What if My Workers’ Compensation Doctor is not Providing the Proper Care?

We’ve all heard stories from friends and loved ones about doctors and nurses misdiagnosing, mistreating or under-diagnosing an injury or illness. Especially for major surgeries and the like, it’s common to consult with different doctors to be sure diagnoses are accurate and treatment you are receiving is the best available.

If your primary care physician isn’t treating you right, simply find another that accepts your insurance.

But what are my options if it’s a work-related injury covered under Workers’ Compensation?

Getting injured on the job is bad enough, let alone dealing with the complications of workers’ compensation. Not knowing all the facts can mean living with chronic back pain or psychiatric trauma for the rest of your life.

Being classified an employee under Colorado Workers’ Compensation laws and procedures entitles you to the necessary medical care to cure and relieve the effects of any on-the-job injury or disease, at no charge to you.

And if the doctor your employer’s Workers’ Compensation insurance carrier sent you to draws a conclusion you feel will not adequately address your injuries, there IS a mechanism to make a change…albeit not quite as simple as changing your family doctor.

Once the doctor declares you have reached maximum medical improvement (MMI), he/she determines whether you have any permanent disabilities after which they notify the insurance carrier. If the insurance carrier agrees with the doctor’s assessment, they file a Final Admission of Liability. You have 30 days after the carrier files the admission to determine if you agree with the MMI determination and the benefits the insurance carrier outlines in the final admission.

If you do not agree with this final assessment, you have the right to request a Division Independent Medical Examination (DIME).

Colorado Workers’ Compensation Rules of Procedure require the parties (i.e. yourself, your employer and the insurance company) negotiate and choose the physician to conduct the DIME before the Division of Workers’ Compensation intervenes. If these good faith efforts fail, which they usually do, either party can request the Division issue a list of three doctors. After the Division issues the list, the insurance carrier strikes one from the list, you strike another and the remaining doctor performs the examination.

Once a doctor is selected and contacted, they must conduct the examination no earlier than 35 calendar days and no later than 50 calendar days following initial contact – unless agreed to otherwise by the parties or Division.

How do I request a DIME in Colorado?

Here’s a typical case: Your back injury isn’t getting any better – the pain is still there or getting worse. You have seen the insurance carrier’s chosen doctor several times and they have determined you have reached maximum medical improvement (MMI) and communicate such to the insurance carrier.

If you do not agree with the insurance carrier’s Final Admission of Liability, you have the right to request a division independent medical examination (DIME) within 30 days of its release by filing an Objection to the Final Admission and a Notice and Proposal to Select an Independent Medical Examiner.

You and the insurance carrier are supposed to agree on a doctor to perform the DIME. These efforts are usually unsuccessful, at which time the carrier files a Notice of Failed IME Negotiations. You have 30 days from this filing to submit the Application for a Division IME.

As the requesting party, you must:

  • Indicate the preferred geographic location for your examination
  • Indicate the body part(s) or medical condition, either physical or mental, to be evaluated
  • List other physicians who have previously or are currently treating the problem

After you file the application with the Division, they issue a list of 3 doctors to choose from. Your insurance carrier strikes one from the list, you strike another and the remaining doctor performs the examination. You must make an appointment with this doctor within five days of their selection.

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Discuss the details of your claim with a Colorado Workers’ Compensation lawyer at The Babcock Firm today. No matter where you are in the state of Colorado, if your case falls within our practice area and we feel our representation can benefit you, an attorney will conduct an in-depth consultation at no charge. We are here to help you secure a successful outcome. Contact us today and learn more about how representation works.