Notification Of Vocational Services {WKC-10146}

WKC-10146 - NOTIFICATION OF VOCATIONAL SERVICES BY PRIVATE REHABILITATION SPECIALIST. This form is used to inform the Wisconsin Department of Workforce Development (DWD) and the relevant insurance company or self-insured employer that a private vocational rehabilitation specialist has been selected to assist an injured worker with returning to employment. This form documents key details such as the injured employee’s personal information, work injury, diagnosed disability, and any work restrictions. It also provides the contact information for the insurance representative and the vocational rehabilitation specialist, including their certification number and agency details. The form includes a section to indicate the type of vocational services that will be provided, such as job placement assistance, vocational evaluation, retraining plan development, or other related services. Submission of this form is voluntary, but failure to complete and return it may delay processing under Chapter 102 of the Wisconsin Statutes, which governs the state’s worker’s compensation system. The form must be signed by the vocational rehabilitation specialist and sent to both the insurance company and the Worker’s Compensation Division. www.FormsWorkflow.com