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Regarding Claim:
Date of Injury:
Dear
,
Welcome to the Temporary Alternative Duty (TAD) work program through Transitional Work Solutions (TWS). We have been notified that your medical provider has released you to return to work with restrictions. We have matched your current abilities with a temporary, alternative duty job assignment at a local nonprofit organization. This assignment will allow you to work, within your restrictions as you continue your recovery, and progress towards a release to full duty.
As an employee in the state of Oregon, you have the right to refuse this offer to return to work without repercussions; participation in the off-site light work program is voluntary.
We are in receipt of the DWC-73 dated
outlining the restrictions under which you are able to return to work. Pursuant to
Texas Workers’ Compensation Commission Rule 129.6, this letter is a Bona Fide Job Offer for you to return to work as a Staff Assistant at a local nonprofit organization (NPO) for a temporary, modified duty assignment.
Details of your alternative duty assignment are as follows:
- Location:
- Contact:
- Phone:
- Acquaintance Meeting:
- Start Date and Time:
- Work Schedule:(not to exceed 8 hours in any workday, or 40 hours per week)
- Job Duties:Other tasks may be assigned within physical restrictions. Additional details can be found on the attached Temporary Alternative Duty Job Description. These duties are aligned with your current capabilities, within your restrictions. If your treating medical provider modifies your current work restrictions, the job duties will be adjusted as necessary.Additional details can be found on the attached Temporary Alternative Duty Job Description. These duties are aligned with your current capabilities, within your restrictions. If your treating medical provider modifies your current work restrictions, the job duties will be adjusted as necessary.
- Attire:[[formData.dressCode]]
- Program Duration:Until release to work with no restrictions, or restrictions that may be reasonably accommodated by the employer, Maximum Medical Improvement identified, or end of a ninety (90) calendar day period; whichever occurs first. Should you reach the end of 90 days, your TAD assignment will be re-evaluated.
- Wage/Pay Rate:
While in this TAD program, you remain an employee of
;therefore, all HR and attendance policies will apply
to you during this program and you will need to adhere to them. Medical and/or physical therapy appointments will be allowed, but you should make every effort to schedule these appointments either before or after your shift whenever possible.
Thank you for your commitment to the temporary alternative duty work program. Please contact me with any questions and to discuss your acceptance of this position. Failure to respond will be considered a refusal of the temporary alternative duty job offer and could impact compensation benefits.
Thank you for your commitment to the Transitional Work Program. Please contact me with any questions and to discuss your acceptance of this position. . Failure to respond will be considered a refusal of the modified duty job offer and could impact compensation benefits.
Sincerely,
Enclosures (2): Job Description, Driving Directions
cc:
Claimant Attorney:
TAD Offer/Refusal
Please check appropriate box indicating your acceptance or declination of this modified duty assignment, sign and date
☐ I, [[formData.employeeName]], accept the temprary alternative duty offer:
-OR-
☐ I, [[formData.employeeName]], refuse the temporary alternative assignment:
Employee Signature _____________________________________________________
Date ___________________