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Checklists

Claims

• Audit Checklist (92 KB PDF)
  Help for self-insured employers to prepare for an audit by L&I.
• IME‑Alternatives to Independent Medical Exams (61 KB PDF)
  Find other ways to get the information you need.
• IME‑Billing Tips (37 KB PDF)
  Billing correctly gets you paid faster.
• IME‑How to Obtain Quality IME Reports (146 KB PDF)
  Getting IMEs done right.
• IME‑When Not to Get an Independent Medical Examination (58 KB PDF)
  When IMEs are not needed.
• No-Show Fee Request Checklist (25 KB PDF)
  Required information for self-insurers requesting a no-show fee order.
• Option 2 Vocational Checklist (66 KB PDF)
  Steps to follow when Option 2 is chosen by the worker.
• Pay During Appeal (129 KB PDF)
  The guidelines L&I uses to determine non-compliance with payment during appeal.
• Pension Review Coversheet (139 KB PDF)
  Required documentation for L&I to make a determination regarding pension.
• Self-Insurance Claim Closure Checklist (30 KB PDF)
  Questions to address when submitting the SIF-5 for claim closure to the L&I self-insured adjudicator.
• Suspension Request Checklist (25 KB PDF)
  Checklist for self-insurers requesting suspension of benefits for non-cooperation.
• Vocational Services Checklist (32 KB PDF)
  Required vocational services documentation that must be submitted to L&I.
• Willful Misrepresentation (Fraud) Checklist (40 KB PDF)
  When requesting a willful misrepresentation order (fraud) on a claim, the information to include in the investigation report.

Instructions

• Audit - Substantially Similar Forms (231 KB PDF)
  Make sure your forms meet the definition of substantially similar.
• Release of Medical Records and Patient Privacy In Workers' Compensation (117 KB PDF)
  Release to help obtain worker medical records.
• SIF-5 Instructions (39 KB PDF)
  Get help completing the SIF-5.