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NY WCB IS-4: Impartial Specialist Exam Report

To help resolve a complex medical question, a New York Board panel, Law Judge or the parties jointly may request an exam by an impartial specialist designated by the Chair of the Workers' Compensation Board. The specialist reports the physical examination or records review on the IS-4, attaching a written report with test results and a list of records reviewed, and lists the days and times available to testify.

Who completes it

The Board-designated impartial specialist physician completes the whole form, with license or authorization number, signature and the certification. The specialist must not have treated the claimant or examined them as an independent medical examiner.

Submitting and payment

How to submit it
Return the original, sworn or verified, to the Board within 20 days of the examination, or within 25 days of receiving records when there is no exam, or by a date the Board sets. The Board sends copies to the parties.
Who pays
The carrier or self-insured employer must promptly pay the specialist under the Impartial Specialist fee schedule or an otherwise approved amount, based on the statement for services submitted to the Board with the IS-4.

Good to know

  • No physician-patient relationship may be established: the impartial specialist cannot provide treatment, cannot have previously treated the claimant, and cannot have examined the claimant as an IME.
  • Either party may request cross-examination of the impartial specialist within 10 days of receiving a copy of the IS-4 from the Board.
  • The original report becomes part of the case record and is scanned into the electronic case folder.
  • The carrier or self-insured employer reimburses the claimant's travel expenses to and from the examination site.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What is an impartial specialist exam in New York workers' comp?

An examination or records review by an unbiased medical expert designated by the Chair of the Workers' Compensation Board. A Board panel, a Law Judge, or the parties jointly may request one to help resolve a complex medical issue, and the specialist reports the results on Form IS-4.

When is the IS-4 report due?

Within 20 days of examining the claimant, or within 25 days of receiving the records if the review is records only, unless the Board directs another date. The report must include test results and a list of records reviewed, and it must be sworn to or duly verified.

Can the impartial specialist be cross-examined?

Yes. Either party may request cross-examination within 10 days of receiving a copy of the IS-4 from the Board. The form asks the specialist to list the days of the week and the times, morning or afternoon, when they are available to testify.