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

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The Network Telephonic Case Manager (TCM) kept me informed of medical and return- to-work plans at onset and during the network process.*
The injured employees are able to get in to see a network-treating doctor within a reasonable amount of time.*
TCM made me aware of medical concerns and/or changes in the medical condition in a timely manner.*
Generally speaking, the injured employees have provided positive network feedback.*
The network doctor/clinic provides the required DWC73 forms in a timely manner.*
If the injured employee was unable to return to work full duty, the network doctor worked with the employer to get the injured worker back to work on transitional duty, if available.*
Referrals to physical therapists, specialists and diagnostic facilities were handled timely.*
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