California DWC-AD Form 10133.33 is the Supplemental Job Displacement Nontransferable Training Voucher Form that a claims administrator must issue to an injured worker who suffered a compensable injury on or after January 1, 2013, has permanent partial disability, and was not offered qualifying regular, modified, or alternative work within 60 days of the first report finding the worker permanent and stationary. The voucher is worth up to $6,000 and pays for skill-enhancement education, tools, licensing, computer equipment, and certain placement services so the worker can re-enter the labor market after a workplace injury.
Roughly 22,000 to 28,000 SJDB vouchers are issued each year in California, and the Division of Workers’ Compensation Audit Unit routinely cites claims administrators for late issuance, missing fields, or failure to attach the Physician’s Return-to-Work & Voucher Report (DWC-AD 10133.36). Getting any single box wrong on this two-page form can delay the worker’s training, trigger penalties under Labor Code §129.5, and even reset the voucher’s expiration clock.
Here is what this guide will walk you through:
- 📋 What every box, line, and checkbox on DWC-AD 10133.33 means in plain English
- ⏰ The 60-day issuance deadline, the voucher’s expiration rules, and the penalties for missing them
- 🧾 Three full filled-out examples covering the most common injury and return-to-work scenarios
- 🏫 How injured workers redeem the voucher at California-approved schools, VRTWCs, and tool vendors
- ⚠️ The 10 most common mistakes claims administrators and workers make, and the exact consequence of each
What the Form Is and Who Must File It
DWC-AD 10133.33 is a California Department of Industrial Relations form created by the Division of Workers’ Compensation under the authority of Labor Code §4658.7 and the implementing rules at 8 CCR §§10133.31–10133.36. The form serves one purpose: to deliver a nontransferable $6,000 training voucher to an injured worker who qualifies for the Supplemental Job Displacement Benefit, often shortened to SJDB.
The claims administrator handling the workers’ compensation claim is the party who must issue and serve this form. That includes insurance carriers, third-party administrators, and self-insured employers. The injured worker does not fill out this form; the worker receives it, signs the redemption sections when buying training or tools, and submits redemption documentation to the claims administrator for direct payment to the provider.
Three audiences interact with the form. First, the claims administrator completes the upper portions, signs Section 8, and serves it. Second, the injured worker signs the redemption blocks (Sections 9 and 10) and presents the voucher to a California-approved school or vendor. Third, the training provider, tool vendor, or Vocational Return-to-Work Counselor completes the provider redemption block to receive payment. The form has been in use under the post-SB 863 framework since the January 2014 revision, which is the current version cited at the top of the official PDF.
Before You Start: Documents and Information You Need
Before opening the form, gather every piece of information needed to populate the boxes accurately. A missing detail forces a re-issuance, which restarts service deadlines and exposes the claims administrator to audit findings under LC §129.
- Injured worker’s full legal name as it appears on government ID, because the voucher is nontransferable and must match the redemption signature.
- Date of injury (DOI) — the SJDB rules differ for injuries before and on/after January 1, 2013, so the DOI controls eligibility.
- Workers’ compensation claim number assigned by the claims administrator, because vendors verify the voucher against the claim file.
- Employer’s legal name and FEIN, since the employer of record at the time of injury is named on the voucher even if the worker has since moved on.
- Claims administrator’s name, adjuster contact, address, phone, and email, because the worker and vendors need a live contact for redemption questions.
- Permanent and stationary (P&S) date from the primary treating physician, because the 60-day issuance clock starts when the claims administrator first receives the medical report finding the worker P&S with permanent partial disability.
- The completed DWC-AD Form 10133.36 (Physician’s Return-to-Work & Voucher Report), which the treating physician must sign and which must be attached when the voucher is issued.
- Any DWC-AD 10133.35 Notice of Offer of Regular, Modified, or Alternative Work that was served, because a valid offer extinguishes the worker’s voucher right.
- Voucher issuance date, because the voucher expires two years after issuance or five years after the DOI, whichever is later, under 8 CCR §10133.31.
- Mailing address for the injured worker, because the form must be served by mail or personal delivery with proof of service.
