Get Ny Ime-5 2014-2026

The NY IME-5 form serves as an essential document for scheduling an independent medical examination related to workers' compensation claims in New York. This guide provides clear and concise steps to assist users in accurately filling out this form online.

Follow the steps to successfully complete the NY IME-5 online.

1. Select the ‘Get Form’ button to access the NY IME-5 form and open it in the online editor.
2. Fill in the WCB case number in the designated field. This number is crucial as it links your examination to the respective workers' compensation claim.
3. Enter the carrier case number, which should be provided by your insurance carrier. This helps identify the specific details of your case.
4. Input the date of the accident as it appears in your records. Accurate information is important for your examination.
5. Complete the claimant's name and address section with your full legal name and current address. This personal information will help locate your records.
6. Specify the date of the examination as requested by the healthcare provider. Ensure this date allows enough time for preparation.
7. Record the date of this notice to ensure the notification timeline is respected. This is critical as it affects your rights concerning the examination.
8. Fill in the insurance carrier's name and address. This information is taken from your insurance documentation.
9. Indicate the place of examination, including the name of the facility where the independent medical examination will occur.
10. Identify who requested the examination in the appropriate section. This could be your insurance company or yourself, depending on the circumstances.
11. Enter the time of the examination as confirmed by the examination facility. This ensures clarity regarding your appointment.
12. If the examination was requested by you, make sure to note your responsibility for any costs and fill in the fee section where applicable.
13. Select whether the independent examiner intends to record or videotape the examination. Completing this item is essential for the notice to be valid.
14. Review the purpose of the examination and special instructions carefully. Ensure you understand your rights during the examination process.
15. Check all entries for accuracy before proceeding to save. Make sure to have completed every necessary section.
16. Once completed, save your changes, and choose to download, print, or share the form as needed for your records or to provide to relevant parties.

Begin filling out your NY IME-5 online today for a streamlined examination process.