All About Claims Newsletter June 2013

The Division has just issued a new newsletter. It reviews the latest legislation on Colorado workers compensation law. The changes in the DIME

(Division Independent Medical Examination) process is also set forth. DIMEs are heavily used in cases. Every attorney and anyone interested should know the process and requirements. So this newsletter is educational in providing some insight. The newsletter even provides a flow chart of the process on its last page. In my experience DIMEs are extremely important in many cases. I have found that the treating physician seldom provides a fair assessment. Some do but most do not. They may place the claimant at MMI (maximum medical improvement) and they then rate or assess permanency at a low level. They may even exclude from the assessment conditions they believe are not from the work injury. When properly selected a DIME can often correct this. They may say that MMI has not be reached so more treatment is needed and they may rate or assess a higher level of permanent injury. Taking issue with the treating doctors conclusions which are then often deemed correct by the insurance is perhaps the most important part of many cases. Frequently a claimant may need additional treatment and usually the extent of permanent injury is greater then what is stated by the treating doctor. A DIME is often the great equalizer and in my experience has often resulted in substantially more benefits for claimants. There can be circumstances where a DIME is needed by the other side too. In every single case an effort should be made to obtain a fair assessment. So a DIME and the DIME process should be important concerns in most cases. An attorney experienced in this area will usually know what to do and how to go about selecting a DIME doctor. It is not a simple process and where possible every claimant should be represented.

Colorado Legislative Update 2013

Colorado posted an update for recent workers comp legislation at the Division website. With respect to the specific statutory legislation that was also posted by the Division. You are encouraged to read the updates. I shall not discuss all of them but one is significant regarding a DIME (Division Independent Medical Examination). It used to be the insurer had 30 days from the mailing of the DIME report to accept it and admit based on it or to apply for a hearing. The time frame is reduced to 20 days but it is from when the Division issues a Notice of Receipt of the report. Another new provision provides that the insurer must pay for reasonable and necessary medical expenses when the claim is later found compensable. I'd say that means they will pay if they contest the claim but it goes against them. Perhaps that will help when you seek treatment on a contested case if you later have it determined to be compensable. Previously if you sought treatment even if you won at hearing they'd say they did not owe for any treatment up to then because it was unauthorized. Also another new law requires they recalculate your benefits within 15 days from the date a fringe benefit like health coverage is terminated by notice. Another key provision concerns what we used to call an 18 month DIME. That now is 24 months and if MMI is determined that doctor can rate the impairment like a regular DIME. There is more but these are significant enough to draw to your attention. UPDATE: The Division issued an alert for adjusters on the new requirements which affect all DIMEs. Check it out here.