When an independent medical examination in a New York workers' compensation case finds permanent partial disability of a non-scheduled body part, the examiner records it on the IME-4.3B. It captures body part, impairment table and severity ranking with supporting history, findings and tests, plus the claimant's work status, residual functional capacities, exertional category, and questions on restrictions, intervening injuries and vocational rehabilitation.
The independent medical examiner completes both pages, identifying the claimant by name, Social Security number, WCB case number, injury date and exam date.
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Attachment for Report of Independent Medical Examination Non-Scheduled Permanent Partial Disability
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The IME-4.3A is for scheduled body parts where a schedule loss of use award applies. The IME-4.3B is for non-scheduled body parts and conditions where a non-schedule award, or classification, is appropriate, and it adds work status, functional capacity and vocational questions.
Whether the claimant could perform at-injury work activities with restrictions, whether they could perform any work with or without restrictions, whether an injury or illness since the date of injury affects residual functional capacity, and whether the claimant would benefit from vocational rehabilitation, each with an explanation.
Exerting up to 20 pounds of force occasionally, up to 10 pounds frequently, or a negligible amount constantly. A job also counts as light when it requires significant walking or standing, sitting with pushing or pulling of arm or leg controls, or a production-rate pace with constant pushing or pulling of materials.