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Processing a Selective Duty Assignment

The procedure is as follows:

1. Treating physician provides restricted/selected duty work disposition slip/report to injured worker and Third Party Administrator (TPA).
2. Injured worker reports restricted/selective duty clearance to employing state agency (ESA).
3. ESA notifies TPA of restricted /selective duty work disposition. ESA then places the injured worker in a pre-established restricted/selective duty assignment or develops an appropriate restricted/selective duty job assignment for the injured worker.
4. ESA requests a slot number from the Department of Administrative Services (DAS).
5. DAS assigns a slot number. If all slots are filled, DAS will place the injured worker on a slot number waiting list.
6. ESA complies with Core-CT time processing requirements for all restricted/selective duty hours worked.
7. After completion of the restricted/selective duty assignment, ESA completes the following:
   - DAS Workers' Compensation Selective Duty Form
   - DAS Workers' Compensation Selective Duty Reconciliation Form
   - The Core-CT transfer invoice

Copies of the employee’s time sheets must be included in the package.

The completed packet is sent to:

Department of Administrative Services
Workers’ Compensation
450 Columbus Boulevard – Suite 1401
Hartford, CT 06103