NY MR/IME-1 2018-2025 free printable template

CHECK ONE:q q q state of New York WORKERS COMPENSATION BOARD Medical Director's Office Riverview Center 150 Broadway Suite 195 Means, NY 12204CHECK ONE:Physician Podiatrist Chiropractor Psychologist

How to fill out health application authorization under

How to fill out NY MR/IME-1

1. Obtain the NY MR/IME-1 form from the official New York Workers' Compensation Board website or request a physical copy from your employer.
2. Read the instructions carefully to understand the required information and documentation.
3. Fill in your personal information, including your name, address, and contact details, in the designated fields.
4. Provide information about your injury or condition, including the date of the incident and medical treatment received.
5. List any previous IME (Independent Medical Examination) appointments, if applicable.
6. Ensure all sections of the form are completed accurately and thoroughly.
7. Review the form for any errors or omissions before submitting.
8. Submit the completed form to the appropriate party as instructed.

Who needs NY MR/IME-1?

1. Individuals who have filed a workers' compensation claim in New York and are required to undergo an independent medical examination (IME).
2. Claimants seeking to provide details about their medical condition and need for benefits.
3. Workers whose claims may be reviewed for validity, basis for treatment, or ongoing eligibility for compensation.

Video instructions and help with filling out and completing health application authorization under

Instructions and Help about health application authorization under

Settling Your Claim Workers' compensation provides payments as needed for lost wages and lifetime medical care for an injury or illness But you and the insurance company can agree to permanently close your claim in exchange for one lump sum payment or an annual payment This is known as settling the claim with a section 32 waiver It's a waiver because you are waiving your righto future compensation in exchange for this payment today Because a workers'compensation claim can pay both lost wages and medical care we'll review how section 32 waiver affects both of these You can settle one and keep the other open, so you get benefits the same way you do today, or you can close Botha's up to you and the insurance company What parts of a claim can be permanently closed First let's talk about the lost wages You can take one lump sum payment for your future lost wages or receive an annual payment The amount is whatever you your lawyer and the insurance company agree upon it is subject to negotiation and like all workers' compensation it's tax-free But remember it's the last workers' compensation payment you'll receive for lost wages due to your injury Medical care If you choose to end your medical care coverage through a section 32 waiver the insurance company will never pay for your medical care again You will receive a one-time lump sum payment You may need to set money aside from the lump sum payment in a special account today for future medical treatment for your workers' compensation injury Medicare set-asides Choosing to end your medical care coverage to a section 32 waiver may affect your right to Medicare benefits in the future When settling a workers' compensation claim the parties must take into account Medicare's interests This is most often done besetting up a Medicare set-aside account out of the proceeds of the section 32waivers settlement which will be used to pay for future medical treatment for your workers' compensation injury Failing to take into account Medicare's interest when you settle your claim can result in Medicare refusing to pay for treatment for your workers' compensation injury Check with Medicare to learn your right sand responsibilities Because Medicare is a federal program the Workers'Compensation Board has no jurisdiction over it What happens if I spend all the settlement money for my medical care After you spend your settlement payment designated to cover your medical care such as out of an MSA you can pay forbear either through Medicare or out of pocket To be eligible for Medicare you must either meet the age requirement or be receiving social security disability insurance Check with Medicare to learn your rights Because it's a federal program the Workers' Compensation Board has no jurisdiction over it If medicare is not an option you must pay for future care out of pocket Health insurance does not cover the cost of work related conditions, so health insurance will not cover the cost of your care even if bought through...

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What is NY MR/IME-1?

NY MR/IME-1 is a form used in New York State for requesting an Independent Medical Examination (IME) for workers' compensation claims or other related matters.

Who is required to file NY MR/IME-1?

Typically, insurance carriers, employers, or legal representatives involved in workers' compensation cases are required to file NY MR/IME-1.

How to fill out NY MR/IME-1?

To fill out NY MR/IME-1, provide information such as claimant details, insurance information, and specific reasons for requesting the IME. Ensure all sections are completed accurately.

What is the purpose of NY MR/IME-1?

The purpose of NY MR/IME-1 is to facilitate the process of obtaining an independent medical evaluation to assess an injured worker's condition and determine the extent of injuries or necessary treatments.

What information must be reported on NY MR/IME-1?

Information that must be reported on NY MR/IME-1 includes claimant's name, date of birth, claim number, insurance carrier details, and the specific medical issues being evaluated.