Form WC179 Division Independent Medical Examination (Dime) Physician Summary Disclosure Form (Insurer or Self-insured Employer) - Colorado

Form WC179 Division Independent Medical Examination (Dime) Physician Summary Disclosure Form (Insurer or Self-insured Employer) - Colorado

What Is Form WC179?

This is a legal form that was released by the Colorado Department of Labor and Employment - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the WC179 Division Independent Medical Examination (DIME) Physician Summary Disclosure form?
A: WC179 is a form used in Colorado for disclosing the summary of the physician's evaluation in a workers' compensation independent medical examination (IME) or Division Independent Medical Examination (DIME).

Q: Who uses the WC179 form?
A: The form is used by the insurer or self-insured employer when they request an IME or DIME for a workers' compensation claim.

Q: What is the purpose of the WC179 form?
A: The purpose of the form is to provide a brief summary of the physician's findings and recommendations after conducting an IME or DIME for a workers' compensation claim.

Q: What information does the WC179 form contain?
A: The form includes the physician's name, contact information, date of the examination, a summary of the examination findings, and the physician's recommendations regarding the claimant's medical condition and impairment.

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Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Colorado Department of Labor and Employment;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form WC179 by clicking the link below or browse more documents and templates provided by the Colorado Department of Labor and Employment.

Download Form WC179 Division Independent Medical Examination (Dime) Physician Summary Disclosure Form (Insurer or Self-insured Employer) - Colorado

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