Wash. Admin. Code § 296-19A-193 – What documentation must be submitted to the department for prejob accommodations?

(1) A vocational provider assisting the injured worker in applying for prejob accommodation assistance must submit to the department a prejob accommodation assistance application. Prejob accommodations assistance applications shall be submitted on a form prescribed by the department.
(2) The prejob accommodation assistance application shall include, but is not limited to:
1. (a) A document supporting the need for prejob accommodation;
2. (b) A description of the prejob accommodation;
3. (c) An itemized account of each expense to be incurred in the prejob accommodation;
4. (d) An ownership agreement;
5. (e) Physician's certification of medical necessity.

[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 03-11-009, § 296-19A-193, filed 5/12/03, effective 2/1/04.]