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How does the Notice of IME Negotiation Form work?

What is the purpose of the Notice of IME Negotiation Form?

• This form notifies relevant parties of the intended IME and the negotiation of terms.
• It sets the groundwork for negotiating physician agreements, helping to define medical assessments for claims.
• If not submitted within the 30-day limit, parties may face delays or loss of rights in the IME process.

What are the key components of the Notice of IME Negotiation Form?

• Critical details including the Workers’ Compensation Number (WC #) and claimant’s name must be correctly filled in.
• Indicate whether an agreement has been reached regarding the physician and associated fees.
• All parties involved must sign the document to validate the negotiations.

How do you fill out the Notice of IME Negotiation Form?

• Collect relevant details such as claim details and physician options before starting the form.
• Discuss and finalize the decision on the chosen physician and their fee with all parties.
• Fill out the form with accurate and clear information to avoid misunderstandings.
• Ensure that all required signatures are obtained to validate the document prior to submission.
• Send copies to all relevant parties and keep a confirmation of mailing for records.

How do you select a qualified DIME physician?

• Ensure that the physician holds a Level II accreditation for independent medical examination.
• Consider any prior treatment the claimant received, as it may affect selection.
• Negotiate physician fees upfront to avoid disputes later.

What happens after filing the Notice of IME Negotiation Form?

• Understand the DIME process and anticipate timelines for assessments.
• Learn how to interpret the report findings and their implications for the claim.
• Know the next steps if disputes arise regarding the IME report.

What should you do if parties cannot agree on a DIME physician?

• Follow specific protocols for resolving disputes without a mutual agreement.
• Steps insurers can take to file the Notice of IME Negotiation Form unilaterally.
• Prepare for possible outcomes and the subsequent steps for claimants involved.

How can pdfFiller help you manage your IME forms?

• Use pdfFiller to easily edit and sign documents, streamlining the negotiation process.
• Share forms with multiple parties securely to ensure everyone stays informed.
• Leverage cloud storage for easy access and management of IME processes at any time.

Where can you find assistance?

• Reach out to the Division of Workers' Compensation Customer Service for direct assistance.
• Explore other resources available for answering questions about the DIME process.
• Utilize the DIME Unit’s support for any filing issues that may arise.