Where to Get the Form and How to Access It
The official, current PDF lives on the DWC Forms page under the “Supplemental Job Displacement Benefit” heading. Always download a fresh copy for each new voucher because the agency periodically updates revision dates, and an outdated revision can be rejected by schools that verify form authenticity through the DWC public information line.
Claims administrators using a workers’ compensation claims platform such as Origami Risk, Guidewire, or Mitchell can usually generate a pre-populated 10133.33 from the claim record, which reduces transcription errors. Self-insured employers without a platform should fill the PDF using Adobe Acrobat Reader so the digital signature in Section 8 carries forward into the served copy. Handwritten forms are accepted but must be legible in black ink because the DWC Audit Unit photocopies served forms during audits.
Workers do not need to download the form themselves; the law requires the claims administrator to deliver it. If a worker believes the voucher is overdue, the worker can file a complaint with the Information & Assistance Officer or file a request for expedited hearing at the Workers’ Compensation Appeals Board (WCAB).
Step-by-Step: How to Fill Out DWC-AD 10133.33 Line by Line
The form is two pages and is organized into ten numbered sections. Complete them in order. Use the exact field names printed on the official PDF, which are reproduced verbatim below.
Section 1: Employee Information
What the field asks in plain English. Section 1 captures the injured worker’s identity: full legal name, mailing address, city, state, ZIP code, telephone number, and the worker’s date of birth.
How to answer it. Print the name in the order First, Middle, Last, in all capital letters when handwritten. Use a residential address — not a P.O. Box — when possible, because some training providers require physical addresses to verify residency. Format the date of birth as MM/DD/YYYY.
A specific example answer. Maria Lopez, born March 14, 1985, living at 4421 Maple Avenue in Bakersfield, would write MARIA E. LOPEZ, 4421 MAPLE AVE, BAKERSFIELD, CA 93301, DOB 03/14/1985.
A nuance or edge case. If the worker only has a P.O. Box, list the P.O. Box in the address line and add the physical residence address in the margin so the Bureau for Private Postsecondary Education can confirm enrollment eligibility. If the worker recently moved, use the address where the voucher should be mailed, not the address of injury.
A common mistake on this field and its direct consequence. Adjusters sometimes copy the worker’s name from an old wage statement that uses a nickname instead of the legal name. The voucher then mismatches the school’s enrollment ID, and the school refuses redemption until a corrected voucher is reissued, costing the worker weeks of lost training.
A misconception people hold about this field. Many workers believe they can list a relative’s address to keep their location private. The voucher is a legal benefits document and must list the worker’s address of record so service of process and audit verification work properly.
Section 2: Claims Administrator Information
What the field asks in plain English. Section 2 collects the claims administrator’s company name, claim number, mailing address, telephone, fax, and email.
How to answer it. Use the legal entity name of the carrier or third-party administrator handling the claim, not the broker’s name. The claim number must match the number on every other document in the file. List the adjuster’s direct line, not a general 1-800 number, because vendors call to verify the voucher.
A specific example answer. SEDGWICK CMS, CLAIM #4302881-WC, 1100 RIDGEWAY LOOP RD, MEMPHIS, TN 38120, PHONE (800) 625-6588 EXT. 4421, FAX (901) 415-7800, EMAIL claims.4421@sedgwick.com.
A nuance or edge case. If the claim has changed hands between TPAs, list the current administrator and note the prior claim number in parentheses so vendors can match historical records. If the carrier has multiple offices, list the office that physically holds the file.
A common mistake on this field and its direct consequence. Listing a generic claims hotline instead of the assigned adjuster forces vendors to wait on hold and often results in the school billing the worker directly. The worker then has to fight for reimbursement, and the DWC Audit Unit treats this as a service-of-benefits failure.
A misconception people hold about this field. Adjusters sometimes think the employer’s address belongs here. It does not. Section 2 is for the claims administrator. The employer goes in Section 3.
Section 3: Employer Information
What the field asks in plain English. Section 3 names the employer of record at the time of injury, including legal name, address, and FEIN if available.
How to answer it. Use the employer’s legal name as registered with the California Secretary of State, not the doing-business-as name. Include the FEIN because the Return-to-Work Supplement Program (RTWSP) cross-references employer identification when the worker later applies for the $5,000 supplement.
