Note: There isn't an outcome for every situation. You may need to choose the closest outcome for the situation.
- Return to Work Outcomes.
- Able to Work Outcomes.
- Services Appropriate Outcomes.
- Services Not Appropriate Outcomes.
- Plan Outcomes.
- Forensic Outcomes.
- Administrative Outcomes.
- Stand-Alone Job Analysis.
- Claim managers only:
| Return to Work Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| RTW1: Return to work, job of injury, same work pattern | All | The worker returns to work at the occupation at the time of injury, same work pattern. | No. |
| RTW2: Return to work, new permanent job, employer of injury | All | The worker accepts the employer's offer of a medically- approved, permanent new job. This outcome includes modified work with the employer at time of injury. | No. |
| RTW3: Return to work, temporary job, employer of injury | All | The worker accepts the employer's offer of a medically approved temporary job consistent with the work pattern at time of injury. Further vocational assessment may be needed if the temporary job ends or the worker has permanent restrictions. | No. |
| RTW4: Return to work, permanent job with new employer | All | The worker returns to work with a new employer at a new or previously held permanent job. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Able to Work Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| ATW1: Full release for work no restrictions | EI, AWA | According to objective medical information, the worker can return to the job of injury. This means either a job analysis of the time of injury job was approved; or the doctor determined that no work restrictions are needed. | No. |
| ATW2: Full release for work, no restrictions | PD, PI | According to objective medical information, the worker can return to the job s/he was performing when injured. This means either a job analysis of the time of injury job was approved; or the doctor determined that no work restrictions are needed. | Dispute rights are given with this determination since the worker was previously found eligible for vocational services. |
| ATW3: Turns down employer of injury's offer of new permanent job | All | The worker did not accept employer of injury's offer of a valid, medically approved, permanent new job. | Yes. |
| ATW4: Turns down employer of injury's offer of new temporary job | All | The worker did not accept employer's offer of a valid, new medically approved temporary job. Further vocational assessment may be needed if the temporary job is no longer available or it is learned that the worker has permanent restrictions. | No. |
| ATW5: Per WAC, employable due to no limitations | EI, AWA | According to objective medical information the worker has no physical or mental limitations/restrictions caused by the industrial injury. (An approved job analysis releasing the worker to the time of injury job is not necessary.) | No. |
| ATW6: Per WAC, employable due to no limitations | PD, PI, Forensic | Objective medical information, obtained after the worker was found eligible for vocational services, shows the worker has no physical or mental limitations/restrictions caused by the industrial injury. | Yes. |
| ATW7: Employable due to transferable skills | AWA, PD, Forensic | The worker has skills from education, work experience, hobbies, and/or volunteer work to perform and obtain the recommended job. | Yes. |
| ATW8: Plan completion, employable | PI | The worker successfully completed the vocational rehabilitation plan authorized by the department. | No. |
| ATW9: Plan not completed, employable | PI | The worker did not successfully complete the vocational rehabilitation plan. The VRC, however, recommends the worker is employable based on the worker's completed coursework and a supportive labor market survey. | Yes. |
| ATWJ: Employer offers job | PD | The employer of record or a chargeable employer makes a valid job offer for bona fide employment – CM code only. | Yes. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Services Appropriate Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| SAS1: Needs further assessment | EI | EI was completed and an AWA is recommended to assess the worker's ability to work. | No. |
| SAS3: Eligible for plan development | AWA, Forensic | Based on medical and vocational information, the worker is eligible and likely to benefit from vocational services to become employable. | Yes. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Services Not Appropriate Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| SNA1: Injured worker declines assessment | EI, AWA | The worker chooses to not participate in early intervention and/or assessment, and/or forensic and signs a statement indicating s/he understands that this may result in termination of benefits. | Yes. |
| SNA2: Not ATW or participate in voc rehab due to industrial injury | AWA, PD, PI, Forensic | The accepted condition(s), along with the vocational information, permanently precludes the worker's ability to work or benefit from vocational services. This outcome should be staffed with the unit vocational consultant for concurrence before submission. | Yes. |
| SNA3: Not ATW or participate in voc rehab due to unaccepted conditions; IW declines | EI, AWA, PD, PI, Forensic | The unaccepted conditions (not the injury or restrictions that were in place at the time of the injury) prevent the injured worker from participating in vocational services. The vocational recommendation must include documentation of an occupational possibility the worker could have benefited from if it were not for the unrelated barriers. This outcome is also used for noncooperation or when the worker's own actions preclude participation in vocational services. This outcome is also used when the worker declines to participate in plan development and/or plan implementation and signs a statement indicating s/he understands that this may result in termination of benefits. | Yes. |
| SNA4: Not ATW or participate in voc rehab due to a combination of the industrial injury and pre-existing conditions | AWA, PD, PI, Forensic | The accepted condition and preexisting conditions, along with the vocational information, permanently preclude the worker from working or benefiting from vocational services. This outcome should be staffed with the unit vocational consultant for concurrence before submission. | Yes. |
| SNA6: Injured worker voluntarily retires | All | The worker chooses to leave the workforce and to not participate in vocational services. The vocational recommendation must include documentation of an occupational possibility the worker could have benefited from if it were not for retirement. | Yes. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Plan Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| PLN1: Plan submitted for approval | PD | The VRC recommends a vocational plan to the claim manager. | No. |
