How to Challenge Your Workers’ Comp Impairment Rating
Posted in Legal Claims on September 25, 2020
Division Independent Medical Exam
The Division Independent Medical Examination (“DIME”) process is used in Colorado by a claimant (an injured worker) or respondents (Employer and Insurance Company) to challenge an impairment rating or placement at maximum medical improvement (“MMI”). There are two types of DIMEs in Colorado. The first, and most common, is a DIME that is requested after the injured worker’s authorized treating provider (“ATP”) places the injured worker at MMI. The second type of DIME is a 24-month DIME that is used by respondents when two years have passed since the injury and an ATP has not placed an injured worker at MMI. You may want to challenge your impairment rating because you believe it was not fair (too low), or your MMI date because it is too soon and you need additional treatment or surgery. To do so you must request a DIME. If you are entering the DIME process, you should consult and obtain an attorney. You do not want to go down this route alone.
Selection of DIME Doctors
The basic process for each DIME type is the same. The process begins by a party filing a Notice and proposing three doctors to perform the DIME. The other party then has 30 days to accept one of these three doctors or to reject these doctors and propose three candidates to perform the DIME. The party who filed the Notice and Proposal could then agree to one of the other party’s three doctors or give notice there is not an agreement on a physician to perform the DIME. The respondents would then file a Notice of Failed IME Negotiations with the Division of Workers’ Compensation. The Division of Workers’ Compensation would issue a panel of three doctors to perform the DIME. The party requesting the DIME has 5 business days to strike one doctor from the panel. The other party has 5 business days from the requesting party’s strike to eliminate one of the two remaining doctors. The doctor that remains will perform the DIME.
Cost of DIME
The cost of a DIME varies based on how many body parts were involved in the work injury and how long it has been since the date of injury. The costs vary from $1000-$2000 and will be paid by the party requesting the DIME prior to being permitted to schedule the appointment with a DIME physician. If the parties initially agree on the DIME, a different cost for the DIME can be negotiated with the DIME doctor. A party can also cancel a DIME once it is set but will have to pay a $250.00 cancellation fee (or more if it is close in time to the DIME appointment).
DIME Opinions Binding Unless Challenged
The DIME doctor’s opinions on MMI and Impairment rating are binding on the parties, unless a hearing is requested. To overcome those opinions, the party challenging the opinion must overcome the opinion by a clear and convincing standard at hearing before an Administrative Law Judge. To challenge a DIME you should get an attorney. Doing so on your own without being familiar with the process would be quite difficult. Likewise, if the employer’s lawyer has challenged a DIME opinion, favorable to you, it would be wise to contact an attorney.
If you find yourself subject to a DIME process by the respondents, you should immediately consult with an attorney. The selection of the correct doctor when a DIME is requested is vital to your success. Like all of us, doctors have biases based on their life experiences and values. Many potential DIME doctors do routine work for the insurance companies as expert witnesses and therefore challenge the claims of injured workers or serve as advisors to insurance companies and provide reasons to deny medical benefits. These doctors tend to see the world through the eyes of the insurance company and are less likely to give an injured worker the benefit of the doubt. Some may even look for a way to limit the insurance companies’ exposure by denying that the injury was work-related, stating certain body parts were not involved, provide lower ratings, or even place you at MMI before your treating physician believe is appropriate. These biased experts can take away your right for future medical treatment, your entitlement to wage loss benefits, and future permanent disability benefits. Other doctors on the DIME panel are known to be fairer to the injured worker. They are not worried about the insurance companies’ interests, but want to make sure your case is evaluated properly as to MMI or the level of your impairment.
DIME Can Be Very Valuable
If you choose the wrong doctor during the MMI process, you could cost yourself tens of thousands of dollars and future medical treatment. Killian Davis Richter & Mayle is willing to help you through this process by helping you select the best doctor for your case, provide you with all the information necessary to fully evaluate if the DIME process is the right option or suggest a better resolution to your claim. Feel free to contact Killian Davis Richter & Mayle to discuss the DIME process or any other questions about your workers’ compensation claim.