Wyoming employers use this Division form to make a written offer of temporary light-duty or part-time work to an injured worker released with restrictions. The treating provider certifies that the duties fit the worker's limits, and the worker accepts or refuses. A signed agreement lets the worker draw temporary light duty benefits alongside reduced wages and keeps the employer's account from being charged, as long as its terms are met.
The employer fills in the job terms (days, hours, wage, start date, duration, duties and maximum physical requirements) and signs the employer certification. The treating physician or other licensed provider signs the Health Care Provider Certification, confirming an exam and that the job fits the listed restrictions, and the employee accepts or refuses and signs.
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Agreement for Light Duty/Restricted Work
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The injured employee's treating physician or another licensed health care provider must certify that the offered work is suitable and accommodates the employee's physical restrictions. The Division's cover letter makes that certification, along with a written offer on its own form, a condition for the employer to qualify for account relief under W.S. 27-14-404(j).
If the worker refuses a bona fide written offer on the Division's form, TTD benefits are reduced to one third. The employer's account is not charged if a licensed provider approved the work, the agreement set days, hours and hourly pay, and the assignment does not exceed 12 months. The worker may note a reason for refusing.
No. The Division's cover letter says employers are not required to offer light duty but encourages it once a worker is released to light or part-time work. The worker then earns reduced wages plus temporary light duty benefits, paid monthly as temporary partial disability, and TTD ends once wages reach 95% of the pre-injury wage.