The Coats case or when is medical pot legal and illegal

Yesterday the Colorado Supreme Court ruled in the Coats case. In that case a disabled employee for the Dish Network was terminated under its no tolerance drug policy. The worker was productive but required medically prescribed marijuana.

He used it in off duty time but of course the mere presence of it in his system was enough that the company felt compelled to terminate him. Now in Colorado medical marijuana is legally allowed by state law so the employee sued because of this termination. He lost because it was determined that medical marijuana is illegal under federal law and its not enough to be legal under state law. Eventually the case reached the Colorado Supreme Court and they also affirmed the dismissal of the lawsuit. Essentially they also ruled that because medical marijuana is illegal under federal law the termination of the employee was proper despite it being legal in Colorado. Now we all know that the federal law is not being enforced in Colorado so does this play any role? Could you assert that the federal law application has been waived or even that the Colorado law has been in effect approved as proper by the feds? It appears in Colorado the answer is that medical pot is legal and illegal and that is the way it is. In terms of workers compensation the potential benefit of medical marijuana is going to complicate matters if it is prescribed to an employee who works for a company that terminates for such use. In Colorado it is now legal and illegal to take any amount of marijuana. That is a tough place to be if it stays this way. For now Coats is the law.

Another Newsletter

Recently the Division of Workers Compensation posted another newsletter. This is for February 2015. As I have said before these newsletters can contain a lot of interesting

material especially for attorneys and adjusters. They can also be useful for the injured worker. The February 2015 newsletter is devoted to medical matters. For example it notes to us that effective April 1, 2015 the injured worker is provided a list of 4 physicians to make a choice for his treatment. There are variations if there are less medical providers within 30 miles of the employers location. Still this is an improvement from years ago when the employer just selected the physician to treat you. That led to criticism of employer favoritism. The new selection process at least affords more choices for the injured worker. Anyone injured at work should carefully review the physician list maintained by the employer. Historically physicians selected by employers come from their insurers who have those they favor. I can assure you that there are physicians who are not dedicated to the injured worker and who try to speedily move along treatment, perhaps to the disadvantage of the claimant. And then there are physicians who are heavily claimant oriented. Attorneys practicing in this area know all about these physicians and those less friendly to claimants. Anyway the newsletter discusses this issue and other medical matters. Those wishing to stay on top of the field should take a look at this newsletter.

Labor pushing for WC Reforms

It is being reported there is interest by labor in some workers comp reforms. Articles on this appear here and there. Over the years my experience with reforms has been to see a reduction in benefits disguised as reform. This has led to lower workers compensation premiums for employers. I've always wondered why employers can select the treating doctors.

My experience is that these selected doctors are not always loyal to their patient the claimant. I've seen cozy relationships with many of them with the insurance. I've seen lack of interest in the welfare of the claimant. Of course there have been other doctors who have been on the claimants side too. But by and large I've wondered why the claimant cannot pick his own doctor. In any event this is one area of interest by labor which may mean an effort to give the claimant more choice. In another area it's been my experience that most injured workers with a serious injury do not stay with their employer. Perhaps they do with a minor injury but anything significant almost always led to some form of job termination. I can understand where this can happen aside from the obvious cases where the employer wants to get rid of the injured worker. Often the claimant is left with restrictions and disability which cannot be accommodated. Others are truly totally disabled. But in some cases the employee wants to work but can no longer do his existing job. Receiving a modest benefit is not enough. Again in this area there is labor interest in reform. Lastly there is interest in changing the penalty portion of the law which permits a 50 per cent reduction in benefits for safety rule violations. I've often wondered how they can say workers comp is no fault and then introduce fault into it as a way to reduce worker benefits. While I am on the side of the injured worker I can see the other side has some points too. Businesses want healthy workers and smart ones too. Injuries or rule violations are an expense they want to minimize. Hopefully there is room to compromise here. For the present the news is that there appears to be an effort in 2014, by labor, to help the injured worker by reforming parts of existing law.

