Colorado Rule 16 Changes - Effective July 1, 2025

The Division of Workers’ Compensation (DOWC) recently announced changes to Rule 16-3(E)(3) regarding the use of a Physician Assistant (PA) or Nurse Practitioner (NP). The changes are effective as of July 1, 2025. The current language states that the physician responsible for all services rendered to an injured worker by a PA or NP “must evaluate the injured worker at least once within the first three visits to the Designated Provider’s office.”

Effective July 1, 2025, the following revised language will take effect:

1. All Colorado workers’ compensation (WC) claims (medical only and lost time) shall have a Physician responsible for all services rendered to an injured worker by any PA or NP.
2. For services performed by a PA or NP, the attending Physician must counter-sign patient records related to the injured worker’s inability to work resulting from the claimed work injury or disease and the injured worker’s ability to return to regular or modified employment, as required by §§ 8-42-105(2)(b) and (3)(c) and (d). The attending Physician must sign the WC164 form, certifying that all requirements of this rule have been met.
3. The Physician must evaluate the injured worker when a treating PA or NP recommends it, when deemed necessary by a Physician, or when requested by the injured worker or Payer.

What does this mean?

The rule change aims to enhance access to care for injured workers by authorizing a PA, NP, physician, and the injured worker to request an evaluation from the designated provider physician. Upon request, the physician is required to conduct the assessment. The proposed rule change would eliminate any time restrictions for physician review and potentially allow the injured worker to compel evaluation at any point in the treatment process.

What if the physician examination does not occur?

In a 2023 decision, the Colorado Court of Appeals upheld the validity of a Final Admission of Liability (FAL) based on a physician assistant's findings of Maximum Medical Improvement. Taylor v. Indus. Claim Appeals Off., No. 23CA0155, at *3 (Colo. App. July 27, 2023). The supervising physician did not examine the injured worker during the first three visits, which violated Rule 16-3. Id. However, the court denied the injured worker’s request to invalidate the FAL, emphasizing that there was no harm from the lack of examination by the physician and noting that the rules of procedure do not offer a remedy for violation of Rule 16-3(E)(3). Id. at *3. The result is that an administrative law judge will have broad discretion to impose a sanction for an alleged Rule 16-3(E)(3) violation.

In the context of the proposed rule change and recent Colorado Court of Appeals case law, the framework governing a designated provider's ongoing use of a Physician Assistant (PA) or Nurse Practitioner (NP), despite the opportunity for interested parties to request a physician, remains unclear. The new Rule 16-3 language may improve access to the treating physician, potentially improving the level of care for injured workers. However, the rule could also lead to legal disputes without a clearly defined remedy.

Want to know more? Contact Ainslie Neubert at aneubert@pollartmiller.com