Sample Letter Form Making A Bona Fide Offer Of Employment printable pdf download

Sample Letter Form Making A Bona Fide Offer Of Employment

To the Employer:

An offer of modified duty must be made in writing, it must be presented with a copy of the

corresponding Work Status Report (DWC-73), and must clearly state the following even if it is the same

as the employee’s regular position:

1. The location at which the employee will be working;

2. The schedule the employee will be working;

3. The wages the employee will be paid;

4. A description of the physical and time requirements that the position will entail; and

5. A statement that the employer will only assign tasks consistent with the employee's physical

abilities, knowledge, and skills and will provide training if necessary.

SORM and DWC consider the following items when evaluating whether an offer of employment is bona

fide:

1. The work location is geographically accessible given physical limitations, distance, and

availability of transportation;

2. The offered schedule is similar to the preinjury work schedule

3. The physical and time requirements are consistent with the doctor’s certification of the

employee’s work abilities; and

4. The manner in which the offer was made to the employee.

Employment is “geographically accessible” to the injured employee if it is within a reasonable distance

from the employee residence unless the employee proves with medical evidence that their physical

condition precludes traveling that distance.

If the employee is released to work with restrictions by a doctor but refuses to accept the work, income

benefits may be suspended based on offered wages.

It also is important the SORM receive copies of all correspondence dealing with a bona fide offer of

employment. Therefore, always send the adjuster a copy of the letter when the letter is mailed and when

an employee’s response is received.

The following two pages contain a sample letter for a Bona Fide Offer of Employment and the sample

instructions that should be sent along with the letter.

Sample Letter Form Making A Bona Fide Offer Of Employment