IME Observer Form {3923a}

3923 - IME OBSERVER FORM. An IME is an exam scheduled by the insurer processing your claim. The insurer will choose the IME provider and pay for the exam. The insurer may require you to attend up to three IMEs. Some exams may be scheduled with more than one health care provider at more than one location, but count only as one of the three IMEs. This is called a panel exam. If your claim is closed and later reopened, the insurer may require you to attend up to three more IMEs. This form provides guidelines for workers in Oregon who are required to attend an Independent Medical Examination (IME) as part of their workers’ compensation claim. It explains the purpose of an IME, items to bring, expenses covered by the insurer, and the process for dealing with invasive medical procedures. It outlines the requirements for attending the exam, including consequences for non-attendance, and the protocol for disputing the exam location. The form also covers the rights of workers to have an observer present, the conduct expected during the exam, and steps to take if there are issues or inaccuracies in the IME report. Additionally, it provides contact information for filing complaints or seeking further assistance from the Workers' Compensation Division and the Ombuds Office for Oregon Workers. www.FormsWorkflow.com