Form Vr 8 - Notice Of Intent To Change Vocational Rehabilitation Provider - Vermont Workers' Compensation

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FORM VR 8
Rev 9/08
DEPARTMENT OF LABOR
WORKERS’ COMPENSATION
PO BOX 488
State File #:
MONTPELIER, VT 05601-0488
(802) 828-2286
NOTICE OF INTENT TO CHANGE VOCATIONAL
REHABILITATION PROVIDER
NOTE: An injured worker entitled to vocational rehabilitation services has the right to change counselors.
If you have been found NOT ENTITLED to vocational rehabilitation this form should not be filed.
Employee Name
Address
City/State
Telephone #:
Vocational Rehabilitation Counselor Choice:
First VR Provider
New VR Provider
Name:
Name:
Address:
Address:
City/State:
City/State:
I am changing because:
This notice should be presented to the employer/insurance carrier prior to changing vocational rehabilitation counselors to fulfill
the requirements of Vermont law, [21 V.S.A. §641(a)]. Notice is required for ALL subsequent changes of counselor.
Print Employee Name
Employee Signature
Date
Original needs to be forwarded to the Department of Labor
Copies need to be forwarded to: Claimant and Claimant’s Attorney, Insurance Carrier and Insurance Carrier’s Attorney,
New Counselor, and Previous Counselor

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