Rehabilitation Request {RQ03}

MN RQ03 - REHABILITATION REQUEST. Submit this form if you want to resolve a dispute about a workers’ compensation rehabilitation issue. You must file the Rehabilitation Request form with the Department of Labor and Industry (department) at the address or fax number at the bottom of the form. Do not file the form with the Court of Administrative Hearings (CAH) - the department will send the Rehabilitation Request to CAH when CAH has jurisdiction under the workers’ compensation law. The department may also send the dispute to CAH when authorized by law. Do not use a Rehabilitation Request form if you also have a dispute about medical, wage loss or permanent partial disability benefits or if the insurer has denied liability for the entire workers’ compensation claim (denial of primary liability). In these cases, you must use a Claim Petition form. The qualified rehabilitation consultant (QRC) must file a Rehabilitation Request form to determine the direction of a plan when no other party has done so, and the QRC is unable to otherwise plan or implement rehabilitation services (unless the insurer has denied ongoing liability for the injury in writing). www.FormsWorkflow.com