Saturday, August 22, 2009
The Office of Administrative Courts holds local level decisions in various locations around the state. They are placing these decisions on the OAC website each month. So for the month of July you can peruse through 302 pages of decisions. Please be aware that these are local level decisions and many of them are appealed. Still you can get the flavor of the cases being heard each month by reviewing these decisions. Cases involving permanent total disability, job termination, medical benefits, partial impairment, efforts to overturn the DIME opinion and much more are set forth. The names of the parties are not going to be revealed but the names of doctors as well as the deciding administrative law judge are noted. The breakdown for most of these cases is to list the facts being found, the legal conclusions being made and lastly the order itself.
Friday, August 14, 2009
If you can no longer work because of all of your health problems then applying for Social Security Disability may be something to consider. Anyone hurt on the job who may be unable to work anymore should also consider applying but check with your attorney on the timing as it is a factor in your workers comp benefits including even your medical benefits. Those that truly are not employable in a substantial way often can make a claim for disability by heading down to the local Social Security office or online. Here is a link to a starter kit at the Social Security website. Since most people have many questions about it I usually advise applying in person if you can do so. Of course going online is another way but please do not just get started without reviewing the online information at the Social Security website. Some common misconceptions about SSD are that you can qualify if you can no longer work in your occupation. Sorry it's not so although age is a very important factor in the agency deciding if you are employable. Another misconception is that you can get it before you stop working. Sorry but most people should not be working to apply for disability. Another misconception is to say my friend got it for his back problems and I have back problems so I also should get it. Sorry but every case is decided on an individual basis where age, other health concerns, education, past jobs and more are considered. Finally you do need to supply some information about jobs and physicians. Click here for that.
Thursday, August 06, 2009
In a short case decided on August 6, 2009 the Colorado Court of Appeals decided that a Division IME is not a medical benefit. In Jones the court was presented with an effort to reopen the comp claim for more medical benefits. The problem for the claimant was that she was injured in 1998 so there were time limitations to deal with in trying to reopen the claim. The court said that the only way the claimant still had time to try reopen her claim is if the DIME was deemed a medical benefit. This would mean her 2004 DIME examination let her have until 2006 to try reopen if the court agreed. The court did not and determined a DIME is not a medical benefit. A DIME is a medical examination but because it involves no treatment or healing it is not a "medical benefit" according to this decision. While I understand the reasoning (the case is very brief) I do have to question it. Believe it or not there is no statutory definition of what is a "medical benefit". There is no question the DIME physician does not render treatment but the opinion he renders may address further treatment. For more information on a DIME click the subject on our blog. For example your authorized doctor may have said you need medications for another 6 months but the DIME doctor may say you need psychological care or long term medications. In a sense the DIME can trigger more treatment but at a minimum even if nothing further is recommended he does address medical issues. This includes your need for further treatment as of the date of his exam. If we think of medical benefits as treatment then clearly a DIME is not a medical benefit. If we think of medical benefits to include any medical exam to assess the need for more treatment then it is a medical benefit. If we ask was it a medical matter I think it was. If we ask if its a benefit then again it is one created by statute. So then putting the two words together and using their plain meaning you do have to question the decision. However for now the Jones case tells us a DIME is not a medical benefit.
Saturday, August 01, 2009
The Division has issued what it calls an emergency rule, effective for claims after August 5, 2009. The new provisions are Rule 8-8 to 8-13 and address when an insurer or employer sends the claimant to its own Independent Medical Examination. Most of us in this field know that when the insurer does this it is seldom an independent objective examination. Insurers tend to pick doctors who favor the insurance side of things. What the rule does is provide details on how this examination must be recorded, how to get a copy and what remedy you have if the recording has confidential information the claimant feels is not to be revealed. All this is because of a new statutory provision just passed by the Colorado legislature. Apparently enough questions have surfaced about insurance oriented doctors asserting what happened during their examination which some feel is untrue. The new law and rule are designed to audio record the examination. Read the new Emergency Rule 8 here. This new rule is a bit complicated so you do need to read it carefully. Clearly after the examination a claimant can receive the first copy even before the insurer. Whoever first requests it must pay for it ($20) but if the insurer wants it they must pay $20 for the first copy for the claimant.