Vocational Providers & Self-insured Employers

When a self-insured employer sees that a worker needs vocational assistance to return to work, they will send a referral directly to a vocational provider. When you (the vocational provider) receive the referral, keep in mind key points when working with the self-insured employer.

Tips for vocational providers

A completed Self Insurance Vocational Reporting Form (SIRVF) cover sheet is a required attachment to all vocational reports submitted to L&I by the self-insured employer.
- Exception: A SIVRF is not required if the worker is not eligible for vocational services because they returned or were released to work at the job at the time of injury, see WAC 296-15-4302.
Send your vocational reports directly to the self-insured employer or its representative. The employer then will send the reports to us.
Progress Reports are not required by L&I but they may be required by the employer or their representative and would be submitted directly to them.
The fee schedule for services and the qualifications for providing vocational services are the same for both L&I-insured claims and self-insurance claims.
Self-insured employers may be eligible for preferred worker benefits if they employ a worker certified as a preferred worker under an L&I-insured claim.
L&I cannot reimburse self-insured employers for:
- Pre-job accommodation costs.
- Professional consultation fee for job modification services.
- Skill Enhancement Training

Below are vocational reporting forms and publications that may be used on Self-Insured claims:

Ability to Work Assessment:

Ability to Work Non-Eligible Assessment Template

Ability to Work Eligible Assessment Closing Report

Plan Development:

Plan Approval Request Report and Plan Certification
Accountability Agreement - English (F280-016-000) Spanish (F280-016-999)
Vocational Plan On-the-Job Training Agreement (F280-039-000)
Plan Time/Cost/Travel Encumbrance (F245-454-000)
Plan Room and Board Cost Encumbrance (F245-372-000)
Plan Development: What Are My Rights and Responsibilities? (F280-018-000)

Plan Implementation:

Plan Modification Form (F245-463-000)

Option 1 Plan Modification Accountability Agreement - English (F280-056-000) Spanish (F280-056-999)

Option 2:

Option 2: What You Need to Know - Self-Insurance (F207-232-000)
Self-Insured Option 2 Vocational Services Summary (F280-064-000)

Tips for vocational providers on Self-Insured bankrupt claims:

L&I takes over management of the claim when a self-insured employer goes bankrupt. Under self-insured bankrupt claims, assigned vocational providers will start providing services under a Vocational Recovery referral.

When working these referrals, monthly progress reports must be manually submitted to L&I.
The first progress report is due 30 days from the start of the vocational referral.
Self-Insurance Vocational Report Forms are not required when submitting vocational closing reports.

Vocational Recovery reporting forms:

For additional information, contact the Self-Insurance program at 360-902-6901.

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