A specific example answer. VALLEY HARVEST PACKING, INC. (DBA VALLEY HARVEST), 8800 ROSEDALE HWY, BAKERSFIELD, CA 93312, FEIN 95-4421887.
A nuance or edge case. If the employer has dissolved or filed bankruptcy since the date of injury, list the employer as it existed on the DOI and add “(former employer — dissolved [date])” in the margin. The voucher is still valid because the carrier — not the employer — funds it.
A common mistake on this field and its direct consequence. Writing the staffing agency name when the worker actually worked for the client employer (or vice versa) creates a special-employment dispute and can stall the voucher while the carriers argue. Match the entity that was insured by the issuing carrier.
A misconception people hold about this field. Workers sometimes assume the voucher comes from the employer. It does not. The carrier funds and issues the voucher; the employer is named only as the entity of record.
Section 4: Date of Injury
What the field asks in plain English. Enter the specific date the workplace injury occurred, or for cumulative trauma, the date the Labor Code §5412 date of injury was established.
How to answer it. Use MM/DD/YYYY. For cumulative trauma, use the §5412 date that the parties stipulated to or that an AME or QME established.
A specific example answer. 09/12/2023 for a single-event injury, or 01/15/2024 (CT 5412 date) for a cumulative trauma claim.
A nuance or edge case. For injuries before January 1, 2013, the worker is not eligible for the 10133.33 voucher; the older 10133.57 form and pre-SB 863 rules apply instead. Confirm the DOI is on or after 1/1/2013 before issuing this form.
A common mistake on this field and its direct consequence. Using the date of the DWC-1 claim form filing instead of the actual DOI shortens or extends the expiration window incorrectly and exposes the carrier to a re-issuance order at the WCAB.
A misconception people hold about this field. Some adjusters think the P&S date goes here. It does not. The P&S date drives the issuance deadline, not the DOI field.
Section 5: Eligibility Statement
What the field asks in plain English. Section 5 contains the certification that the worker meets the four statutory eligibility criteria: a compensable injury, permanent partial disability, no qualifying offer of regular/modified/alternative work, and the attached physician’s report.
How to answer it. Check each box that applies. All four boxes typically must be checked for a valid voucher. Attach a copy of the Physician’s Return-to-Work & Voucher Report (DWC-AD 10133.36) signed by the primary treating physician.
A specific example answer. Adjuster Lin Park checks all four boxes and writes Attached: 10133.36 signed by Dr. Sandra Patel on 02/14/2026.
A nuance or edge case. If the employer made a timely offer of modified work that the worker rejected, the worker is not eligible and the voucher should not issue. Document the rejection with the served DWC-AD 10133.35 and a proof of service.
A common mistake on this field and its direct consequence. Issuing the voucher without attaching the 10133.36 makes the voucher facially defective; schools refuse to redeem it, and the DWC Audit Unit cites the carrier for incomplete benefit delivery.
A misconception people hold about this field. Adjusters sometimes believe a generic “P&S report” satisfies the attachment requirement. It does not. The regulations specifically require the 10133.36 form, signed by the treating physician.
Section 6: Voucher Amount and Expiration
What the field asks in plain English. This section states the voucher amount ($6,000 for all post-1/1/2013 injuries regardless of PD rating) and the expiration date.
How to answer it. Write $6,000.00. Calculate the expiration as the later of (a) two years from the issuance date, or (b) five years from the date of injury, per 8 CCR §10133.31(g).
A specific example answer. Voucher issued 03/01/2026 for a 09/12/2023 DOI: expiration is 09/12/2028 (five years from DOI is later than two years from issuance).
A nuance or edge case. If the voucher is reissued because of a defect, the expiration date does not restart from the reissuance date — it remains tied to the original issuance date and DOI. Note this in the margin so the school does not reject a “stale” voucher.
A common mistake on this field and its direct consequence. Using a flat two-year window from issuance shortens the worker’s redemption period and can be challenged at the WCAB, where judges routinely order extended expiration dates.
