Reminder to Use and Fully Complete the Current Form IME-5

In keeping with the goals of the New York State Workers’ Compensation Board (Board) to provide efficient and timely benefits to employees, the Board requires the use of the current Claimant's Notice of Independent Medical Examination (Form IME-5) when notifying an injured worker that an independent medical exam is required. This form must be fully completed, including the purpose of the exam and the IME provider's authorization number.

Please ensure your organization is using and fully completing the current version of Form IME-5. Older versions of the form received after December 30, 2022, will be discarded without processing.

More information

All IME-related forms can be found on the Board's website.

Questions? Please email regulations@wcb.ny.gov.