Court of Appeals case on travel expenses

In a recent case the Colorado Court of Appeals decided in the Winter case to

address mileage and travel expenses. The claimant was from Trinidad but had to travel to Vail for authorized treatment. At first the claimant was advanced the cost of travel, hotel and meals. However after the third visit the insurer advanced only the travel mileage and not hotel or meals. The claimant advised the insurer he could not afford this unless it was advanced. The matter went to a hearing where the judge ruled against the claimant. This was appealed an eventually reached the Court of Appeals. The court affirmed the decision. Prepayment of hotel and meals is not a requirement even where this can lead to a harsh result. The court did note the claimant was able to use a credit card in this case and did get reimbursed within 30 days but suggested the Division of Workers Compensation may wish to address that issue. Usually claimants are treated locally but I have had cases where travel was necessary. Most claimants can use a credit card but some are quite poor. They may not have such a card or other resources so it would be helpful to have the Division address this for those cases as suggested by the court. Many times the benefits provided in a workers compensation case are barely enough to cover living expenses and asking the claimant to pay travel expenses and wait for reimbursement is expecting a lot. Anyway this case reviews all this and the court decision is the current law on the subject.

Firefighter Court of Appeals Case Zukowski

On July 3, 2013 the Colorado Court of Appeals issued a decision I call Zukowski. It is a case that concerns the statutory presumption that certain diseases arise from firefighting duties. The statute shifts the burden to Respondents to overcome the presumption or else the disease will be considered covered under workers compensation. The problem for firefighters is that they do not keep track of all their exposures to toxic chemicals or factors that can cause job related diseases. To improve that situation the statute was passed. However since then there have been efforts to defend against such a presumption. This blog has previously noted this (see the Littleton case entry in this blog for November 3, 2012). In the Zukowski case the firefighter had a melanoma which led to a claim. Respondents lost the hearing and the appeal to the next level but appealed further and the court reversed the prior rulings. In other words the firefighter lost the case barring further appeal. At the hearing the Respondents produced evidence through two physicians. Essentially they concluded that there were greater risk factors for the development of the melanoma from non work factors. The court ruled that the evidence was enough to overcome the statutory presumption and that the hearing judge interpreted the statute too heavily against the Respondents. It was error to require that the statutory presumption can only be overcome by proving the disease was caused by something else unrelated to the job. The court viewed such a standard as akin to saying strict liability applies against the Respondents. My concern is that the evidence was really indicating that non work factors were the greater risk factors then the job exposure to the development of the melanoma. I would say that this defense could well impair the statute's intent. Respondents can use this approach forcing the firefighter to again try to show his melanoma came from work and that could be difficult. My concern is that risk factors or the increased risk do not show what caused the disease and the statute sought to indicate it would presume the cause came from work activities and exposures. In any event the case is required reading in any firefighter case.

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.

ICAP Almanza case on DIME jurisdictional requirement

The Almanza case decided by ICAP several weeks ago reminds us about the awesome power of a jurisdictional situation. It is not freely available on the web but I was provided it in a recent update. It reminds us that anything that is jurisdictional must be carefully handled. In this case there was a DIME examination and report issued. Respondents were concerned about the examination and sought by motion to delay the requirement that they either admit based on the report or contest it with a hearing application. They requested an extension of time to admit or contest the DIME report until depositions were conducted. A prehearing ALJ (administrative law judge) agreed and issued an order of extension. Ultimately this led to a hearing where the claimant's impairment rating was reduced because the DIME report was not a proper DIME report and a new DIME had reduced it. The claimant appealed to ICAP. In this decision ICAP determined the original extension of time was error because it is a jurisdictional matter. The requirement to admit or contest the DIME report is 30 days and no extension granted by the judge was proper. It further ruled the original report was not improper. The DIME physician had a communication with the claimants interpreter which while improper did not invalidate the report as a matter of law. Here the claimants appeal was successful and the original DIME rating was ordered. So where a matter is jurisdictional it is almost etched in stone. Respondents must admit or contest a DIME report within 30 days as provided by law. No extensions are possible although Respondents in this case could have contested it and sought a delay of the hearing date which is not a jurisdictional matter.

Traumatic Brain Injury proposed guideline

On November 15, 2012 the Division of Workers Compensation will have a hearing to address its proposed treatment guideline for Traumatic Brain Injury. For more information on this check out this page. Treatment guidelines are the recommended protocols for all to consider in the treatment of those with a traumatic brain injury. Such an injury, even if seemingly mild, may have long term effects on a claimant to include their employability. Assuming the proposed guidelines go through then it may be important when we are dealing with such injury to refer to these guidelines from time to time. While deviations from the guidelines may be possible the guidelines provide a framework for assessing ongoing treatment. In returning a claimant to work the proposed guidelines note that those with a TBI should not just be released to light or sedentary duty without specific physical or cognitive limitations. Drawing the attention of the treating physician to the guidelines and even specific quotes from those guidelines might be an important thing to act on. In any event these proposed guidelines are coming up for hearing so those with a TBI case should monitor the situation.

