This version of the form is not currently in use and is provided for reference only. Download this version of Form F207-202-000 for the current year.

Form F207-202-000 Independent Medical Exam (Ime) Travel and Wage Reimbursement Request - Washington

Preview

Fill PDF Online

PDF

Word

Fill PDF Online

Fill out online for free

without registration or credit card

What Is Form F207-202-000?

This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F207-202-000?
A: Form F207-202-000 is the Independent Medical Exam (IME) Travel and Wage Reimbursement Request form specific to Washington.

Q: What is an Independent Medical Exam (IME)?
A: An Independent Medical Exam (IME) is a medical examination requested by an insurance company or employer to evaluate a person's medical condition or disability.

Q: Who uses Form F207-202-000?
A: Form F207-202-000 is used by individuals in Washington who are requesting reimbursement for travel and wage expenses related to an Independent Medical Exam (IME).

Q: What expenses can be reimbursed using this form?
A: Expenses related to travel (such as mileage, transportation, and lodging) and lost wages due to attending an IME can be reimbursed using this form.

Form Details:

Released on March 1, 2021;
The latest edition provided by the Washington State Department of Labor and Industries;
Easy to use and ready to print;
Quick to customize;
Compatible with most PDF-viewing applications;
Fill out the form in our online filing application.

Download a printable version of Form F207-202-000 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.