Opinion ID: 1281018
Heading Depth: 1
Heading Rank: 3

Heading: Petitioner's Second Attempt to Receive Rehabilitation Services

Text: On November 10, 1999, a letter was sent to the petitioner's claims representative by an administrator for Simonton. The letter stated that the Simonton administrator had received correspondence from ... WC that stated the claimant is indeed eligible for rehabilitation services. The Simonton letter then asked the Division claims representative to refer the petitioner to Recourse, Inc., the employer's preferred provider for rehabilitation because Simonton had all their claims transferred from QRS to Recourse months ago. In an order dated January 28, 2000, the Division referred the petitioner to Recourse, Inc. (Recourse) for rehabilitation services. A rehabilitation counselor for Recourse subsequently interviewed the petitioner, and the petitioner clearly expressed both a desire to return to work and a desire for vocational rehabilitation services. The rehabilitation counselor informed the petitioner, in several meetings, that his rehabilitation would proceed according to a seven-step rehabilitation hierarchy. This hierarchy is mandated through regulations implemented by the Division. [2] The regulation simply begins by stating that if the Workers' Compensation Commissioner determines that an injured worker cannot complete a lower-numbered step in the hierarchy, then the next higher-numbered step must be used. The first four steps of the rehabilitation hierarchy require returning the injured worker to work with the same employer, at the same or different positions and with varying degrees of retraining. The next two steps require that the injured worker be employed by a new employer, step five without retraining, and step six with retraining. The final step of the hierarchy, step seven, requires that the injured worker be enrolled in a retraining program designed to lead to suitable gainful employment in the labor market. The Recourse rehabilitation counselor also spoke with Simonton, and determined that Simonton did provide light and modified duty work to its employees. However, Simonton indicated to the rehabilitation counseloras it had previously advised QRSthat the petitioner's job with the company had been terminated, along with the positions of other seasonal employees, on December 18, 1998. After multiple meetings with the petitioner and his counsel, and several phone calls to Simonton, the rehabilitation counselor determined that the petitioner was not eligible to receive vocational rehabilitation services. The rehabilitation counselor took the position that because the petitioner's job had been terminated, this counselor is unable to proceed with the first four steps of the rehabilitation hierarchy[.] As the counselor stated in her report: I contacted [the petitioner's claims representative at the Division] and informed him, per my conversation with the pre-injury employer, the claimant was not eligible to receive continued vocational rehabilitation services since he had been terminated from employment with Simonton Windows on 12/18/98 as a result of the terms and conditions of his contract with Simonton Windows as a seasonal employee. In other words, because the petitioner was a seasonal employee, he could not be returned to his job with Simontonand therefore could not complete the first four steps of the rehabilitation hierarchy. The rehabilitation counselor appears to have taken the position that because the petitioner could not successfully complete the first four steps, he was ineligible for steps five through seven of the hierarchy. On May 1, 2000, the Recourse rehabilitation counselor sent the petitioner a letter stating that his vocational rehabilitation file was closed [3] because he was ineligible for rehabilitation services. The petitioner's attorney disputed this declaration by the rehabilitation counselor, and spoke with a supervisor at the Division by telephone. The supervisor agreed with petitioner's attorney that the Recourse rehabilitation counselor was wrong in finding that the petitioner was ineligible for vocational rehabilitation services. The supervisor indicated she would have Recourse carry through with the petitioner's rehabilitation because it was a preferred employer company, or she would find another provider of rehabilitation services. The petitioner states in his petition that on June 14, 2000, the Division supervisor spoke by telephone with the rehabilitation counselor at Recourse. The supervisor explained that the petitioner was, in fact, legally eligible for vocational rehabilitation services, and gave Recourse another opportunity to provide the services. However, the rehabilitation counselor at Recourse did not agree with the Division's assessment, and replied that she would have to speak to Simonton's attorney before she could agree to provide any rehabilitation services to the petitioner. The rehabilitation counselor apparently indicated to the Division supervisor that she would call back once she had received advice from Simonton's attorney. The rehabilitation counselor at Recourse never responded back to the Division's phone call.