Social Security Disability Update

There is a new rule on Fibromyalgia. SSR 12-2p pertains to evaluating the disease. The policy on this is to make sure there is solid medical evidence of fibromyalgia. Merely having a diagnosis of fibromyalgia is not enough. They will review the physicians notes to see if they document the condition over time. The point is that when seeking disability that there be decent medical evidence of the condition including strength and functional abilities. Read what it says so that the treating physician can be alerted when providing a report. Getting your ducks lined up is important in obtaining disability benefits. Often relying on a diagnosis alone is dangerous. You may know your situation but the details are important in any case. Many times I have seen doctors say you have problems but that is only part of the story. The big part is how it affects you and has it been established in the records. Moreover as part of this update it is important to know that they are tightening up on issuing favorable decisions. One attorney posted on his blog about this with links to other commentators. With approval rates down you can expect that attorneys will be careful on taking a case. In turn a claimant should check with other attorneys if your first choice declines to take your case. Many times I was surprised that an attorney had declined a case which I thought with good effort was winnable. It is all a matter of experience and personal style with an attorney so if you truly believe you are not employable keep trying to obtain an attorney to work with and follow his suggestions. You can help with your own case not so much by knowing the law as by following through on your attorneys suggestions. He will want to line up your claim and any way you can help will improve your chances. For example in many cases I have used questionnaires for a doctor to fill out. They help document your condition and your functional abilities. The claimant being a patient of the doctor may be asked to bring this to his doctor and ask for his help. If your doctor is really supportive then he will do it at low or no charge. You help your own case by following along with the plan of your attorney. At present if disability approvals are going down that is all the more reason to follow your attorney's plan.

Changes in Some Treatment Guidelines

The Colorado Division of Workers Compensation has issued revised treatment guidelines effective February 2012 for Chronic Pain and Complex Regional Pain Syndrome/Regional Sympathetic Dystrophy. The latter we used to call RSD and it along with Chronic Pain have seemed to evolve over the years. They are complicated matters and physicians have often disagreed with each other on diagnosis and treatment. Those utilized by insurers tend to be conservative and seldom side with the claimant and those utilized by claimants tend to be liberal and generally side with the claimant. The purpose of the guidelines is to set forth the recommended methodology and these matters are among the most difficult to deal with. The guidelines provide clues as to what to do when handling such matters. Since many claimants have chronic pain and RSD can be extremely disabling the guidelines afford us some idea of treatment. They are long but interesting to read. A claimant may want to be informed so he or she can discuss matters with the treating physicians. While the internet may have good information you can start your research by reading any guidelines posted on the Division website.

Crowell Court Case notes Ongoing Penalties

The Colorado Court of Appeals issued a ruling today in a case I call Crowell. In this case a claimant had a workers comp injury to a breast implant. Later it required replacement because of gradual distortion and discomfort. The ATP (authorized treating physician) recommended the surgery and sent a request to the insurer. The insurer denied the surgery in essence considering it elective and not medically required. The insurer did promptly deny within the time required by Rule 16-9 and 16-10 but never really sought out a medical review as indicated by Rule 16-10(B). This then triggered a hearing request by the claimant. At hearing the judge concluded the respondents were responsible for the surgery and also imposed a $500 penalty for violating the rule by simply denying the preauthorization request for surgery without seeking a medical review. The issue before the court is whether the penalty part of the original decision should be for a one day violation or whether it was an ongoing violation subject to an continuing penalty. The court decided that some violations are ongoing in nature and that was the situation in this case so it remanded the matter back to decide what should be an ongoing or continuing penalty. It clearly ruled the penalty should be imposed on a daily basis since the violation could have been cured by obtaining a medical review as required by the rule. Many times physicians seek preauthorization because a surgery is expensive and they want to know they will be paid. The rule does indicate a failure to properly act within the rule can mean the surgery is authorized but what doctor will act here with a denial staring him in the face? Here the insurer was questioning and contesting the surgery and never sought out a medical review despite knowing it was going to a hearing to address the issue. To me thinking it was just a one day violation because thereafter the surgery was authorized is not much of a solution and could encourage denials in many cases. As noted in the rule unreasonable delay or denial as determined by the Director or a judge may subject you to penalties as happened here so a claimant is not limited to assuming a surgery is authorized; he or she can also pursue continuing penalties in some cases. The real failure and delay here was leaving the claimant and the doctor hanging by just denying the surgery with a letter without some medical review to back up the denial even when it is thought the surgery was elective.

