Notice to employees of change in medical provider (MPN)
A notification for employers to post stating their participation in MPN. (English/Spanish) Download PDF
View ArticleNotice to employees of change in medical provider (MPN)
The Employee Implementation Notice of SeaBright BrightCure Customized MPN ____________ participates in the SeaBright BrightCure Customized MPN. Unless you pre-designate a physician or medical group,...
View ArticleTransitional Return to Work Program Policy and Procedures (Sample)
Transitional Return to Work Program Policy and Procedures (Sample) Policy Statement (Company Name) is committed to working with our employees who are injured on the job. We will make every effort to...
View ArticleWritten Acknowledgement of Return to Work Program Implementation
Acknowledgement of Return to Work Program Implementation I acknowledge that _(Company Name)____ has been advised of SeaBright’s requirement that we have a Return To Work Program Policy and Procedure in...
View ArticleAlternate Work Assignments
Modified Duty – Alternate Work Assignment Agreement Employee: Date of Birth: Claim #: Location: Date of Loss: Employer: Temporary Work Assignment Position: Start Date: Hours to be worked: Anticipated...
View ArticleLetter offering modified work
(Employer Letterhead) Date Certified Mail Employee: Employer: Claim No.: Date of Loss: OFFER OF MODIFIED WORK Dear: We currently have temporary modified work, which will enable you to return to work in...
View ArticleTest results of employee's physical capabilities
A form for to gauge the physical capabilities of an employee. Download PDF
View ArticleForm letter in which an employee signifies they have been informed about...
This MPN implementation notice may be provided by mail or included on or with an employee’s paystub, paycheck or distributed through electronic means, including email, if the employee has regular...
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