Under the preliminary draft of Rule 11, the parties submit raw medical records to the Division. A Division team will then generate a final DIME packet using submissions from respondents and the claimant. That packet, and a separate packet with any unused files, are sent to the parties for review and approval. The Division has stated that the policy of this change is to reduce process delays, provide more consistent packets assembled with less effort and ease the physician review process. However, it may come at the expense of respondents as the proposed fee structure now requires respondents to pick up the invoice beyond a $1,500 flat fee deposit made by the requesting party. For any DIME that requires substantive medical review, the cost may be more comparable to an IME with the proposed rule change.
Under the proposed Rule 11-3(B)(1), the medical record packet shall include all relevant records regarding the diagnosis, treatment, and evaluation of the claimant’s work-related injury(ies) or disease(s), as well as any relevant pre-existing condition(s), injury(ies), or disease(s), if applicable and available. However, Rule 11-3(B)(2) sets out what may not be included, such as “surveillance recordings, depositions, vocational rehabilitation reports, non-treating case manager records, prior orders and other records may not be submitted without written agreement of all parties or by order of an ALJ or the Director. “
The parties may still agree to limit the issues to be addressed by the DIME with a written agreement signed by all parties and served upon the DIME unit and physician no later than seven days prior to the DIME examination. The Division created an optional form to use called the Notice of Agreement to Limit the Scope of the DIME form.
Once a notice and proposal and application for a DIME is filed, the insurer or self-insured employer will have thirty days to submit the records to the Division “in the manner designated by the Division.” WCRP Proposed Rule 11-3(B)(3). Then the claimant will have ten days to supplement the records from the time they receive notice from the Division an initial draft record packet has been submitted. Failure to timely or properly submit the records may result in termination or rescheduling of the DIME by the Director, at the cost of the defaulting party.
Once records are received, the Division will produce a proposed medical records packet. The parties will have ten days to:
Once the DIME packet has been agreed to, the Division will submit the packet to the Division IME physician and all parties no later than 14 days prior to the scheduled examination. Supplemental records may only be submitted by an order of an ALJ finding good cause.
The DIME fee under the proposed rule would be based on the total time necessary to complete the DIME, payable in fifteen-minute increments at the rate prescribed by Rule 18 in effect on the date of the appointment. The billable time frame shall begin once the Division confirms the DIME physician and ends when the DIME physician submits the report.
The DIME physician shall receive a $1,500 base fee as a deposit from the requesting party prior to scheduling the examination (unless the claimant is found indigent, then the $1,500 fee is paid by respondents). The DIME physician will then invoice respondents for the final DIME fee minus the $1500 deposit.
The impact of this rule makes the DIME process significantly more expensive for respondents, especially if the case has a considerable medical history for the DIME physician to review.
Where a DIME is terminated, the physician shall be paid for their time reasonably spent in preparation prior to receiving notice of the termination. The defaulting party is billed for this time. The defaulting party is presumed to be the requesting party, absent an order to the contrary. If the termination fees are less than the $1,500 deposit done by the requesting party, the DIME physician shall refund the difference to that party within ten days of receiving the notice of termination. However, if the termination fees are greater than the $1,500 deposit, the physician will bill the insurer or self-insured employer who are required to pay the termination fees within ten days of receiving the invoice.
Where a DIME physician cancels a DIME, the entire DIME fee must be refunded.
While the rising cost of a DIME presents a concern for respondents, there may also be a benefit in gained quality and quantity of DIME physicians. Under the proposed billing structure, more physicians could see it as a viable avenue to expand their practice, providing a greater depth to the current DIME physician pool.
Want to know more? Contact Robbie Morrison at [email protected] or 877-259-5693.
