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.
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.
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.