Thursday, August 06, 2009
Court of Appeals decides a DIME is not a medical benefit
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.