*** This form is for EMPLOYER use only. IMO Med-Select Network® Claims Only. ***

"*" indicates required fields

Your injured employees are able to get in to see a network treating doctor within a reasonable amount of time*
The network doctor/clinic provides required DWC 73 forms in a timely manner*
If the injured worker was unable to return to work full duty, transitional duty was discussed*
Referrals to physical therapists, specialists and diagnostic facilities were handled in a timely fashion*
Generally speaking, injured employees have provided positive feedback regarding their experience with their network treating doctor*
The IMO Telephonic Case Manager (TCM) kept you informed of medical and return to work plans at the onset and during the network process*
The IMO Med-Select Network has facilitated a positive impact in coordinating the medical treatment plan and RTW successful outcome*
We do not use this information to identify you. This is only used to correctly identify the employer.
Please contact me for further comments