RTWSP-Supplemental $5,000.00

RTWSP-Supplemental $5,000.00

$5,000.00 Return-to-Work Supplement Program

(en Español)

Employees injured on or after January 1, 2013, who have received a supplemental job displacement benefit voucher (SJDB), may also qualify for an additional one-time $5,000 payment.

The Return-to-Work Supplement Program (RTWSP) will mail approved applicants a $5,000 check that can be used to supplement the earnings lost from being injured.

Eligibility for RTWSP payment:

  • Date of injury must be on or after January 1, 2013.
  • Applicant must have received a SJDB voucher for that injury.
  • Apply by the deadline. RTWSP must receive your application within one year from the date you were mailed the SJDB voucher

How to apply:

The application for the one-time $5,000 payment is available online. If you do not have access to the internet, every DWC district office has a kiosk equipped with a computer, scanner, and printer for your use. Information and Assistance Officersare available in person and over the phone.

You will need the following information to complete the application:

  • The entire SJDB voucher including proof of service (page 6)
    • SJDB voucher in .pdf or .tiff format for uploading and attaching to online application
  • Adjudication (ADJ) number
  • Workers’ Compensation claim number
    • Claim numbers are issued by the claims administrator when an injury claim form is filed.

What is the amount of the supplement?

A one-time $5,000 Return-to-Work supplement is issued to an injured worker who meets the eligibility criteria. The amount of this supplement may be adjusted by the director of DIR based on further studies conducted by the director in accordance with Labor Code section 139.48.

Where can I apply?

The RTWSP application is only available online. If you do not have access to a computer, every DWC district office has a kiosk near the Information and Assistance office, equipped with a computer, scanner, and printer for your use.

Where can I find my ADJ number?

You can look up your ADJ number by using the EAMS Search Function or you can contact the Information and Assistance office nearest to you. The ADJ number can also be found on most documents filed with  DWC.

Where can I find my workers’ compensation claim number?

The claim number can be found on any document received from the claims administrator (adjuster or insurance company).

Does my SJDB Proof of Service need to be signed?

Yes, it should be duly signed by the authorized issuing party.

Can anyone complete the SJDB voucher?

Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payment is guilty of a felony.

Where can I find the SJDB Proof of Service?

The Proof of Service for the Supplemental Job Displacement Benefit (SJDB) voucher is found on page 6 (the last page) of the voucher.

What if I disagree with the RTWSP’s eligibility decision?

If you disagree with the decision, you may file an official appeal within 20 days of receipt of the determination at any of the Division of Workers’ Compensation district offices. The official appeal must include the ADJ number of the SJDB voucher submitted with your RTWSP application, your full name, and a clear and concise statement of the facts constituting the basis for your appeal.

copy of the officially filed appeal must be served on the Return-to-Work Supplement Program at:

Department of Industrial Relations
1515 Clay St, 17th Floor
Oakland CA 94612

When did the RTWSP regulations become effective?

The effective date of the Return to Work Supplement program regulations is April 6, 2015. The implementation date is April 13, 2015.

Will Need further assistance or have questions regarding eligibility?

Contact RTWSP staff at rtwsp@dir.ca.gov or 510-286-0787 Monday-Friday, 8:00-5:00 p.m. PST.