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Submit Referral 1-800-460-3173 info@jbamedical.com

"EXCEEDING THE STANDARDS"

Independent medical examinations are an essential aspect of an insurance company’s arsenal to protect its policyholders from abusive and outright fraudulent claims. IME’s are a valuable tool by which insurance companies can secure an impartial second medical opinion.

All reports are reviewed by a licensed adjuster to ensure that all pertinent questions are answered in the report, and that the report reads in a manner that the adjuster can make a proper determination on the treatment being received. At JBA Medical, we are committed to quality and customer service.

Key elements to a JBA IME include:

Diagnosis
Work Capability
Causal Relationships
Maximum Medical Improvement, if requested
Appropriateness of Care
Medical Recommendation
Percentage Impairment Rating, if requested

Ime Referral Form :

Date

Adjuster Email

Company

Adjuster

Phone Number

Fax Number

Claim Number

Policy Number

Date of Loss

Insured First Name

Claimant/Patient First Name

Insured Last Name

Claimant/Patient Last Name

Claimant/Patient Address

Claimant/Patient Date of Birth

City

State

Zip Code

Phone W/ Area Code

Preferred Date for IME

Social Security Num (Optional)

Transportation Needed

Translator Needed

Language

Attorney Information:

Attorney First Name

Attorney Last Name

Law Firm Name

Address

Address 2

City

State

Zip Code

Phone W/ Area Code

Fax Number

Type of Review:

Chiropractic

Orthopedic

Neurological

Dental

Psychiatric

Plastic Surgery

Internal Medicine

Other

Type of Case:

No Fault

Worker's Comp

Disability

Other

Treating Physician:

Name

Address

Address 2

City

State

Zip Code

Phone W/ Area Code

Current Diagnostic

Documents:

Maximum Total Upload Size is 100M

Click to add Additional Documents

Please provide an Email Address if you wish to receive an Upload Receipt

Specific questions to be answered by the examining physician:

Please include additional Claimants needing exam in this section.

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