooperate with the vocational counselor — refusal to participate can affect your benefits
✓ You may be entitled to maintenance benefits during rehabilitation/retraining
✓ If you disagree with the rehabilitation plan, you can request a review through your state's workers' comp system

More Workers' Compensation Forms

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FROI · State Workers' Compensation Agencies

Report of workplace injury or occupational disease filed with the state agency and insurer. Required within 3-10 days of injury depending on state. Establishes the claim in the system.

California Workers' Comp Claim Form

DWC-1 · California Division of Workers' Compensation

Employee claim form for workers' compensation benefits in California. Employer must provide within one working day of learning of a workplace injury or illness.

New York Employee Claim

C-3 · New York Workers' Compensation Board

Employee's claim for compensation filed with the NY Workers' Compensation Board. Must be filed within 2 years of the accident or within 2 years of when the claimant knew or should have known the condition was work-related.

Texas Employee's Claim for Compensation

DWC-041 · Texas Department of Insurance, Division of Workers' Compensation

Employee's claim for compensation for a work-related injury or illness in Texas. Must be filed within one year of injury or within one year of when the employee knew or should have known the condition was work-related.

Florida First Report of Injury or Illness

DFS-F2 · Florida Division of Workers' Compensation

Florida's first report of injury or illness form. Employer must file within 7 days of knowledge of an injury or within 24 hours if the injury results in death.

North Carolina Notice of Accident to Employer

Form 18 · North Carolina Industrial Commission

Notice of Accident to Employer and Claim of Employee. Must be filed when injured on the job in North Carolina. Written notice to employer required within 30 days; claim filed within 2 years.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Workers' Compensation Agencies or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.