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Hello
and
,
I have a placement for
,
Claim Number
,
and have attached
the GA WC-240a form to be sent to the treating physician for approval.
[[formData.nurseCaseManager]], please review the WC-240a Job Analysis form for accuracy and complete any blank fields including the employer portion. Please email a copy to [[formData.claimsAdjusterName]] to review and inform that you are sending to the provider for signature.
[[formData.claimsAdjusterName]], should the WC-240a need to be edited or revised, please advise within 24 hours of receipt.
[[formData.nurseCaseManager]], please send the WC-240a form to the treating physician for approval. Ensure the authorized treating physician approves the light duty job within 60 days of their last examination. Once the WC-240a is approved we can set a start date, so please return the approved form to me as quickly as possible.
[[formData.claimsAdjusterName]], please ensure that a copy of this documentation is sent to the claimant and the claimant’s attorney (if represented).
Below are the details of the placement. Please let me know if you have any questions.
Location:
Schedule:
Job Duties:
Other tasks may be assigned within physical restrictions. Tasks are self-paced, not production oriented.
Travel Information:
(Directions will be provided with WC-240 Job Offer)
I look forward to setting a start date upon physician approval of the GA WC-240a. Please let me know if you have any questions.
Thank you!