Self-insurance - Wikipedia, The Free Encyclopedia
Self-insurance is a risk management method in which a calculated amount of money is set aside to compensate for the potential future loss.Division IMEs -- Denver Colorado Workers Comp Lawyers Eley Law Firm
http://www.eleylawfirm.com 866-458-6360 Attorney Cliff Eley of Eley Law Firm in Denver Colorado explains what Division Independent Medical Examinations or Division IMEs are in workers' compensation cases.
[GRAPHIC: The Eley Law Firm, Helping Injured Workers, 1873 S. Bellaire St., No. 1200, Denver, CO, 80222, 303-785-2828, www.eleylawfirm.com]
Hello. I'm Cliff Eley. I'm a workers' compensation attorney in Colorado. My practice is limited to representing injured workers, and I've been doing that for 27 years. Today I'm talking about what are called Division Independent Medical Examinations, or Division IMEs. These are different than a regular independent medical exam or IME. An IME is where the injured worker is examined by a non-treating doctor, usually at the request of the insurance carrier. Those exams usually have no binding effect. An IME might be used to influence the judge or treating physician.
A Division IME is different than that, and usually has much more legal effect on your case. It's called the Division IME because it's done through the Division of Workers' Compensation pursuant to the Workers' Compensation statute. It is most frequently used after the treating physician puts the injured worker at Maximum Medical Improvement and gives them a rating. If either side contests the date of Maximum Medical Improvement or the rating, they can ask for a Division IME.
The cost of the exam is usually $675.00, and it is usually paid by the requesting party, but if the injured worker can't afford the exam, there is a procedure for getting the insurance company to pay for it. Frequently, an injured worker is put at Maximum Medical Improvement, but he still has symptoms and restrictions and believes there's more that can be done. Usually, the only option in that case is to ask for a Division IME.
This is how it works. When an injured worker is placed at MMI, the insurance company usually has to file a Final Admission of Liability. It will state the date of MMI and the rating that the treating doctor gave the injured worker. It will also state how much permanent disability the insurance company will pay for the permanent impairment rating.
From the date the Final Admission is filed, the injured worker has 30 days to file an objection to the Final Admission and to file a Notice and Proposal.
[GRAPHIC: Notice and Proposal form]
The Notice and Proposal is notice to the insurance company that you want a Division IME. On the Notice and Proposal, and you need to list two or three doctors that you will agree to for the Division IME.
If the parties can't agree on a doctor, then the insurance carrier files a document called the Notice of Failed Independent Medical Examination Negotiation.
[GRAPHIC: Notice of Failed Independent Medical Examination Negotiation form]
This tells the Division of Workers' Comp that the parties can't agree on a doctor, and when that is received, the Division of Workers' Compensation sends out a list of three doctors which they pick randomly from their list of potential Division IME doctors. None of these doctors can have treated the worker before.
Each side crosses off one doctor, and the injured worker goes to the doctor that remains. The requesting party then files the Application for Division Independent Medical Examination, which lists the issues and the parts of the body that require a rating.
[GRAPHIC: Application for Division Independent Medical Examination form]
The insurance company then sends all of the medical records to the Division IME doctor, and the doctor does the exam and issues a report. This usually takes about three months.
What that doctor says regarding the date of Maximum Medical Improvement and the rating is binding on the parties. The only way to get around that opinion is to go to a hearing and show by clear and convincing evidence that the Division IME doctor is wrong. So if the Division IME doctor says that you're not at MMI, then you continue to get treatment, and if you were on temporary disability benefits that were cut off because you were placed at MMI, then those should start up again from the date they were cut off.
If the Division IME doctor says that you're at MMI and that you have a higher or lower disability rating, then your permanent disability benefits will be adjusted accordingly. The rating given by the Division IME doctors are frequently higher than the treating physician's ratings, but they can be lower or the same. In most cases, though, it's worth having a Division IME.
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