Colorado Division of Workers' Compensation Changes to Rule 11

LEGISLATURE UPDATE

Colorado Rule 11 Changes - Effective April 1, 2025

The Division of Workers’ Compensation (DOWC) recently announced that the proposed changes to Rule 11 have been adopted and will go into effect on April 1, 2025. According to the Division, the purpose of the change is to reduce process delays, provide more consistent Division IME packets assembled with less effort, and to ease the physician review process.

Required and Prohibited Records

• Under the adopted Rule 11-3-(B)(1), the medical records packet must include all relevant records related to the diagnosis, treatment, and evaluation of the claimant’s work-related condition.
• However, certain documents, such as surveillance recordings, depositions, and vocational rehabilitation reports, cannot be included unless all parties agree, or a judge orders their inclusion.

Submission and Review Process

• The insurer or self-insured employer must submit the records to the Division within 30 days of the Division IME application notice.
• The claimant has an additional 10 days to add any relevant documents.
• The Division compiles a draft medical records packet, which is then sent to both parties for review. Any disputes must be resolved within 10 days through written objections or a pre-hearing conference.
• The finalized packet is sent to the DIME physician 14 days before the scheduled examination.

Limitations

• The parties may agree in writing to limit the scope of the Division IME, ensuring the examination focuses on specific medical issues.
• Any additional medical records submitted after the final packet require a judge’s order showing good cause.

Changes in DIME Fee Structure

Understanding the payment structure and fees in the Division Independent Medical Examination (Division IME) process under the newly adopted rule is essential.

• The Division IME fee is based on the total time needed to complete the examination, billed in 15-minute increments at a rate set by Rule 18 in effect on the appointment date.
• The fee begins once the Division IME physician is confirmed and ends when they submit their final report.
• A $1,000 base fee must be paid by the requesting party before scheduling, unless the claimant has applied for indigent status, in which case payment is due 14 days after the ruling on indigency or the Division IME physician’s final selection—whichever is later.
• After completing the Division IME, the insurer or self-insured employer must pay the remaining balance of the Division IME fee, ensuring that the physician is paid at least $1,000 total for their services.

Rescheduling and Termination of DIME

A Division IME can only be rescheduled by the requesting party or by order and requires a good cause finding if rescheduled more than once.

Termination Fees

• More than 14 days before the exam → $250 termination fee → Refund of $750 to the paying party.
• 14 days or less before the exam → $500 termination fee → Refund of $500 to the paying party.
• 5 days or less before the exam → $1,000 termination fee → No refund of the base fee.
• If the Division IME physician cancels → Full refund of the $1,000 base fee.

Rescheduling Fees

• More than 14 days before the exam → No rescheduling fee applies.
• 14 days or less before the exam → $250 rescheduling fee applies.
• 5 days of less before the exam → $500 rescheduling fee applies.
• If the Division IME physician reschedules → base fee is applied to the new appointment, regardless of the timing.
• If the Division IME physician reschedules more than two times → physician shall pay a $250 fee to the party who requested the Division IME.

Conclusion

The impact of the adopted rule makes the Division IME process significantly more expensive for respondents, especially if the case has a considerable medical history for the Division IME physician to review. However, there will likely be a benefit in the quality and quantity of available Division IME physicians moving forward.

Want to know more? Contact Ivanka Hoffman at [email protected]