Co proposal 2026

1. Click ‘Get Form’ to open the co proposal in the editor.
2. In Section I, enter your WC #, Carrier Claim #, Social Security #, and Claimant Name. Specify the Date of Injury and indicate whether you are the claimant or respondent by checking the appropriate box.
3. Provide the name of the physician you propose for the IME. Ensure that this physician is Level II accredited. You can find a list of accredited physicians on the Division’s website.
4. Sign as the requester and provide your phone number. If applicable, check the box indicating you claim to be unable to pay for the IME.
5. In Section II, list all parties who received copies of this document along with their addresses. Ensure accuracy for proper communication.
6. Finally, review all entries for completeness and accuracy before submitting your form through our platform.

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