If you are a medical provider and your patient needs an impairment rating, please follow the steps below.
Fill out our request for authorization (RFA) form for a Comprehensive Ratable Impairment Report, then send it to the insurance carrier for approval. Wait until you have received the signed form back from the insurance carrier.
For claims with State Compensation Insurance Fund (SCIF), please download this RFA form.
For all other insurance carriers, download this RFA form.
Important: The insurance carrier must sign the exact RFA form above. We are unable to accept separate letters or emails. This exact form must be signed.
Download our injury cover letter here.
Provide your contact information and select the body part that requires impairment rating.
After the previous steps have been completed, fax or email* us the following documents: