(1) A person with a permanent impairment that is a substantial obstacle to employment may apply for SIF certification. Application for SIF certification is voluntary on the part of the applicant.
(2) Application for certification requires the following documentation:
(a) a completed SIF application form signed by the applicant, which includes:
(i) information regarding applicant's education, training, and job skills;
(ii) the applicant's employment history for the past ten years;
(iii) the applicant's assessment of the impact of applicant's permanent impairment on future employment; and
(iv) a description of any modifications to employment reasonably necessary to accommodate work restrictions; and
(b) a completed SIF medical evidence of permanent impairment form signed by a treating physician, which includes:
(i) an assessment of applicant's permanent impairment;
(ii) an assessment of the impact of applicant's permanent impairment on applicant's employability, including a description of permanent work-related restrictions and limitations;
(iii) copy of a treating physician's notes documenting applicant's permanent impairment and obstacles to employment, including any work restrictions, if available; and
(iv) evidence the applicant has achieved maximum medical improvement.
(3) The department shall review the application, the medical evidence of permanent impairment form, and other supporting documentation. The department shall evaluate whether the applicant qualifies for certification, in accordance with the requirements set forth by ARM 24.29.2610.
(4) The department encourages persons with a permanent impairment that is a substantial obstacle to obtaining employment or reemployment to apply for certification when a treating physician has not completed the medical evidence form. The department shall notify the applicant in writing when a medical evidence of form or other supporting information is needed to complete the certification process.
(5) The applicant may submit a signed release to the department that authorizes the department to contact, notify, and confer with a referring agent, a designated representative, or applicant's medical provider.
(6) When the department approves an application, the department shall notify the applicant and referring agent, if applicable, and provide the applicant with an SIF certification card.
(7) The department shall retain an incomplete application for a period of one year. When an application remains incomplete one year after submission, the department shall deny the application.
(8) When the department denies an application, the department shall inform the applicant and referring agent, if applicable, in writing of the reasons for denial.
(9) Upon the written petition of the applicant, the department shall reconsider the denial of an application, pursuant to the administrative review process outlined by ARM 24.29.206. The applicant shall submit the petition for administrative review and any additional information for department consideration within six months following a denial.
(10) After an administrative review that affirms the denial of an application, the applicant may submit a written request to the department for a contested case hearing, pursuant to ARM 24.29.207.