Oklahoma Application for Independent Medical Examiner

State:
Oklahoma
Control #:
OK-SKU-0775
Format:
PDF
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Description

Application for Independent Medical Examiner

The Oklahoma Application for Independent Medical Examiner is an application form created by the Oklahoma Workers' Compensation Commission (OCC) to be used by independent medical examiners (Times) when evaluating a claimant's medical condition in the state of Oklahoma. The application is used to provide medical records and other information to the IME for review and evaluation. It includes information such as the claimant's medical history, current medical condition, diagnosis, treatment, and any necessary tests or evaluations. The application also includes the IME's contact information, the date of the exam, the type of exam, and the reason for the exam. There are two types of Oklahoma Application for Independent Medical Examiner: Redesignation and Non-Designation. The Redesignation form is used to predesignate an IME for a particular case and the Non-Designation form is used to request an IME to evaluate a claimant’s medical condition withouredesignationon.

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FAQ

When you are injured on the job and you are unable to work for more than 7 calendar days, you are eligible for weekly benefits amounting to 70% of your average weekly wage, up to the maximum set by law. The maximum is equal to the state's average weekly wage.

The employee will be reimbursed within 60 days of receipt of the form.

Being uninsured in the state of Oklahoma can lead to severe penalties. If you're required by law to provide workers' compensation insurance and you fail to do so, you can face a fine of up to $1,000 per day without coverage.

All Oklahoma employers are required to carry workers' compensation insurance. Oklahoma's workers' compensation system covers medical expenses and lost wages resulting from work-related injuries and illnesses.

In Oklahoma, most employers must provide coverage to their employees with workers' compensation coverage. Employers may buy their insurance from a private insurance company.

Amount: compensation is equal to 70% of the difference between the employee's average weekly wages and the employee's wage-earning capacity in the same employment or otherwise, if less than before the injury. It may not exceed 80% of the employee's average weekly wages at the time of the accident.

The form is listed under Affidavit of Exempt Status on the Case OK website. The cost for an Affidavit of Exempt Status is $50.00 plus a $1.00 online processing fee. Please note the Workers' Compensation Commission will not accept checks for the Affidavit of Exempt Status Fee.

More info

Sample Independent Medical Evaluation (IME) Report Template. The below can be used as a starting point to organize your IME report.An IME is an independent medical evaluation that is used to resolve questions about your medical condition for purposes of a workers' comp claim. This work involves examining injured workers in workers' compensation and personal injury cases and issuing a written report on your findings. There are several situations when an independent medical examination may be requested, so employers should be aware of the process. The requesting party must submit form WC77-. Request for Qualifications. An independent medical examiner (IME) is a specialist with qualifications relevant to your injury. They do not replace your nominated treating doctor. Pursuant to Section 13-n and 12 NYCRR 300.

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Oklahoma Application for Independent Medical Examiner