DIME Presentation Rev 11/28/2018

Starting the DIME Process

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● The requesting party files the Notice and Proposal and Application for the DIME.○ Within 30 days of the Final Admission the claimant must file the Notice and Proposal and

Application for the DIME.○ Within 30 days of receiving an MMI report from an ATP the carrier must file the Notice and

Proposal and Application.

● Within 15 days of filing the Notice and Proposal and Application for a DIME a claimant seekingto claim indigence must file an Application for Indigent Determination at the OAC.○ Copies must be provided to the other parties and the DIME unit.○ The DIME process will not be held in abeyance while the indigent application is pending, unless

ordered by an ALJ.○ Any other party to the claim may file a response, stating the specific grounds for the objection,

at the OAC within 8 days of the mailing of the Application for Indigent Determination form.○ The determination of indigence will be based on the claimant’s financial status on the date the

application is filed and any extraordinary circumstances.○ If the claimant receives permanent indemnity benefits by a final order or approved settlement

the paying party will receive a fee reimbursement.○ Within 14 days of an indigent order or final DIME Physician Confirmation (whichever is later)

the paying party must pay the fee to the DIME physician.

DIME Physician Selection

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● Within 30 days from the filing of the Notice and Proposal and Application the requesting party and respondents must negotiate the selection of a physician.○ If the parties cannot agree on a physician the carrier must file the Notice of DIME

Negotiation form.○ If the parties have agreed on the DIME physician and the fees either party may file

the Notice of DIME Negotiation form.○ There will be no additional fees for medical reviews, medical deposition reviews, or

return visits for range of motion testing.

● Within 5 days of receiving the Notice of DIME Negotiation form the Division will confirm the agreed upon physician and fee or send a panel of three physicians to the parties in writing.

● Within 5 business days of the issuance of the three physician list either party may request a summary disclosure of any physicians on the panel.

Striking & Scheduling

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● Within 5 business days from the issuance of the three physician panel the requestingparty may strike one name and notify the opposing party and the DIME Unit.○ This happens if neither party requests summary disclosure information.

● Within 5 business days from the notice of the requesting party’s strike the opposingparty may strike another physician and notify the requesting party and the DIMEUnit.

● Within 14 days of receiving the DIME Physician Confirmation the requesting partymust pay the DIME physician and then, only after the physician receives the fee,schedule the DIME with the selected physician.○ This exam must be scheduled no earlier than 45 days or later than 75 days after the

requesting party receives the notice of the DIME Physician Confirmation.

○ Failure to make the appointment and advise all parties in writing within 14 days may resultin a Director’s order to show cause why the DIME process should not be terminated.

○ An order by an ALJ is required to hold the proceedings in abeyance once an appointmenthas been scheduled.

DIME Examination Fees

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Over two years but less than 5 years and/or three

or four body regions

$1,000 $2,000$1,400

Over 5 years and/or five or more body regions

Two years or less and/or less than three body

regions

Based on date of injury to the filing of the DIME application

Medical Records & Interpreters

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● Within 14 days of the Division confirming the selected DIME physician the carrier must submit onecomplete copy of medical records to the claimant.

● Within 10 days of receiving the initial carrier records packet the claimant must serve the carrier withany additional relevant medical records.

● At least 14 days prior to the examination the carrier must provide a singular final packet to the DIMEphysician.

● The parties may agree to limit the issues to be addressed in the DIME.○ The parties must include and sign the Notice of Agreement to Limit the Scope of the DIME form in the medical

records packet served on the DIME physician immediately following the chronological index.○ The DIME Unit must be provided a copy of the agreement.

● At least 14 days prior to the examination a claimant seeking an interpreter must notify the carrier ofthis need.○ The carrier is responsible for arranging and paying for the services of the interpreter.

● No later than 7 days prior to the DIME examination supplemental records must be served by anyparty concurrently to the DIME physician and all other parties.○ Any submission of supplemental records requires an ALJ finding of good cause.

● Within 20 days of the examination the DIME physician must submit the original report with allattachments to the DIME Unit and all parties.

The Content & Exclusions of Medical Records

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Exclude from Medical Records

● Surveillance recordings● Depositions● Vocational rehabilitation reports● Non-treating case manager records● Prior orders and other records● Duplicate records

These inclusions and exclusions can only be overcome by agreement of all parties OR

an order of an ALJ.

Include in Medical Records

● Records regarding○ Diagnosis, treatment, and evaluation of the claimant’s

work related injury(ies)○ Any relevant pre-existing condition(s), injury(ies), or

disease(s), if applicable and available.● Dated cover sheet listing

○ The claimant’s name○ WC#○ Time and date of appointment

● Chronological index of the records○ List the date and the provider corresponding to each

record.○ Tabbed by year, beginning with the earliest record

Communications During the DIME Process

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Permitted Communications by the DIME Physician

With all parties With the carrier or carrier counsel

With the paying party or paying party counsel

With the requesting party

Communications regarding administrative matters.The parties negotiating selection of the DIME physician and agreed upon fees. Communications in furtherance these negotiations must involve all parties to the claim.

The format of the medical records

Issues regarding the invoice Scheduling, rescheduling, or termination of the appointment with notice to the opposing party.

Rule 11 states that the parties must provide the DIME Unit with copies of any permitted correspondence with the DIME physician.

Rescheduling & Termination● A DIME can only be rescheduled once.

○ More than once requires a good cause finding by an ALJ.

● The DIME examination may only be rescheduled or terminated by the requesting party or by order.

● The parties and the DIME physician may use the Notice of Reschedule or Termination form to notify the DIME Unit of any rescheduling, termination, or failure to attend the examination.

● If a party reschedules, they must pay any applicable fee to the DIME physician within 10 days of initiating the rescheduling.

● The physician must receive the reschedule fee before the requesting party may reschedule the appointment.

● The rescheduling and termination fees apply to the agreed-upon DIMEs under section 11-4(A)(2)(a)(i). ○ The fees will be determined based on the section 11-5(A)(1)-(3) category that would have

applied. 9

Rescheduling Penalties

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RESCHEDULEDIME is rescheduled more

than 10 days before the scheduled date

DIME is rescheduled 10 days or less days before the

scheduled date

DIME is rescheduled 1 business days or less prior

to the scheduled date

$1,000 DIME No fee $500 $1,000

$1,400 DIME No fee $700 $1,400

$2,000 DIME No fee $1,000 $2,000

● The parties and the DIME physician may use the Notice of Reschedule or Termination form to notify the DIME Unit of any rescheduling, termination, or failure to attend the DIME.

● The party responsible for the rescheduling must submit the rescheduling fee, if applicable, to the DIME physician within 10 days of the defaulting event.

● The requesting party may only reschedule the appointment after the physician receives this fee.

Termination Penalties

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TERMINATIONDIME is terminated more than 10 days before the

scheduled date

DIME is terminated 10 days or less days before the scheduled

date

DIME is terminated 1 business days or less prior to

the scheduled date

$1,000 DIME $250 $500 $1,000

$1,400 DIME $350 $700 $1,400

$2,000 DIME $500 $1,000 $2,000

● The party responsible for the rescheduling or terminating must submit the termination fee, if applicable, to theDIME physician within ten (10) days of the defaulting event.

● The DIME physician shall refund the DIME fee minus the termination fee to the paying party within ten (10)days of receiving the Notice of Reschedule or Termination form.

DIME Follow-Up● What triggers a Follow-up Dime?

○ If a DIME physician determines that a claimant has not reached MMI and recommendsadditional treatment.

● Who performs the Follow-up DIME?○ The original DIME physician, unless the physician is unavailable, declines, or the parties agree to

a new DIME physician.

● Who files?○ The carrier must file the Follow-up DIME form after the claimant completes all additional

recommended treatment.

● How much is the fee?○ If the parties have agreed on a new DIME physician, the parties must agree on a follow up fee.

■ DIME Follow-up, rescheduling, and termination fees can be found in Rule 11-7(D).■ The carrier is responsible for paying the follow-up examination fees, absent an agreement

by the parties and the DIME physician or an order by an ALJ.

● Who has notice responsibility?○ The carrier must notify all parties involved in writing of the date and time of the follow-up DIME. 12

DIME Follow-Up Fees

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Follow-Up DIME With the Original Physician

3 months or less after the last evaluation

Over 3 months but 6 months or less after the

last evaluation

Over 6 months but 12 months or less after the

last evaluation

Over 12 months after the last evaluation

$350 $700 $1,000 $1,400

● Absent an agreement of the parties and the DIME physician, or an order from an ALJ, the carrier shall pay any additional examination fees.

● The physician must receive the follow-up examination fee prior to scheduling the examination.

Follow-Up DIME With a New DIME Physician

Less than 5 years from the date of injury to the request for the follow-up evaluation

5 years or more from the date of injury to the request for the follow-up evaluation.

$1,400 $2,000

Rescheduling of the Follow-Up DIME Fees

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DIME is rescheduled more than ten (10) days before scheduled date

DIME is rescheduled ten (10) days or less before

the scheduled date

DIME is rescheduled one (1) business day or less before scheduled date

$350 Follow-up DIME No fee $350 $350

$700 Follow-up DIME No fee $700 $700

$1,000 Follow-up DIME No fee $700 $1,000

$1,400 Follow-up DIME No fee $700 $1,400

$2,000 Follow-up DIME No fee $1,000 $2,000

● If the follow-up DIME is rescheduled the party responsible for the rescheduling must submit the required fee, if applicable, to the DIME physician within ten (10) days of the defaulting event.

● The requesting party may only reschedule after the physician receives this fee. ● Rescheduling of the DIME more than once requires a finding of good cause by an ALJ.

Termination of the Follow-Up DIME Fees

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DIME is terminated more than ten (10) days before

the scheduled date

DIME is terminated ten (10) days or less before

the scheduled date

DIME is terminated one (1) business day or less prior to the scheduled

date

$350 Follow-up DIME $350 $350 $350

$700 Follow-up DIME $350 $700 $700

$1,000 Follow-up DIME $350 $700 $1,000

$1,400 Follow-up DIME $350 $700 $1,400

$2,000 Follow-up DIME $350 $1,000 $2,000

● The DIME physician must refund the follow-up examination fee minus the termination fee to the paying party within ten (10) days of receiving the Notice of Reschedule or Termination form.

Subsequent DIMEs

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● If a claim is reopened it is considered a subsequent DIME.○ This subsequent DIME will be treated as a new DIME and subject

to all DIME procedures.

○ By filing the application form in a claim where a DIME has been

completed previously, the requesting party certifies the claim has

been reopened.

● The party requesting the subsequent DIME will be considered the requesting party regardless of whether that party requested the original DIME.

Parting Notes

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● Any Notice and Proposal and Application with a Certificate of Mailing dated on or after January 1, 2019 is subject to the updated Rule 11.

● Payment requirements are included in Rule 11-5 and 11-7.

● The party requesting a DIME physician as a witness at any proceeding for any reason is responsible for paying the physician. (Rule 18)

● The 20 day deadline for the carrier to file an admission of liability or request a hearing tolls from the issuance of the DIME Unit’s notice that the unit received a sufficient report.

○ The report must conform to the DIME Report Template

The DIME Unit’s main number is 303-318-8655

Please utilize our Email address as the primary method of communication: imeunit@state.co.us

18DIME Presentation Rev 11/28/2018