A misconception people hold about this field. Workers and even some adjusters still believe the voucher amount scales with the PD rating (the pre-SB 863 rule). Under current law, every eligible worker gets the same $6,000.
Section 7: Permitted Uses Checklist
What the field asks in plain English. Section 7 lists the categories of permitted spending: tuition at California-approved schools, books and supplies, tools, licensing fees, exam fees, computer equipment (capped at $1,000), and up to 10% ($600) for vocational and return-to-work counseling.
How to answer it. This section is preprinted; the adjuster does not check boxes here. Read it carefully and provide the worker a plain-language summary in the cover letter so the worker knows what is reimbursable.
A specific example answer. Adjuster includes a cover letter explaining: Up to $1,000 for a laptop, up to $600 for a Vocational Return-to-Work Counselor, the rest for tuition, books, tools, and licensing.
A nuance or edge case. The $1,000 computer cap is a hard ceiling. If the worker buys a $1,400 laptop, the voucher pays $1,000 and the worker pays the $400 difference out of pocket; the school cannot bill the carrier for the overage.
A common mistake on this field and its direct consequence. Workers sometimes spend the entire $6,000 on a single tuition invoice and then need tools they can no longer afford. Once the voucher is exhausted, no top-off is available.
A misconception people hold about this field. Many workers think the voucher pays for living expenses, transportation, or childcare during training. It does not. Those costs are not reimbursable under LC §4658.7.
Section 8: Claims Administrator Signature and Date
What the field asks in plain English. The claims administrator’s authorized representative signs and dates the form, certifying the information is true.
How to answer it. Sign in blue or black ink. Print the signer’s name and title beneath the signature. Date with the actual issuance date because that date drives the two-year expiration calculation.
A specific example answer. Lin Park, Senior Claims Examiner, Sedgwick CMS, Signed 03/01/2026.
A nuance or edge case. Electronic signatures are accepted under California Civil Code §1633.7 provided the signing platform records intent and identity. A typed name without an e-signature platform is not sufficient.
A common mistake on this field and its direct consequence. Backdating the signature to extend an internal deadline is fraud and can trigger an audit penalty plus referral to the DWC Anti-Fraud Unit.
A misconception people hold about this field. A supervisor’s signature is not required; any authorized adjuster can sign. The voucher is valid as long as the signer has authority to bind the carrier.
Section 9: Injured Worker Acknowledgment
What the field asks in plain English. The worker signs to acknowledge receipt of the voucher and the attached materials.
How to answer it. The worker prints name, signs, and dates after reading the form. The worker does not need to sign before redeeming, but most schools require a signed voucher to process payment.
A specific example answer. Maria E. Lopez, signed 03/05/2026.
A nuance or edge case. If the worker has a conservator or guardian ad litem, that representative signs on the worker’s behalf and attaches the conservatorship order.
A common mistake on this field and its direct consequence. Signing in pencil or with a digital photo of a signature is rejected by many schools’ compliance teams, forcing the worker to re-sign and delaying enrollment by weeks.
A misconception people hold about this field. Workers sometimes think signing here waives their right to dispute the voucher. It does not. Signing only acknowledges receipt; the worker can still file a claim at the WCAB if the voucher amount or eligibility is disputed.
Section 10: Provider Redemption Block
What the field asks in plain English. The training provider, school, tool vendor, or VRTW counselor completes this block to redeem the voucher: provider name, address, license/approval number, services rendered, dollar amount, invoice number, and provider signature.
How to answer it. The provider lists its BPPE approval number, WIOA-eligible training provider ID, or VRTW counselor certification number. The provider attaches an itemized invoice and submits to the claims administrator within 30 days for direct payment under 8 CCR §10133.31(f).
A specific example answer. Bakersfield College Workforce Development, BPPE #44218, Medical Assistant Program tuition, $4,200, Invoice #BC-2026-0917, signed by Registrar Jorge Mendez on 04/12/2026.
A nuance or edge case. A non-California school can only redeem the voucher if the worker has relocated and the school is accredited by a federally recognized accreditor. Otherwise, redemption is denied and the worker must select a California-approved alternative.