Walmart and Concentra to Pay $8,000,000 Settlement

In the Gianzero federal case Wal-Mart and Concentra were sued in a class action lawsuit alleging various violations including of the Colorado Workers Compensation Act, bad faith, RICO, and much more. The basics of the case was the assertion that Wal-Mart and its insurer conspired to dictate, withhold, delay, deny or interfere with the medical care of injured workers. The case made a big impression and received commentary elsewhere. The allegations involved setting forth protocols for treatment and referrals which violated the Workers Comp Act and which restricted or denied or dictated care. As alleged, Concentra then implemented "flowsheets" which were then imposed on its doctors which preempted the exercise of independent medical judgment. In my view the adjuster could control treatment which I see as the inherent conflict in most health insurance situations. He who has the money can be expected to try to set the rules! Naturally all of this was hotly contested but in the proposed settlement Wal-Mart, Concentra and their insurers have recently agreed to pay $8,000,000 to settle the case without formally admitting they were out of line. Class members would receive up to $520 each if they were treated at a Concentra facility between 2001 and November 1, 2011. The detailed proposal sets forth the proposed settlement and more is available at this website including the original complaint and the notice of the proposed settlement to potential class members. If you were injured working at Wal-Mart you may be eligible for a check should it all be approved. Added expenses are also sought by the attorneys for fees and costs. Moreover as part of the settlement they are to cease the disputed activity for 4 years and have educational training for adjusters and certain staff of Concentra regarding the prohibition on dictation of care provisions of the Workers Compensation Act. In my view this is a significant victory for doctors and claimants who deserve to have medical treatment handled as a medical matter and not unduly influenced by non-medical personnel who work for the employer or its insurer.

Colorado workers comp insurance rates to go up

The Denver Post is reporting that businesses can expect a rate increase on their workers compensation insurance coverage. This after a few years of declines. Why? The number of claims is not going up. The explanation appears to be in the continuous and unrelenting increase in medical costs. Here is the Colorado statement on all this. This rise in medical costs when the economy is not inflating remains ominous for all of us. The failure of society to address this is rather sad. We all talk about it but it takes a concerted effort and in our politically charged country we are less interested in problem solving and more in ideology. Wouldn't it be nice if they set up a task force to address such costs in a sensible way? I mean an across the board analytical review. If medications are a big factor find ways to lower that expense. If we need more nurses or practitioners find ways to increase the numbers with educational incentives. If caution leads to the running of multiple and usually unneeded tests find ways to prioritize those tests rather then run all of them at a time. If malpractice rates are too high find ways to make providers accountable without increasing those rates. I mean weed out the bad apples especially in workers compensation. Simplify the paperwork too! While I do like the medical treatment guidelines I saw recently what appears to be making it more complicated to obtain prior authorization. In workers compensation there are many disputes in what I see as primarily medical legal issues. When we go to a hearing and it seems to be a legal issue on compensability in reality many such cases involve medical causality. So some of these rising costs involve insurers hiring experts to question causality and treatment. As an example an attorney related to me that he had obtained a DIME opinion that the claimant is not at MMI. In the past this just led to more treatment and a reassessment. Overcoming a DIME historically has not been easy but the pattern is now to question everything. There are doctors out there that will nearly always assert an injury is not work related or that the DIME doctor made a mistake. A DIME would cost $675 but they spend $5000 or more fighting it. The point is not all the rising costs in workers compensation are based on purely medical matters. Some come from the insurer disputing matters. It also drags out the proceedings which I do not really see as helping the claimant needing treatment and it is costly. In any event businesses can expect higher workers comp premiums next year.