| PLN7: Plan failed (VRC recommendation) | PI | The plan is no longer viable. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Forensic Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| FOR1: further clarification | Forensic | Not enough information exists to issue an outcome and additional medical/vocational information is needed. This outcome should be staffed with the unit vocational consultant before submission and is intended for referrals where the VRC is unable to recommend one of the following: services not appropriate, services are appropriate, or able to work. | No. |
| FOR2: Injured worker moved out of geographic service area of VRC | Forensic | The worker changed locations and is unable to work with the assigned vocational provider. | No. |
| FOR3: Assigned VRC no longer available | Forensic | The VRC leaves a firm where a payee provider relationship exists and the referral was made to either 1) the vocational firm or 2) a VRC who can no longer provide service in the geographical area. | No. |
| FOR4: Clerical or administrative error | Forensic | CM cancels vocational referral because, for example, the referral was sent to the wrong service location, the wrong referral type was sent, the referral was sent to the wrong provider or the referral was sent on the wrong the claim number. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Administrative Outcomes | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| ADM1: injured worker is medically unstable | EI, AWA, PD, PI | The worker is temporarily, medically unable to participate in vocational services for at least 90 days due to the injury. | No. |
| ADM2: Pre/post unrelated issues temporarily preclude voc | EI, AWA, PD, PI | The worker is temporarily unable to participate in vocational services due to medical or other circumstances unrelated to the injury. | No. |
| ADM3: Injured worker moved out of geographic area of VRC | EI, AWA, PD, PI | The worker left the service location of the current VRC; a new VRC is needed. | No. |
| ADM4: Assigned voc counselor no longer available | All | VRC leaves the profession and is no longer accepting referrals. All referrals must be closed. | No. |
| ADM6: Referral made in error | EI, AWA, PD, PI | CM cancels vocational referral because, for example, the referral was sent to the wrong service location, the wrong referral type was sent, the referral was sent to the wrong provider or the referral was sent on the wrong the claim number. | No. |
| ADM8: VRC leaves firm | All | The VRC leaves a firm where a payee provider relationship exists and the referral was either made to 1) the vocational firm or 2) a VRC who can no longer provide service in the geographical area. | No. |
| ADM9: Worker cannot be located | All | The VRC is unable to make contact with the worker. | No. |
| ADMA: VRC declines referral | All | To be used when VRC determines that the referral is not appropriate. Examples include: Conflict of interest; VRC not available; not ready for a referral due to medical issues, etc. VRC may use this outcome for up to 14 days after the referral assignment. A maximum of three professional hours may be billed for reviewing the file and preparing a brief rationale, using the standard VCLOS routing sheet. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Stand-Alone Job Analysis | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| JA01: Job analysis is complete. | SAJA | The service has been completed and the job analysis has been sent to L&I. | No. |
| JA02: Job analysis is incomplete. | SAJA | The service has been completed and the job analysis has been sent to L&I. The provider attempted to, but didn't complete, the job analysis. This outcome isn't to be used in the situations covered under the administrative outcomes listed below. Some examples of appropriate use of this outcome are when:
|
No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
These outcomes are available to claim managers but not to VRCs
| Services Appropriate Outcomes for claim managers only | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| SAS2: EI completed; no AWA referral at this time | EI | EI completed but CM decides not to refer for assessment until additional information is obtained. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Services Not Appropriate Outcomes for claim managers only | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| SNA5: At department's discretion, not eligible for voc services | All | CM reviews decision that vocational services are not appropriate when factors including, but not limited to, the worker's lack of participation in previous or current vocational efforts, indicate the injured worker is unlikely to benefit from vocational services. The vocational recommendation needs to include documentation of an occupational possibility the worker could have benefited from if not for the unrelated barriers. | Yes. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Plan Outcomes for claim managers or vocational services specialists only | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| PLN2: Plan approved | PD | The department agrees to authorize a vocational plan. | Yes. |
| PLN3: Plan denied | PD | The proposed plan isn't sufficient and a new VRC is assigned. | No. |
| PLN4: Plan deemed approved | PD | L&I didn't approve the proposed plan within 15 days. | Yes. |
| PLN8: Plan failed (CM outcome) | PI | The CM determines that the plan is no longer viable. | No. |
| OPT2: Option 2 plan | PI | Option 2 plan selected. | Yes. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
| Administrative Outcomes for claim managers only | |||
|---|---|---|---|
| Outcome | Referral Type * | Definition | Dispute Rights? |
| ADM5: Lack of VRC progress | All | This outcome is used when the VRC demonstrates a lack of progress. It is not for use when the case is not making progress, in general, and the VRC is resolving or attempting to resolve barriers with documentation and/or action. CM should assign to a new VRC if a vocational referral is still needed. | No. |
| ADM7: Fee cap reached | EI, AWA, PD, PI | VRC reaches fee cap for referral. CM re-refers to a different vocational provider, if a vocational referral is still appropriate. | No. |
| ADMB: Vocational services terminated due to failure to participate | PD, PI | CM uses this outcome when an eligible injured worker is not cooperating with the vocational process. | No. |
| * AWA: Ability to Work Assessment, EI: Early Intervention, PI: Plan Implementation, PD: Plan Development, SAJA: Stand-Alone Job Analysis. | |||
