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Clear Entire Form COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers Compensation Independent Medical Examination Section 633 17th St., Suite 400, Denver, CO 80202-3626 303.318.8655 Request
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Begin by carefully reading the instructions provided with the compensation independent medical examination form.
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Fill in your personal information accurately, including your full name, contact details, and any relevant identification numbers.
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Provide details about the injury or condition for which you're seeking compensation. Be specific, thorough, and use medical terminology where appropriate.
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Answer all the questions on the form truthfully and to the best of your knowledge. If a question is unclear, seek clarification from the relevant authority before submitting the form.
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Who Needs Compensation Independent Medical Examination:

01
Individuals who have sustained an injury or developed a medical condition as a result of a workplace incident or accident may require a compensation independent medical examination.
02
Employees who are seeking compensation for work-related injuries or illnesses might be required by their employer or insurance provider to undergo this type of examination.
03
Compensation boards or government organizations overseeing workers' compensation claims may request a compensation independent medical examination to evaluate the severity and impact of the claimed injury or condition.
Note: It is essential to consult the specific guidelines and regulations of your jurisdiction or organization regarding compensation independent medical examination requirements.
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Compensation Independent Medical Examination (IME) is a medical evaluation conducted by a neutral physician to assess an individual's injuries and health status in relation to a workers' compensation claim.
The employer or insurance company may require the injured worker to undergo a Compensation Independent Medical Examination as part of the workers' compensation process.
The injured worker will need to schedule an appointment with the designated medical examiner and provide all medical records and relevant information for the examination.
The purpose of Compensation Independent Medical Examination is to provide an impartial assessment of the individual's injuries and health status to help determine the appropriate compensation for the workers' compensation claim.
The Compensation Independent Medical Examination report should include details of the examination findings, diagnosis, treatment plan, and any other relevant medical information.
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