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Massachusetts Application to Serve as an Impartial Physician

State:
Massachusetts
Control #:
MA-SKU-1102
Format:
PDF
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Description

Application to Serve as an Impartial Physician

The Massachusetts Application to Serve as an Impartial Physician is a form used by medical professionals in Massachusetts to apply to become an Impartial Physician. Impartial Physicians are independent medical professionals appointed by the state Department of Industrial Accidents to evaluate injured workers in workers’ compensation cases. The Application consists of three parts: Part A is the applicant’s personal information, Part B is the applicant’s professional qualifications, and Part C is the applicant’s agreement to abide by the regulations of the Department of Industrial Accidents. Applicants must provide a copy of their medical license, a copy of their CV, and a signed statement affirming their willingness to abide by the rules and regulations of the Department of Industrial Accidents. The Massachusetts Application to Serve as an Impartial Physician is available in two forms: The Standard Application and the Specialty Application. The Standard Application is used by physicians with experience in general medicine, while the Specialty Application is used by physicians with specialty training in a particular medical field. The APPLICATION is reviewed by the Department of Industrial Accidents, and upon approval, the applicant is appointed as an Impartial Physician. The Impartial Physician is responsible for evaluating injured workers and providing medical opinions in workers’ compensation cases.

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Massachusetts Application to Serve as an Impartial Physician