A common mistake on this field and its direct consequence. Submitting a redemption without the BPPE or WIOA number forces the carrier to deny payment, and the school often turns the bill over to the worker’s personal collections.
A misconception people hold about this field. Providers sometimes believe they can charge the worker the difference between the invoice and the voucher cap and bill the carrier separately. They cannot. The voucher is the worker’s sole entitlement; overages are the worker’s responsibility.
Three Filled-Out Examples Using Real Scenarios
The three scenarios below show how DWC-AD 10133.33 plays out in the most common fact patterns. Each table has eight or more rows tracking the entries section by section.
Scenario 1: Maria Lopez — Warehouse Worker, No Offer of Modified Work
| Form Section | What Maria’s Adjuster Enters |
|---|---|
| Section 1: Employee | MARIA E. LOPEZ, 4421 MAPLE AVE, BAKERSFIELD, CA 93301, DOB 03/14/1985 |
| Section 2: Claims Administrator | SEDGWICK CMS, Claim #4302881-WC, Adjuster Lin Park, (800) 625-6588 x4421 |
| Section 3: Employer | VALLEY HARVEST PACKING, INC., FEIN 95-4421887 |
| Section 4: Date of Injury | 09/12/2023 |
| Section 5: Eligibility | All four boxes checked, 10133.36 attached signed by Dr. Patel |
| Section 6: Amount/Expiration | $6,000.00; expires 09/12/2028 |
| Section 8: Adjuster Signature | Lin Park, 03/01/2026 |
| Section 9: Worker Signature | Maria E. Lopez, 03/05/2026 |
| Section 10: Provider Redemption | Bakersfield College, BPPE #44218, $4,200 tuition + $800 books + $1,000 laptop |
Scenario 2: Marcus Chen — Construction Foreman, Modified Offer Rescinded
| Form Section | What Marcus’s Adjuster Enters |
|---|---|
| Section 1: Employee | MARCUS T. CHEN, 220 GRAND AVE APT 4, OAKLAND, CA 94610, DOB 11/02/1979 |
| Section 2: Claims Administrator | GALLAGHER BASSETT, Claim #GB-7781299, Adjuster Renee Adams, (510) 555-0181 |
| Section 3: Employer | PACIFIC RIM BUILDERS, LLC, FEIN 27-3398101 |
| Section 4: Date of Injury | 02/22/2024 |
| Section 5: Eligibility | All four boxes checked; modified offer rescinded after 28 days, 10133.36 attached |
| Section 6: Amount/Expiration | $6,000.00; expires 03/15/2028 (2 yrs from issuance) |
| Section 8: Adjuster Signature | Renee Adams, 03/15/2026 |
| Section 9: Worker Signature | Marcus T. Chen, 03/19/2026 |
| Section 10: Provider Redemption | Laney College Project Management Cert, $3,800; Home Depot tools $1,200; PMP exam $675 |
Scenario 3: Aisha Robinson — Home Health Aide, Cumulative Trauma
| Form Section | What Aisha’s Adjuster Enters |
|---|---|
| Section 1: Employee | AISHA M. ROBINSON, 1809 53RD ST, SACRAMENTO, CA 95819, DOB 06/30/1972 |
| Section 2: Claims Administrator | ATHENS ADMINISTRATORS, Claim #ATH-559021, Adjuster Devon Ruiz, (916) 555-3400 |
| Section 3: Employer | GOLDEN STATE HOMECARE, INC., FEIN 46-1287443 |
| Section 4: Date of Injury | 07/01/2024 (CT §5412 date) |
| Section 5: Eligibility | All four boxes checked; no offer of regular/modified/alt work, 10133.36 attached |
| Section 6: Amount/Expiration | $6,000.00; expires 04/01/2028 |
| Section 8: Adjuster Signature | Devon Ruiz, 04/01/2026 |
| Section 9: Worker Signature | Aisha M. Robinson, 04/07/2026 |
| Section 10: Provider Redemption | Sac City College LVN Program $5,400 + VRTW counseling $600 (10% cap) |
How to File the Completed Form
Filing here means serving the form on the injured worker, because DWC-AD 10133.33 is not filed with a court — it is delivered to the worker. Use one of the three accepted channels and keep proof of service for at least five years under 8 CCR §10101.1.
