Colorado Workers’ Compensation law is complex and difficult to understand. While this may be the first time you have dealt with the law, it is not the first time your adjuster has. You must be sure that you know the law before you agree to anything that the adjuster suggests.
There are many areas where the adjuster can try to pull the wool over your eyes and hope to get one over on you because you don’t know your rights.
Mileage For Medical Treatment:
You are eligible to be reimbursed for mileage to and from any medically prescribed treatment in Colorado workers’ comp cases.
“Medically prescribed” mileage is mileage to and from any type of treatment for your condition that is prescribed by your doctor, including:
- physical therapy,
- picking up prescriptions,
- surgery and
- appointments with your doctor.
Your adjuster may not tell you that you are entitled to this reimbursement.
Your Treating Physician:
Under Colorado law, your employer has the right to choose a doctor for you. But if your employer doesn’t choose a doctor you may have the right to choose your own doctor. Once the doctor is chosen, it cannot be changed unless you and the insurance company agree to a new doctor.
Your Average Weekly Wage and Fringe Benefits:
The benefits you receive for your time off work are calculated from your average weekly wage (AWW). If you are unable to return to work due to your work injury, you are entitled to receive Temporary Total Disability (TTD) or TPD benefits. TTD is two-thirds of your average weekly wage.
What you may not know is that certain fringe benefits such as employer-paid health insurance, paid meals and lodging should also be factored in to the computation of your average weekly wage.
Independent Medical Examinations:
Once you are put at Maximum Medical Improvement (MMI) by your doctor, either you or your insurance company can request a second opinion through a Division Independent Medical Examination (DIME) The DIME doctor will decide whether they agree with your doctor’s date of MMI, and will calculate an impairment rating.
Choosing the DIME doctor can have drastic consequences for your case. If your case ends up in court, the DIME doctor’s opinion is entitled to extra weight, and can only be overcome with “clear and convincing” evidence. Therefore, it is crucial to select a doctor who is likely to be fair to you.
The law requires you to negotiate with the insurance company and try to agree on a doctor to perform the DIME.
- Of course, the claims adjuster has done this multiple times and knows which doctors are more likely to favor the insurance company and the employer.
- On the other hand, you have no way to know which doctors tend to be fair.
- For this reason, it is easy for the adjuster to take advantage of you and trick you into agreeing to an unfavorable doctor.
- At the very least, you lose the opportunity to suggest a reasonable doctor that the insurance company might agree to.
If you cannot agree with the adjuster on a doctor to perform the DIME, the Division of Workers’ Compensation will issue a list of three doctors, and each side has a chance to strike one doctor. The adjuster knows what doctor on the list will give them the best result, but you are unlikely to know which doctor is most likely to be fair to you. For these reasons, it is generally advisable to have a competent attorney working for you to maximize your odds of a favorable DIME.
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