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DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers Compensation 7 CCR 11013 WORKERS COMPENSATION RULES OF PROCEDURE Rule 11 Division Independent Medical Examination These rules apply to parties

How to fill out division independent medical examination

How to fill out division independent medical examination:

1. Begin by carefully reading the instructions provided with the division independent medical examination form. It is important to understand the purpose and requirements of the examination before proceeding.
2. Fill in personal information such as your name, contact details, and any identification numbers requested. Ensure that all information entered is accurate and up to date.
3. Provide a detailed medical history by answering all the questions regarding your past and current medical conditions, surgeries, medications, and allergies. Be honest and thorough in your responses to ensure accurate evaluation.
4. If applicable, provide information about any recent work-related injuries or accidents that may have led to the need for the division independent medical examination.
5. Follow the instructions for the physical examination section. Depending on the purpose of the examination, it may require specific tests, measurements, or evaluations by a healthcare professional. If necessary, schedule an appointment with a qualified medical practitioner to carry out the required examinations.
6. Fill out any additional sections of the form as instructed, such as the patient consent section or any specific declarations required.
7. Review the completed form for any errors or missing information. Make sure all necessary fields are filled out properly before submitting the division independent medical examination.
8. Submit the completed form to the appropriate entity or organization as indicated in the instructions. Follow any additional submission guidelines provided.

Who needs division independent medical examination:

1. Division independent medical examinations are typically required for individuals who have been involved in work-related incidents, accidents, or injuries. It helps assess their medical condition and determine their ability to return to work or continue performing their job duties.
2. Employers may request division independent medical examinations when there are concerns about an employee's physical or mental health affecting their job performance or safety.
3. In some cases, insurance companies or legal entities may require division independent medical examinations as part of the claims process or to evaluate the extent of an individual's injuries or disabilities for compensation purposes.
4. Division independent medical examinations may also be necessary for individuals applying for specific licenses or certifications that require medical clearance, such as for commercial drivers or pilots.
5. Overall, the need for a division independent medical examination depends on the specific circumstances and requirements of various organizations, industries, or regulatory bodies.

For pdfFiller’s FAQs

What is division independent medical examination?

Division Independent Medical Examination (DIME) is a medical evaluation conducted by a neutral physician to determine a worker's medical condition and impairment rating.

Who is required to file division independent medical examination?

The employer or insurance carrier is required to file for a Division Independent Medical Examination.

How to fill out division independent medical examination?

The Division Independent Medical Examination form should be completed by the employer or insurance carrier and submitted to the Division of Workers' Compensation.

What is the purpose of division independent medical examination?

The purpose of Division Independent Medical Examination is to help resolve disputes related to a worker's medical condition and impairment rating.

What information must be reported on division independent medical examination?

The Division Independent Medical Examination must include the worker's medical history, current condition, and any previous medical treatments.

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