Specialty Workers' Compensation Solutions

Insurance

Absentia Managed Care Solutions

RTW PlaceRite® Referral Form

  • Your Contact Info

  • Employer

  • State information to be included with Referral

  • Employee

  • Please enter a value less than or equal to 100.
  • Additional Information

  • Please enter a value less than or equal to 1000000.
  • (i.e. Forklift Operator, Receptionist) If pre-injury occupation was not clerical, list any clerical skills the employee has, i.e. can answer telephones, can type. Any other transferrable skills.
  • Click here to read the full Terms and Conditions
    Note: If restrictions or work status changes after referral is made, please contact the RTW PlaceRite® Administrator via phone at 1-800-789-2242 or via fax at 1-866-432-4619 or via email at rtwplacerite@rtwi.com