RTW – Return to Work

If you receive medical treatment and/or miss any work, you must have a Return to Work (RTW) for Workers’ Compensation Form (RM0005) completed by your treating physician.

Provide the release to your supervisor immediately after your appointment unless you are to remain off work. You are responsible for staying in touch with your supervisor. You cannot return to work without this form.

If the form lists restrictions, you and your supervisor will review the restrictions. Your supervisor will contact RM prior to your return to work to discuss any modified duty due to restrictions. LPS does allow employees to return to work in a modified duty capacity.

It is the responsibility of your doctor to outline the restrictions that apply for your injury. It is the decision of LPS as to whether or not you can perform the essential functions of your employment with those restrictions.

Updated January 13, 2026