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Board Announcements Implementation of Forms Associated with SLU Evaluations

Date: March 2, 2021

The Board has received a number of inquiries associated with the electronic version of the Doctor's Report of MMI/Permanent Impairment (Form EC-4.3), as described in Subject Number 046-1067, specifically related to Schedule Loss of Use evaluations.

The paper Form C-4.3 is the May 2018 version. The revised electronic EC4.3 has not yet been similarly revised. Therefore, it does not reflect the enhanced information set forth in the paper version. The Board anticipates publishing the updated electronic version online in the near future. In the meantime, evaluating providers should utilize the existing EC-4.3, and include all of the necessary findings that comply with the 2018 Impairment Guidelines within an attached narrative.

If you have any questions about the form, please write to

Thank you.
NYS Workers' Compensation Board Medical Director's Office