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Empowered Inc. Claim Management Services
  • Services
    • Independent Medical Evaluations
    • Peer Record Review
    • Medicare Set-Asides
    • Claim Auditing
    • Rapid Response Program
  • Online Forms
    • Claim Auditing Form
    • Claim Oversight Request Form
    • Independent Medical Evaluation Request Form
    • MSA Referral form
  • Company Overview
    • About Us
    • Benefits
    • Experience
    • Service Commitment
    • Why Use An IME Vendor
  • Contact
  • Search

Online Forms

Below is a list of forms that are available for online submission. All forms are submitted using a secure encryption method to ensure that your private information is protected at all times.

Claim Auditing
Claim Oversight
Independent Medical Evaluation
Medicare Set-Asides – Liability Referral

Please feel free to contact us with any questions.

Empowered, Inc.
PO Box 2832
Poughkeepsie, NY 12603-2832
Phone: (845) 453-6057
Fax: (855) 950-4939
Email: referrals@empowered-inc.com