Pre Job Accommodation Assistance Application {F245-350-000}

F245-350-000 - PRE-JOB ACCOMMODATION ASSISTANCE APPLICATION. This form from the Washington State Department of Labor and Industries is used by workers with an open state fund workers’ compensation claim—or those receiving a statutory pension—who need equipment or accommodations to participate in a retraining plan or perform a job consistent with vocational recommendations. The form ensures the requested accommodations are medically necessary, directly related to the accepted conditions on the claim, and not for convenience. This assistance is only available when no employee-employer relationship exists and the cost of the request does not exceed $10,000, including prior approvals. Applicants must include supporting documentation, such as a provider’s statement of medical necessity, a consult or narrative report, vendor bids, and a signed ownership agreement. The form also outlines whether the items will become the worker’s property (if used for a job goal) or remain L&I’s property during retraining. www.FormsWorkflow.com