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Form IME-4.3A Attachment for Report of Independent Medical Examination Scheduled Loss of Use - New York
What Is Form IME-4.3A?
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form IME-4.3A?
A: Form IME-4.3A is an attachment for the Report of Independent Medical Examination Scheduled Loss of Use in New York.
Q: When is Form IME-4.3A used?
A: Form IME-4.3A is used when submitting a Report of Independent Medical Examination for Scheduled Loss of Use in New York.
Q: What is the purpose of Form IME-4.3A?
A: Form IME-4.3A is used to provide additional information regarding the scheduled loss of use due to a work-related injury in New York.
Q: What information is required in Form IME-4.3A?
A: Form IME-4.3A requires detailed information about the claimant's injury, medical history, treatment, and any impairments or restrictions caused by the injury.
Form Details:
- Released on May 1, 2018;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form IME-4.3A by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