- U.S. Mail (most common). Mail the original signed form plus the 10133.36 to the worker’s address of record. There is no fee. Use a Proof of Service by Mail and retain the signed proof. Expected delivery is three to seven business days; the issuance date is the date of mailing, not delivery.
- Personal delivery. Hand the form to the worker, often at a deposition or Mandatory Settlement Conference. Document with a signed acknowledgment of personal service. No fee.
- Electronic delivery. Permitted only if the worker has consented in writing under 8 CCR §10205.4. Email the PDF and request a delivery receipt. Keep the email and receipt as proof of service.
- Filing with the WCAB. Not required for issuance, but if the worker disputes the voucher, the worker files a Declaration of Readiness to Proceed at the district office for that case and the carrier serves the form there.
The processing time for the worker’s first redemption is typically 30 to 45 days from when the school submits the redemption packet. Carriers must pay direct to the provider, not the worker. The carrier’s proof-of-payment record is the canceled check or EFT confirmation, which the DWC Audit Unit reviews during routine audits.
What Happens After You File
Once served, the worker has up to two years from issuance — or five years from the DOI, whichever is later — to redeem the voucher at a BPPE-approved school, a WIOA-eligible training provider, or a tool vendor. The worker selects the program, enrolls, and asks the school to bill the claims administrator using Section 10 of the voucher.
After the worker redeems any portion of the voucher, the worker becomes eligible to apply for the separate Return-to-Work Supplement Program (RTWSP), a one-time $5,000 payment funded by the DIR Return-to-Work Fund. The worker must apply within one year of the voucher issuance date or risk losing the supplement.
If the carrier fails to issue the voucher within 60 days of the first medical report finding the worker P&S with PD, the worker can file an expedited petition at the WCAB. Judges routinely order issuance plus penalties of up to 25% of the voucher value under LC §5814 for unreasonable delay. The Audit Unit can also assess administrative penalties under LC §129.5 of up to $40,000 per pattern of violations.
Mistakes to Avoid When Filling Out the Form
- Missing the 60-day issuance deadline. Triggers §5814 penalties up to 25% of the voucher and possible audit fines.
- Failing to attach DWC-AD 10133.36. The voucher is facially defective and schools refuse redemption.
- Listing the wrong DOI. Skews the expiration calculation and exposes the carrier to a re-issuance order.
- Using a P.O. Box for a school that requires a residential address. Delays enrollment until a corrected voucher is served.
- Issuing the form for a pre-1/1/2013 injury. Wrong form; the worker’s benefits fall under the older 10133.57 rules.
- Computing the expiration as a flat two years from issuance. Shortens the window when the five-years-from-DOI rule controls.
- Leaving Section 8 unsigned or undated. Renders the voucher unenforceable, and the DWC Audit Unit treats it as non-issuance.
- Sending only the form without the cover letter explaining permitted uses. Workers blow the budget on tuition and run out before buying tools.
- Using a non-BPPE school without checking accreditation. The school cannot redeem, and the voucher dollars are lost when expiration hits.
- Forgetting to log the issuance date in the claim file. Auditors infer non-issuance, leading to penalty assessments.
- Allowing the worker to sign before reading the 10133.36. Sets up a later dispute over informed consent.
- Backdating the issuance date to mask a late delivery. Constitutes fraud and triggers referral to the DWC Anti-Fraud Unit.
Do’s and Don’ts
- Do download a fresh PDF from the DWC Forms page for each issuance because revision dates change.
- Do attach the 10133.36 every time, since the regulation makes it mandatory.
- Do calculate the expiration as the later of two years from issuance or five years from DOI to protect the worker’s full statutory window.
- Do keep the proof of service for at least five years to defeat audit findings.
- Do list the assigned adjuster’s direct line so vendors can verify the voucher quickly.
- Do confirm BPPE or WIOA approval before the worker enrolls so the provider can redeem.
- Don’t sign the form before verifying the worker’s name matches government ID, because mismatches block redemption.
- Don’t issue the voucher when a valid offer of regular, modified, or alternative work was timely served and not rescinded — the worker is ineligible.
