Now Available - Revised Doctor’s Report of MMI/Permanent Impairment (Form EC-4.3)

New York State Workers' Compensation Board sent this bulletin at 11/05/2021 09:00 AM EDT

Now Available - Revised Doctor’s Report of MMI/Permanent Impairment (Form EC-4.3)

In a Workers’ Compensation Board (Board) announcement dated March 2, 2021, the Board referenced 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 046-1067A, specifically related to Schedule Loss of Use evaluations.

The online version of Form C-4.3 is now available for use.

Both the online and paper versions have been updated. Please be advised of the following changes:

The billing section has been simplified with space to include information from just one exam.
Question 5 that asked if the patient would benefit from vocational rehab has been removed from Attachment B.

If you have any questions about the form, please email ImpairmentGuidelines@wcb.ny.gov.

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