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Workers’ Compensation Board

New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo

Subject No. 046-708

Revised Board Forms in Support of Amendment of
IME Regulations (12 NYCRR § 300.2)

Date: August 1, 2014

On February 11, 2014, the Chair of the Workers' Compensation Board (Board) adopted amendments to the regulations governing the conduct and reporting of Independent Medical Examinations (IMEs) (12 NYCRR §300.2). The amended regulation became effective on February 26, 2014.

Previously released Subject No. 046-666 highlighted the significant changes contained in the amended regulation. The complete text of the amended regulation is located on the Board’s website under Laws, Regulations and Decisions.

The following forms were recently revised in support of the amendment to the IME regulations:

IME-3   Practitioner's Report of Request for Information/Response to Request Regarding Independent Medical Examination

IME-4   Practitioner's Report of Independent Medical Examination

IME-5   Claimant's Notice of Independent Medical Examination under Section 137 WCL

IME-7   Statement of Registration Section 13-n, WCL (for entities deriving income from independent medical examinations)

NOTE: If you are an IME entity, you will be contacted by the Board directly regarding updating your registration and completing the revised IME-7.

Updated versions of these forms can be found on our website. Older versions of these forms will not be accepted more than 60 days after the effective date of this announcement.

Questions related to this announcement can be directed to the Medical Directors' Office by email at: Legal questions may be directed to the Office of General Counsel at:


Robert E. Beloten