Supplement Job Displacement Nontransferable Training Voucher (Between 1-1-04 And 12-31-12) {DWC AD 10133.57}

DWC - AD 10133.57 - SUPPLEMENTAL JOB DISPLACEMENT NONTRANSFERABLE TRAINING VOUCHER FORM FOR INJURIES OCCURRING BETWEEN 1/1/04-12/31/12, INCLUSIVE.This is a California workers’ compensation form issued by the Division of Workers’ Compensation for injuries occurring between January 1, 2004 and December 31, 2012. This voucher is provided to eligible injured employees who have a permanent partial disability and do not return to regular, modified, or alternative work. The form documents the voucher amount based on the permanent disability award and may be used for approved education, retraining, or skill enhancement expenses, including tuition, fees, books, and vocational or return-to-work counseling (subject to limits). Sections are completed by the claims administrator and the injured employee, and the employee must sign and use the voucher before the listed expiration date. www.FormsWorkflow.com