{"id":48,"date":"2020-07-31T03:48:24","date_gmt":"2020-07-31T03:48:24","guid":{"rendered":"https:\/\/jvconsult.us\/?page_id=48"},"modified":"2021-01-21T06:31:20","modified_gmt":"2021-01-21T06:31:20","slug":"referral","status":"publish","type":"page","link":"https:\/\/jvconsult.us\/index.php\/referral\/","title":{"rendered":"Referral"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"48\" class=\"elementor elementor-48\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b2e9b8e elementor-section-stretched elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"b2e9b8e\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6a01456\" data-id=\"6a01456\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7675ad6 elementor-widget elementor-widget-heading\" data-id=\"7675ad6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">REFERRAL<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fdf26ad elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fdf26ad\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-f075a0a\" data-id=\"f075a0a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8a61850 elementor-widget elementor-widget-text-editor\" data-id=\"8a61850\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<h3>Settlement Walk-Through Checklist<\/h3>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e45d033 elementor-widget elementor-widget-text-editor\" data-id=\"e45d033\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>We will prepare and submit your settlement document to the WCAB for a case number and obtain the Award\/Order Approving once the case number is assigned.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f45864 elementor-widget elementor-widget-text-editor\" data-id=\"4f45864\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<ul><li>Signed Settlement Documents<\/li><li>P&amp;S report from PTP and\/or PQME<\/li><li>Benefit Printout showing TTD Paid<\/li><li>Wage Statement (if TTD paid at less than maximum)<\/li><li>First and Final TTD Benefit Notices<\/li><li>Benefit Notice (showing we explained right to PQME)<\/li><li>PQME Waiver (not necessary, but preferred if no PQME)<\/li><li>Medical Report showing Release to RTW verifying final TTD<\/li><\/ul>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f15334b elementor-widget elementor-widget-text-editor\" data-id=\"f15334b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<h3>Independent Consultative Rating Checklist<\/h3>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bcdbe80 elementor-widget elementor-widget-text-editor\" data-id=\"bcdbe80\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>Rating per the AMA Guidelines with a full analysis.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-60f9705 elementor-widget elementor-widget-text-editor\" data-id=\"60f9705\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<ul><li>P&amp;S report from PTP and\/or PQME<\/li><\/ul>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-d723821\" data-id=\"d723821\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f373428 elementor-widget elementor-widget-text-editor\" data-id=\"f373428\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<h3>REFERRAL FORM<\/h3>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9b2a877 elementor-widget elementor-widget-text-editor\" data-id=\"9b2a877\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>*required<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-27c7609 elementor-widget elementor-widget-shortcode\" data-id=\"27c7609\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f42-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/48#wpcf7-f42-o1\" method=\"post\" class=\"wpcf7-form init\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"42\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.4.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f42-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><strong style=\"font-size:1.2em;\">INSURANCE INFORMATION<\/strong><\/p>\n<p><label> Adjuster Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap adj-name\"><input type=\"text\" name=\"adj-name\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Adjuster Email*<br \/>\n    <span class=\"wpcf7-form-control-wrap adj-email\"><input type=\"email\" name=\"adj-email\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Adjuster Phone*<br \/>\n    <span class=\"wpcf7-form-control-wrap adj-phone\"><input type=\"tel\" name=\"adj-phone\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Company Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap comp-name\"><input type=\"text\" name=\"comp-name\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Company Address*<br \/>\n    <span class=\"wpcf7-form-control-wrap comp-address\"><input type=\"text\" name=\"comp-address\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><strong style=\"font-size:1.2em;\">CLAIM INFORMATION<\/strong><\/p>\n<p><label> Claimant Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap clmt-name\"><input type=\"text\" name=\"clmt-name\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Claimant Date of Birth*<br \/>\n    <span class=\"wpcf7-form-control-wrap clmt-dob\"><input type=\"date\" name=\"clmt-dob\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Date of Injury*<br \/>\n    <span class=\"wpcf7-form-control-wrap doi\"><input type=\"date\" name=\"doi\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Claim Number*<br \/>\n    <span class=\"wpcf7-form-control-wrap clm-number\"><input type=\"text\" name=\"clm-number\" value=\"\" size=\"40\" maxlength=\"30\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Claimant Occupation*<br \/>\n    <span class=\"wpcf7-form-control-wrap clmt-occ\"><input type=\"text\" name=\"clmt-occ\" value=\"\" size=\"40\" maxlength=\"50\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Employer Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap emp-name\"><input type=\"text\" name=\"emp-name\" value=\"\" size=\"40\" maxlength=\"80\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Type of Referral*<br \/>\n    <span class=\"wpcf7-form-control-wrap ref-type\"><select name=\"ref-type\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"Walk-Through Settlement\">Walk-Through Settlement<\/option><option value=\"Independent Consultative Rating\">Independent Consultative Rating<\/option><option value=\"Other (specify in &#039;Additional Information&#039;)\">Other (specify in &#039;Additional Information&#039;)<\/option><\/select><\/span> <\/label><\/p>\n<p><label> Additional Information<br \/>\n    <span class=\"wpcf7-form-control-wrap add-info\"><textarea name=\"add-info\" cols=\"40\" rows=\"10\" maxlength=\"3000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span> <\/label><\/p>\n<p><strong style=\"font-size:1.2em;\">UPLOAD DOCUMENTS<\/strong><br \/>\n<em>See checklist. Max 2 MB per document.<\/em><\/p>\n<p><span class=\"wpcf7-form-control-wrap file-01\"><input type=\"file\" name=\"file-01\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-02\"><input type=\"file\" name=\"file-02\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-03\"><input type=\"file\" name=\"file-03\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-04\"><input type=\"file\" name=\"file-04\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-05\"><input type=\"file\" name=\"file-05\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-06\"><input type=\"file\" name=\"file-06\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-07\"><input type=\"file\" name=\"file-07\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-08\"><input type=\"file\" name=\"file-08\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-09\"><input type=\"file\" name=\"file-09\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap file-10\"><input type=\"file\" name=\"file-10\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.gif,.pdf,.doc,.docx,.ppt,.pptx,.mov,.mp3,.mp4,.wav,.wmv\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><input type=\"submit\" value=\"Send Referral\" class=\"wpcf7-form-control wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>REFERRAL Settlement Walk-Through Checklist We will prepare and submit your settlement document to the WCAB for a case number and obtain the Award\/Order Approving once the case number is assigned. Signed Settlement Documents P&amp;S report from PTP and\/or PQME Benefit Printout showing TTD Paid Wage Statement (if TTD paid at less than maximum) First and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/pages\/48"}],"collection":[{"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/comments?post=48"}],"version-history":[{"count":9,"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/pages\/48\/revisions"}],"predecessor-version":[{"id":597,"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/pages\/48\/revisions\/597"}],"wp:attachment":[{"href":"https:\/\/jvconsult.us\/index.php\/wp-json\/wp\/v2\/media?parent=48"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}