Court Allows TTD After MMI in Loofbourrow Case

In Loofbourrow the Colorado Court of Appeals dealt with a case where the claimant had been placed at MMI (maximum medical improvement)by the authorized medical physician at the time. He returned to work and then worsened. At that point he requested medical treatment and the situation deteriorated as the Respondents denied the claim and did not provide treatment. Even the AWW (average weekly wage) was disputed. At the hearing the judge ruled in favor of the claimant on the issues. He was granted TTD (temporary total disability) benefits even though he had been previously placed at MMI and never contested that. The claim was determined to be compensable and claimant had the right to pick his doctor given the lack of medical treatment. He even won on the AWW issue which seemed to involve reduced hours after the original injury but the judge provided a higher figure. The other side appealed and ICAP (Industrial Claim Appeals Panel) overturned the award of TTD which led to the court decision just issued this week. The court affirmed the judge and reversed ICAP. The Respondents asserted that after being placed at MMI which was never disputed the claimant could not receive TTD. That legal position is a correct one when a claimant has been receiving TTD and reaches MMI. However in this case the court reasoned that after MMI he worsened so the claim remained open to further review. He did not need to seek to reopen and his right to challenge the earlier MMI could not happen until after a FAL (Final Admission of Liability) was filed which had yet to happen. Can you imagine the position this claimant was in? He is hurt at work but seemingly quickly recovers. But his hours are reduced and when he worsens the Respondents decide to fight everything. It is appealed and then appealed again to the court. How long did this person go without benefits as the administrative process went through all the appeals? It appears the last work was in August 2009 so while the court ruled in the claimants favor it took quite a while to obtain benefits and that is assuming there will not be a further appeal. UPDATE: The Colorado Supreme Court affirmed this decision on January 27, 2014.

New Court Case on Medical Benefits

The Colorado Court of Appeals issued a decision yesterday that concerns ongoing medical benefits. In the Hire Quest case we have a rather technical argument that is addressed by the court. It seems an example of how technical arguments get in workers compensation proceedings. In this case the parties went forward at a first hearing which addressed a safety rule violation, credits for paid temporary benefits and the permanent impairment based on a DIME (Division Independent Medical Examination). Before the hearing the issue of permanency became uncontested because the employer/insurer withdrew the opposition to the DIME doctors impairment rating. So the first hearing addressed permanency, temporary and safety rule violation issues but that judge said issues not expressly decided are reserved for future determination. Well claimant later went forward on the issue of ongoing medical treatment needed and the other side said he could not because he never raised the issue at the first hearing and it was waived. They also asserted that the judge reserving issues was not specific enough so that prior hearing closed out the matter. The court decided that the reservation was good enough to preserve the right to address medical benefits after the first hearing so they found in favor of the claimant. Common sense would tell you that medical benefits could be addressed later but the insurer tried to use a prior court decision to say the claimant was required to add the medical issues at the first hearing or else it was waived. This waiver argument is essentially saying address all issues at once or the insurer saves money by alleging too bad so sad you lose (waive) your potential right to further treatment. Even if the judge reserves matters it is not good enough unless it is a specific reservation of a medical issue according to the insurer's view of an early case they were citing. The court disagreed with that interpretation. My view is that workers comp should handle all treatment that is needed for a work injury and not made into a game of technicalities which passes the buck on treatment to others such as the taxpayers. In this case we did have the DIME doctor saying more treatment was needed and I am not sure why it was not made an issue but it could be that there was no dispute made by the insurer until later. To me you have to wonder if the insurer waived objecting to further treatment but anyway the claimant prevailed.

Division IME Forms Including a new one WC78

You can access numerous forms pertaining to DIME's or Division IME's at this webpage maintained by the Division. It includes a new form which pertains to requesting a DIME to assess maximum medical improvement (MMI) after 18 months. Usually your treating physician determines MMI as soon as possible but there are times when he has not addressed it despite the passage of much time and treatment. The insurer may then seek to arrange a DIME to determine MMI. This new form WC78 is part of that process. Be aware that this 18 month DIME is addressing MMI. If impairment is also addressed it does not mean that is anything more then informational. In a recent Industrial Claims Appeal case I call Baca the insurer went with an 18 month DIME and then went with that DIME's impairment rating which was zero. They filed a Final Admission trying to close the case. The local judge ruled against them and struck the Final Admission. directing that the claimant return to the treating physician for the rating. The higher panel in effect stopped the appeal because that ruling did not deal with money or benefits but the case makes us all aware that an 18 month DIME may not address impairment in a way that can be acted upon by the insurer. Of course the Baca case may not be over but the form WC78 issued shortly thereafter indicates any rating by a 18 month DIME is informational only.

