Notice Of Offer Of Modified Or Alternative Work (Between 1-1-04 And 12-31-12) {DWC AS 10133.53}

DWC - AD 10133.53 - NOTICE OF OFFER OF MODIFIED OR ALTERNATIVE WORK FOR INJURIES OCCURRING BETWEEN 1/1/04 - 12/31/12, INCLUSIVE. This is a mandatory California form used by claims administrators to offer eligible injured employees a modified or alternative job following a work-related injury occurring between January 1, 2004, and December 31, 2012. The form outlines essential job details, wages, duration, physical requirements, and whether the position meets statutory criteria such as lasting at least 12 months and paying at least 85% of pre-injury wages. Employees have 30 days to accept or reject the offer, and failure to respond may reduce permanent disability payments by 15% and disqualify the employee from receiving the Supplemental Job Displacement Benefit unless certain exceptions apply. The form also provides required notices and dispute-resolution information. www.FormsWorkflow.com