Notice of DIME Negotiations Forms
| Form Name | Notice of DIME Negotiations |
| Form # | WC165 |
| Form Revision | Rev 04/25 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | This form is used by the insurer to notify the Division that the parties have failed in the attempt to negotiate the selection of an Independent Medical Examination (IME) physician. |
| Claimwire Description | n/a |