Rule 16 and 18 Proposed Changes

The Division lets us know about proposed rule changes and this change concerns Rules 16 and 18. These are medical matters which are changed just about every year because medical costs keep rising. Rule 18 involves medical billing and Rule 16 utilization review. The proposed rules are posted and then adopted after comments are received and reviewed. Most of this is not very exciting information except for doctors and other providers although at times a claimant or claimant's attorney does have to look at the rules. What a doctor can charge for legal things like testimony, consultations, reports and the like are important to know. Such matters are often the responsibility of the claimant if he or she asks for any of them. So wanting to have the doctor come to the hearing is fine but it is also at a cost to the claimant. So while these rules seem complicated to read and perhaps not that important to claimants most of the time there are situations where a claimant needs to check on what the rule says. For example, in the past there has been litigation on the subject of what is called prior authorization. This area involves a provider getting advance approval for something and when approval is not forthcoming the doctor and perhaps the claimants attorney may wish to dispute it and even seek penalties. What is addressed in Rule 16 on the subject becomes quite important in such a situation.

Medicare Quickly Covers End Stage Renal Disease

There need be no prolonged wait to obtain medicare if you have ESRD (end stage renal disease). Often those who obtain Social Security disability have to wait for medicare but in this situation no matter who you are or even if you have not obtained any disability benefits you can quickly get medicare coverage. This article which appears in this link addresses this matter along with other points. Sadly obtaining disability can be a prolonged process but it is good to know that in this area you can quickly get on medicare regardless of your age or circumstance. I still believe that leaving medical care in the hands of private insurance is not the best approach for those with serious injury or illness. We can believe in free enterprise but also realize that society has to step in when it affects all of us. We see this with fire protection and police and the military and education. Also we should see that in the human area of healthcare. Its high cost and immense impact on all of us should be a social or societal concern. In any event medicare can step in for you if you have ESRD without much waiting around.

SB 11-199

While this senate bill 11-199 is awaiting the governor's signature I expect it to become law. There are 4 provisions in the bill worth noting. First, it requires that the insurer pay costs in advance, if requested by the claimant, for an insurer IME or vocational evaluation. This means the cost for the claimant to travel, food and even a hotel must be paid or the claimant can refuse to attend. If they pay and claimant does not attend they can get an offset from future compensation due the claimant. Next, a Final Admission must admit for future recommended treatment by the authorized doctor unless there is a record of a contrary medical opinion. This prevents the insurer from disregarding physician maintenance treatment once the claimant reaches MMI. At times insurers never admit for further treatment even though its need is undisputed. A claimant may think or even be told by the doctor he can get further treatment only to be denied by the insurer and the bill seeks to avoid such a practice. Third,procedurally it corrects a discovery matter by not requiring those represented by an attorney to first ask permission before starting discovery. That extra step (documenting you asked permission) seemed just a waste of time and paper. Last, the bill makes it clear that any lump sum request regardless of the date of injury is not a waiver of the right to seek permanent total benefits. For those readers not familiar with the last issue the history of it is a claimant would receive an admission for permanent partial benefits of a certain amount, let us say $30000.00, and yet feel he was much more disabled so he'd seek permanent total disability benefits. Since by law the admission had to be paid out every other week the claimant sought it in a lump sum. That was deemed a waiver of his claim for permanent total benefits. The poor claimant was stopped in his tracks by accepting the lump sum perhaps just to pay bills and other expenses. You had to be careful to avoid this but the law has been changed. A total disability claim is no longer waived by accepting a lump sum.

Munoz Court Case on DIME waiver

The Court of Appeals decided yesterday to reverse ICAP and the hearing judge on an issue concerning seeking a DIME. The claimant requested a DIME to review the treating doctors opinion. A DIME is a Division Independent Medical Examination which involves a process to select a doctor to conduct the examination on various medical matters such as MMI and impairment. In Munoz the claimant sought a DIME and requested a specific type of doctor. However that was not provided so he applied for a hearing to address the selection. In the meantime he did not schedule the appointment with the physician in question then set to do the DIME. Instead he filed a second application seeking penalties against the state agency for not staying the matter pending resolution of his hearing issue A hearing judge and ICAP decided he had not stayed the process by filing an application for hearing so he lost by waiver his right to seek the DIME. The claimant argued the application for hearing was sufficient to stay the DIME process. The judge and ICAP decided any stay had to be by law a motion and an application did not do it. They concluded he waived his right by not filing the motion. The appellate court reversed ICAP and determined an application for hearing was good enough to preserve the claimants right to have his DIME concerns addressed before proceeding. This appeal was more complicated then what I have indicated as it was argued the claimant did not even preserve his right to appeal and also the claimant wanted to penalize the state Division of Workers Compensation for not staying the process when he sought a hearing. Usually appeals are not simplistic but the key part of the decision involved a claimants right to stay a DIME process to address his concerns on the selection process. You can read the case here.