Referal Forms
& Documents

We typically request the below claim file documents (if available) to create our file:

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• C-3 or C-4

• Job Description

• FCE Report

• Perm Restricts/Final PR

• Wage Calculation Form

• PPD Rating or Date of PPD Evaluation

• Name of Attorney (if rep’d)

• IME Reports

• Counselor Assignment letter

• Claims Acceptance Letter

• Initial Consultative Medical Report

 

 

Our referral forms can be downloaded if interested in using them.

 

For any questions email us at: admin@rvalv.com