What is an Impartial Specialist?

An Impartial Specialist (IS) is a physician with outstanding qualifications whose expert, unbiased medical opinion helps the Workers' Compensation Board (Board) resolve medical disputes in certain workers’ compensation cases. Members of this select IS panel are chosen by the Chair of the Workers' Compensation Board (Chair).

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Who Qualifies to Become an Impartial Specialist?

To be an IS, a physician (M.D., D.O.) should:

• Possess a valid and unrestricted NYS license
• Have no restrictions on any state medical license
• Be board-certified in an American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) recognized specialty or sub-specialty
• Have five or more years of practice in the specialty/subspecialty
• Actively treat patients
• Possess outstanding medical qualifications, which may include an academic affiliation or publications in peer-reviewed medical journals

The Board seeks applicants whose practice does not include a significant number of independent medical examinations (IME) or record reviews. A significant number is defined as more than 20 IME or record reviews annually on behalf of either employers/insurers or injured workers.

An IS must complete at least three credits of continuing medical education courses on workers' compensation medical practice, that are approved by the Chair prior to designation as an IS. A physician designated as an IS shall complete additional relevant continuing medical education courses offered by the Board as set forth by the Chair.

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What are the Duties of an Impartial Specialist?

The duties of an IS are to:

• Accept IS examination requests from the Chair (unless a conflict of interest exists)
• Perform a physical examination and/or record review as requested
• Prepare and submit a written report addressing the issue in dispute
• Testify at a hearing or deposition (if requested); testimony often occurs by phone
• Comply with Workers’ Compensation Law

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When is an Impartial Specialist Used?

An IS is used to help resolve a medical dispute in certain cases. The decision to refer an issue to an IS may be made by any of the following:

• Full Board or Board panel (administrative appeal)
• Workers' Compensation Law Judge (trial level)
• By agreement of the parties

Use of an IS is required in claims involving certain employees of the Board or the State Insurance Fund [WCL § 20(2)(h)].

Exceptional Designation

Under exceptional circumstances, the Board may select someone to serve as an IS on a one-time basis. This may occur, for example, when there is no designated IS who meets all the IS requirements within a reasonable distance of the claimant, but has the requisite expertise or experience for the case.

In order to be an IS under exceptional circumstances, a physician must:

• Possess a current, valid, and unrestricted license within the state where the IS examination will be performed
• Be board-certified in their specialty or have demonstrated expertise in the specialized field necessary for the particular examination
• Have any other professional qualifications that the Chair or Board deems necessary for a particular case

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How is an Impartial Specialist Assigned?

Impartial Specialist Panel List

The Board will maintain a list of the IS panel members on its website. The list includes office location(s), specialty or sub-specialty, and contact information. Parties may use the list to identify a mutually acceptable IS.

Assignment of an Impartial Specialist

Mutual agreement: When an IS is requested, the parties may agree to a particular IS. The parties have ten days to identify a mutually acceptable IS. The Board will assign the selected IS, subject to availability and absent any conflict.

Board selection: If the parties do not agree on an IS, the Board will select an IS from the Panel based on specialty, geography, and availability. If no designated IS is appropriate or available, the Board may identify a one-time IS to review the case. See Exceptional Designation above.

Objection to Assignment of Impartial Specialist

Either party may object to using a particular IS on any of the following grounds:

• The IS previously treated or examined the claimant (outside the bounds of being an IS)
• The IS has an appearance of or actual conflict of interest (e.g., the IS is in practice with the claimant’s treating provider)
• The IS does not have the appropriate qualifications to assess the medical issue in dispute

Objections must be submitted in writing to the Chair, with a copy sent to the opposing party. The objection must be received within five days of the notice of assignment. Decisions on objections are made by the Board.

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Exam or Record Review?

The Board will make a determination on whether the IS must perform a physical examination of the claimant or whether the opinion can be made based solely on a record review. If an examination is necessary, the Board will schedule the exam and notify the claimant of the time and location.

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Scheduling of Exam – How is it done?

The Board arranges the date, time, and location of IS exams. Parties are notified of this information at least seven days prior to the exam.

Exams must be conducted during the normal office hours of the IS, but cannot be scheduled before 8:00 a.m. or after 6:00 p.m., on weekends, or on public holidays unless agreed to by the claimant.

When an IS exam is ordered, the claimant must attend. If the claimant cannot attend a scheduled exam, he or she must give reasonable notice – at least 24 hours – to the IS and the Board.

The issue in question may be decided against the claimant if the claimant:

• Does not give reasonable notice when he or she cannot attend a scheduled exam
• Repeatedly reschedules an exam without good cause
• Does not schedule an exam when requested

An IS may request a fee of $350 if the claimant fails to provide at least 24 hours' notice prior to canceling an exam.

Transmission of Medical Records

The Board provides an electronic copy of the medical records in the Board's file at the time of scheduling. The parties may submit to the Board any relevant documents not contained in the Board's electronic case file within ten days of the ordering of the IS (prior to scheduling). These records will be scanned into the electronic case file; the Board sends the following to IS:

• Medical reports
• Decision that referred the case to the IS
• Minutes of testimony of a doctor in the case
• Minutes of testimony of the claimant (when indicated)
• Non-scannable objects, such as relevant x-rays or other imaging films, that are part of the Board’s file

The claimant must bring any relevant x-rays or other imaging films that are not part of the Board's file to the exam. If a review of record is ordered, the claimant should send the relevant films to the IS within ten days of assignment. In either case, the claimant is entitled to reimbursement from the insurer for any reasonable cost to obtain these films.

