Thursday, May 16, 2013

The Meza case on 18 month DIME opinions

On May 9, 2013 the Colorado Court of Appeals issued the Meza case. The case has been in the system for years. Originally the claimant hurt his right foot in an admitted on the job injury. He was treated an eventually released back to work without restrictions or impairment. Four years later after ongoing pain the claim was reopened and he received additional treatment. Because the claimant was still being treated by the authorized physician and 18 months had gone by the employer sought a DIME (division sponsored independent medical examination). This is permitted by statute. This 18 month DIME found the claimant to be at MMI (maximum medical improvement) and rated his permanent impairment at 20 per cent (part for the spine and part for CRPS a nerve disease). All related to the original injury. Respondents filed a Final Admission and the claimant argued the 18 month DIME only can address MMI so he needed to be returned to his authorized physician for a rating. A judge agreed and his authorized doctor rated him at 27 per cent impaired. Respondents then sought a regular DIME which resulted in a rating of 4 per cent. The second DIME removed from the rating that portion for the CRPS and spine because it was unrelated to the work injury. Read the case for more details on the history. In any event the claimant at a hearing sought to overcome the second DIME and also assert that the 18 month DIME opinion was binding on the second DIME in addressing that the spine and CRPS was causally related to the work injury. The claimant lost and eventually the case got to the Court of Appeals. There the claimant lost again. This case really discusses an 18 month DIME and what effect it has on a later DIME. The court determined the 18 month DIME only can address MMI. Even causality can be addressed in a rating by a regular DIME. It is clear the court limited an 18 month DIME to a narrow issue so a later DIME is not bound by the rating or causal opinion of an 18 month DIME. I had thought that causality is part of every DIME opinion but it appears the court made a distinction between an 18 month DIME and a regular DIME. UPDATE: See my blog post for June 10, 2013 where statutory changes were made altering future use of this case as precedent.

Thursday, May 02, 2013

Maximum Benefit Rates effective July 2013

The Division has provided everyone with its new maximum rate figures for Colorado workers compensation benefits. Each year it revises the maximum rates and effective July 1,2013 it has new rates. These apply to injuries after that date. It is important to realize that maximum rates are set because rates are not unlimited. With a work injury not everyone receives a fair amount. Workers compensation benefits are limited or capped. Often an injured worker would tell me he's not getting enough compensation when by computation he was getting the correct amount. But the correct amount does not mean your compensation rate is going to be high. It is an insurance benefit and is designed to provide what the state has determined it must provide. The basic concept is to receive two-thirds of your average weekly wage when you are unable to work after your work injury. Thinking it is going to be high or even equivalent to your take home pay is unlikely. Historically benefits have not been taxable so at least that is a plus. And medical benefits are not limited although there can always be a dispute on what is reasonable in treatment. If your doctor prescribes a trip to the Bahamas for your psychological well being it is going to be disputed. But be aware that disputes involving your average weekly wage are common. Claimants often believe the figure provided by the insurer is wrong. Overtime and even health benefits may be part of the figure. When possible do seek out an attorney to represent you as soon as you can. Even a case where the claim is admitted can have much to deal with including what is the correct average weekly wage.