Compare work and restrictions
Modified-Duty Offer Review Worksheet
Use this tool now
Place the written offer beside the latest work-status report. Copy each restriction exactly, list the offered task and physical demand, mark any unclear difference, and preserve questions and responses before the start date.
How to use it
- 1.Use the latest written medical restrictions and written offer.
- 2.Complete one prompt for every restriction and major job demand.
- 3.Take unresolved differences to the treating doctor or adviser promptly.
Worksheet
Modified-Duty Offer Review Worksheet
1. Offer date and proposed start date
Copy both dates from the written offer.
2. Job title and work location
Record department, supervisor, and location.
3. Schedule and expected hours
Include shifts, breaks, overtime, and duration.
4. Wage or pay basis
Copy the amount or method stated in the offer.
5. Exact medical restriction
Copy the doctor's wording without paraphrasing.
6. Offered task linked to that restriction
Describe the task, equipment, pace, and frequency.
7. Physical demand
Record lifting, standing, walking, gripping, bending, driving, or overhead work.
8. Difference or unclear point
State the mismatch or question without guessing.
9. Written question sent
Record recipient, date, and delivery proof.
10. Response or updated restriction
Keep the answer or new work-status report.
Avoid
- — Do not rewrite the doctor's restriction in broader terms.
- — Do not rely only on a verbal job description.
Keep with this tool
- — Written offer
- — Current work-status report
- — Job description
- — Schedule and wage details
- — Questions and delivery proof
- — Employer or doctor response
Common questions
What if the offer is only verbal?
Ask for the tasks, schedule, wages, location, and start date in writing so they can be compared with the medical record.
Does a mismatch decide benefit eligibility?
No. This worksheet identifies facts and questions; medical, claim, and benefit issues may require individual review.
What if restrictions change?
Start a new comparison with the updated work-status report and keep the earlier versions.
Read the deeper explanation
When Modified Duty Does Not Match Your Work Restrictions in CaliforniaAuthoritative sources
Check the linked official source for current forms and rules. Updated: .
WCLG
Need help with the actual claim?
Every claim depends on its documents, medical evidence, and procedural history. WCLG offers a free consultation without promising a result.