Referral Process for Adjusters

If you are a claims adjuster or a nurse case manager and your claim needs an impairment rating, then please follow the steps below.

1. Return our Signed RFA for an Impairment Report

Fill out our request for authorization (RFA) form for a Comprehensive Ratable Impairment Report.

For claims with State Compensation Insurance Fund (SCIF), please download this RFA form.

For all other insurance carriers, download this RFA form.

2. Complete the Cover Letter

Click here to download our injury cover letter.

Provide your contact information and select the body part that requires impairment rating.

3. Send Us the signed RFA, Completed Cover Letter, and Patient Records

After the previous steps have been completed, fax or email* us the following documents:

  • The signed RFA form.
  • The injury cover letter.
  • Relevant patient records.

Fax: (206) 338-3005

Email: records@pr4report.com

* WARNING: While convenient, normal unencrypted email is an insecure technology. Sender assumes all responsibility for sending sensitive information via insecure methods of communication.


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