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How is an Impartial Specialist Exam Conducted?

Representatives of either party are not allowed to attend the exam. The claimant may bring a family member or friend to the exam. The IS may, in their discretion, exclude any person the claimant brings from being present at the examination. The examination shall not be recorded by the claimant or the IS.

Interpreter

If the claimant has limited English proficiency, the Board will arrange for the services of an interpreter at the exam.

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IS Report – What Happens After the Exam?

The IS must complete a written report following the exam or record review on the Form IS-4. All sections of the form are required to be completed.

The report must be submitted to the Board within 20 business days from the date of examination or 25 days from receipt of record (if no exam was performed).

Receiving the Impartial Specialist Report

Once the Board receives the report, it will transmit the report to the parties: insurer, claimant, and claimant's legal representative (if any).

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IS Testimony – When is it Required?

Either party may request cross-examination of the IS. The request may be made at a hearing or by returning the Cross-Examination Inquiry form letter (EC-411) within ten days of receiving the IS report.

If the claimant has legal representation, the parties shall depose the IS within 45 days of the request. If the claimant is unrepresented, the IS will be cross-examined at an expedited hearing before a Workers' Compensation Law Judge (WCLJ). If the IS cannot appear at a hearing or deposition due to unforeseen circumstances, the hearing or deposition shall be rescheduled within 20 days. If the IS fails to appear for testimony without cause, he or she may be subject to removal from the IS Panel.

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Fee Schedule – What is it?

IS Report

The IS is paid a set fee for review of record, examination (if necessary), and preparation of a report. The fee depends upon the complexity of the medical issue(s) in dispute, and may be modified by the Chair or Medical Director under unusual circumstances. The fee schedule is as follows:

$750 for an opinion on one of the following:

• Issues related to causation, treatment or ongoing disability for injuries of the extremities (for example, shoulder, knee, wrist, ankle or foot)
• Level of impairment for PPD schedule loss of use
• Whether a surgical procedure requiring pre-authorization meets the MTG criteria and should be performed

$1,250 for an opinion on one or more of the following:

• Issues related to causation, treatment, or ongoing disability for non-scheduled injuries (e.g., neck, back or other body systems)
• Level of impairment for nonschedule permanent partial disability
• Whether any second surgery should be performed
• Other complex medical issues including injuries/conditions involving more than one body part

Missed Exam: $350 if claimant fails to attend examination without at least 24 hours' notice of cancelation

Testimony

The IS is entitled to a fee of $450 for testifying at a deposition or hearing. Testimony can often be provided by phone. The WCLJ may allow a greater fee commensurate with special circumstances that increase the time spent on a particular case.

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How is an Impartial Specialist Paid?

Examination and Report

Within 30 days of receiving the IS report (Form IS-4) and an invoice (a statement of services that includes the agreed upon fee set upon assignment) from the IS, the Board transmits the report and invoice to the insurer (with a copy to the IS). The insurer shall pay the fee within 30 days of transmission of the IS report and invoice.

Testimony

The insurer must pay the fee of $450 or a fee as determined by the WCLJ according to special circumstances of a case within 30 days of the date the IS testifies at either a deposition or hearing.

Under special circumstances, the IS may request a fee greater than $450 by stating the request on the record as part of the deposition or hearing. Special circumstances that may be considered by the WCLJ or Board are the length of time spent testifying, any delay between the scheduled start time for testimony and the time testimony actually began, and travelling time from the Impartial Specialist's office to the testimony location.

If the IS does not appear for a deposition or hearing, it will be rescheduled within 20 days. Failure to appear for the rescheduled deposition or hearing may result in the removal of the Impartial Specialist’s name from the IS Panel.

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What is the Relationship between the Impartial Specialist and Claimant?

The IS is not permitted to treat the claimant during or after the exam. Only a limited patient-physician relationship is created between the claimant and IS. The IS must comply with all WC laws and regulations.

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Removal of an Impartial Specialist – What is the Process?

Complaints

Any interested party may submit a written complaint to the Chair regarding an IS. Complaints will be investigated and appropriate action will be taken as indicated by results of the investigation.

Removal

The Chair (or the Chair's designee) can remove an IS from the IS Panel for any of the following reasons:

• A misrepresentation on the IS application
• Failure to maintain the qualifications listed on the application
• Refusal or failure to comply with Workers' Compensation Laws (WCL) and the requirements of the IS program

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How Do I Become an Impartial Specialist?

Completing an Application

Qualified physicians may obtain the Health Provider's Application for Designation as an Impartial Specialist by clicking here: Form IS-1

Completed applications should be submitted to:

State of New York Workers' Compensation Board
Attn: WCB Medical Director's Office
Riverview Center
150 Broadway
Suite 195
Menands, NY 12204

The Board will promptly notify applicants of its decision. Applicants who are designated as Impartial Specialists will serve a renewable five year term.

Renewal of Designation

An IS who wants to renew their term should complete a Physician's Application for Renewal of Designation as an Impartial Specialist, Form IS-1R, at least 60 days before the current term ends.

The Board will promptly notify applicants of its decision.

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Questions?

Call the NYS Workers' Compensation Board at (800) 781-2362
or
email: provider@wcb.ny.gov.

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