Your search for "Independent Medical Exam" returned 16 documents.
| Title | Type | Number |
|---|---|---|
| Medical Examiners' Handbook
Book: A publication for independent medical examiners, attending doctors and consultants, this document contains guidelines, sample reports and billing procedures for preparing and conducting impairment ratings and independent medical exams in Washington's workers' compensation system. Beginning July 1, 2012, free Category I CME credits are available for completing the self-assessment associated with this handbook. Go to www.Imes.Lni.wa.gov and click on Medical Examiners Handbook for information on the exam. L&I and the authors have no financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this document. |
Publication | F252-001-000 |
| Provider Account Application - Independent Medical Examiner (IME)
In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815. |
Form | F245-046-000 |
| Approved Independent Medical Examiner (IME) Update
To update or correct the IME's contact, availability, qualificaitons and/or exam sites. |
Form | F245-051-000 |
| Comentarios Sobre el Exámen Médico Independente
Also available in: English Used by the injured worker to provide comments to L&I about their recent medical exam by an IME. |
Form | F245-053-999 |
| Independent Medical Exam Comments
Also available in: Spanish Used by the injured worker to provide comments to L&I about their recent medical exam by an IME. |
Form | F245-053-000 |
| Independent Medical Exam Doctor's Estimate of Physical Capacities
IME Doctor’s Estimate of Physical Capacities: For use by independent examiners when asked to estimate physical capacities as part of an IME requested by the department. |
Form | F242-387-000 |
| Independent Medical Exam Template
Template used by a doctor during an independent medical exam. |
Form | F245-058-000 |
| Independent Medical Examination (IME) Provider Exam Sites
List the locations where the doctor does independent medical exams on a regular basis. |
Form | F245-047-000 |
| Independent Medical Examination Fax Cover Sheet
Independent Medical Examination Fax Cover Sheet |
Form | F245-383-000 |
| Notice of Independent Medical Exam No-Show or Late Cancellation
Notice of Independent Medical Exam No-Show or Late Cancellation |
Form | F245-382-000 |
| Travel Reimbursement Request - Crime Victims
If you are considered a victim of crime, use this form to track your travel expenses for medical, retraining or vocational services or for an independent medical exam. You should have approval from your claim manager before you travel. |
Form | F800-049-000 |
| Your Independent Medical Exam
Also available in: Spanish Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form. |
Form, Publication | F245-224-000 |
| Your Independent Medical Exam (IME)/Su Examen Médico Independiente (Spanish)
Also available in: English Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form. |
Form, Publication | F245-224-999 |
| Your Independent Medical Exam (IME): Crime Victims Compensation Program
Fact Sheet: Provides answers to commonly asked questions about independent medical exams (IMEs) and contact information. Includes a form for requesting travel-related reimbursement for attending an IME. |
Publication | F800-115-000 |
| Your Independent Medical Exam: For Employees of Self-Insured Businesses
Also available in: Spanish Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers. |
Publication | F207-202-000 |
| Your Independent Medical Exam: For Employees of Self-Insured Businesses - Spanish (Su Examen Médico Independiente: Para empleadores de negocios autoasegurados)
Also available in: English Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers. |
Publication | F207-202-999 |
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