The IME Report. Upon completion of the IME, the Contractor must deliver the Physician’s comprehensive typed narrative report of his/her findings to OSC within 21 days of the date of the IME. The Report must be signed by the Physician and must include the following:
(1) Complete identification of the Member, including name, age, gender, home address, System identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the Report as the last page. (Whether the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.)
(2) Name of examining Physician and his/her specialty.
(3) Summary of all records provided by OSC and/or provided by the Member.
(4) Medical history of the Member including: • History of accident/injury and any intervening history. • If re-examination, intervening history. • History of any prior conditions which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors. • Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination).
(5) Scope of examination and findings, including copies of medical test results and reports, including: • Description of examination, including any review of tests performed (if applicable). • Copies of the test results performed by the Physician or at the Physician’s request. • Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. • Conclusion, containing answers to the questions asked by the System. Physician should stay within his/her specialty and only respond to issues requested for review.
(6) Testimony availability • Physicians must be available to provide testimony at OSC hearings. A Physician’s availability for testimony at hearings must be indicated on the Physician’s report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”).
(7) Where applicable and appropriate, any safe and reasonable treat...
The IME Report. Upon completion of the IME, the Contractor must deliver the Physician’s IME Report of their findings to OSC within 30 days of the date of the IME. The IME Report must be signed by the Physician and must include the following information:
(1) Complete identification of the Member, including name, age, gender, home address, NYSLRS identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the IME Report as the last page. The IME should still take place even if the Member declines to provide their picture. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.
(2) Name of examining Physician and their specialty.
(3) Summary of all records provided by XXXXXX and/or the Member.
(4) Medical history of the Member including: History of accident/injury and any intervening history, If re-examination, intervening history, History of any prior conditions which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors, and Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination).
(5) Scope of examination and findings, including copies of medical test results and reports, including: Description of examination, including any review of tests performed (if applicable), Copies of any test results performed by the Physician or at the Physician’s request, Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency, and The Physician’s conclusion, containing answers to the questions asked by NYSLRS. The Physician should stay within their specialty and only respond to issues requested for review.
(6) Testimony availability The Physicians must be available to provide testimony at NYSLRS hearings. A Physician’s availability for testimony at hearings must be indicated on the Physician’s IME Report (availability includes “day of the week” and “A.M. and/or P.M.”).
(7) Per NYSLRS’s request, response(s) to issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement...
