Accident Tracking - 38911 Preserve

38911 Preserve

Please select at least two applicable statements, including one related to the Independent Medical Examination (IME)

Employee disagrees with the termination of benefits

and/or

Employee requires further medical care

and one of the following:

Employee believes an independent medical examination (IME) may be helpful to resolve this dispute and requests that WCB schedule this now

Employee is filing this to preserve rights under IC 22-3-3-7(e) and will request an IME in the future if necessary

Most Recent Comment:

38911 Received Date

File Date

Representing