- Don’t mix up the DOI and the P&S date, because the DOI controls the five-year clock and the P&S date controls the 60-day issuance clock.
- Don’t verbally promise the worker the voucher pays for transportation or childcare; it does not.
- Don’t allow workers to sign in pencil; many schools reject pencil signatures on benefits documents.
- Don’t rely on a generic carrier 1-800 line in Section 2; vendors need a live adjuster.
Pros and Cons of Filing on Your Own vs. With Help
| Filing Pro Se (Worker without Attorney) | Filing With an Applicant’s Attorney |
|---|---|
| Pro: No 15% attorney fee deducted from the worker’s PD award under LC §4906 | Pro: Attorney monitors the 60-day deadline and files §5814 penalty petitions when carriers delay |
| Pro: Worker controls timing of school selection and can use the I&A Officer for free | Pro: Attorney coordinates with VRTWCs and ensures the 10133.36 is properly completed |
| Pro: Free help from the Information & Assistance unit is widely available | Pro: Attorney often catches when a “modified work” offer is invalid and recovers the voucher |
| Con: Worker may miss the deadline to apply for the $5,000 RTWSP supplement | Con: Fee comes out of the PD award, reducing net recovery |
| Con: Carriers sometimes drag their feet when no attorney is involved | Con: Adds time because attorney must coordinate with adjuster, doctor, and worker |
| Con: Worker may pick a non-BPPE school and lose the voucher | Con: Some attorneys do not aggressively pursue voucher disputes because fees are capped |
FAQs
Is the voucher always $6,000?
Yes. For all injuries on or after January 1, 2013, the voucher is a flat $6,000 regardless of the worker’s permanent disability rating, under LC §4658.7.
Can the voucher be transferred to a family member?
No. The voucher is expressly nontransferable; only the named injured worker can redeem it at an approved provider.
Does the voucher expire?
Yes. It expires two years from issuance or five years from the date of injury, whichever is later, under 8 CCR §10133.31(g).
Do I write the date of injury or the P&S date in Section 4?
Yes — you write the date of injury in Section 4. The P&S date is reflected on the attached 10133.36 and drives the issuance deadline, not Section 4.
Should I check all four eligibility boxes in Section 5?
Yes — all four boxes typically must be checked, and the 10133.36 must be attached. If any box does not apply, the worker is likely not eligible.
Can I list a P.O. Box in Section 1?
Yes, but add the residential address in the margin because some BPPE-approved schools require a physical address for enrollment.
Does the employer’s name go in Section 2?
No. Section 2 is for the claims administrator. The employer’s name belongs in Section 3.
Can I use the voucher for living expenses while in training?
No. The voucher only covers tuition, books, supplies, tools, licensing, exam fees, computer equipment up to $1,000, and up to 10% for VRTW counseling.
Do I qualify for the $5,000 RTWSP supplement?
Yes, if you redeem any part of your voucher and apply within one year through the Return-to-Work Supplement Program.
Can the carrier take the voucher back if I miss the expiration?
Yes. Unredeemed funds revert to the carrier; there is no extension absent a WCAB order finding good cause.
If my employer offered modified work, am I still eligible?
No, if the offer met the regulatory standards in DWC-AD 10133.35, was timely, and was not rescinded — the offer extinguishes voucher rights.
Can I redeem the voucher at an out-of-state school?
No, unless you have relocated and the school is accredited by a federally recognized accreditor and approved by your claims administrator.
What if the carrier refuses to issue the voucher?
Yes, you can act — file an expedited hearing request at the WCAB and seek penalties under LC §5814.
Can my attorney sign Section 9 for me?
No. Only the injured worker — or a court-appointed conservator with documentation — may sign Section 9.
Related reading
- How to Fill Out California WCAB DWC-1 (w/Examples) + FAQs
- How to Fill Out California WCAB Stipulation with Request for Award + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 100 (w/Examples) + FAQs
- How to Fill Out California WCAB Petition for Vocational Rehabilitation + FAQs
- How to Fill Out California WCAB DWC-AD 10133.32 (w/Examples) + FAQs