Independent Medical Opinions in Workers' Compensation

1. A report of Maximum Medical Improvement (MMI) is issued by the treating physician.
2. Within 30 days, the insurer files a Final Admission (FA) or applies for a DIME.
3. If an insurer files an FA, within 30 days the injured worker must object in order to apply for a DIME.
4. The party requesting the DIME must apply by filing a form WC77 Notice and Proposal and Application form with the DIME Unit.
5. Injured workers seeking indigency must file the application for indigency determination within 15 days with the prehearing unit.

1. When the application for a DIME is complete, the insurer will receive a request from the Division to upload the medical records.
2. Within 10 days of receiving a proposed DIME packet notification from the Division, the claimant may review and supplement.
3. Within 10 days of approval by the claimant, both parties must review and approve what will become the final DIME packet and objections must be made in writing.
4. Any disputes between the parties regarding the final DIME packet will require a prehearing order.
5. The Division will deliver the final DIME packet to the DIME physician and the parties 14 days prior to the scheduled examination.

View the Medical Records for DIME webpage to learn more.

1. The parties have 30 days to attempt to negotiate a DIME physician.
   1. If agreement is reached, all parties and physician must agree on the fees and sign a Negotiation form.
2. If parties are unable to reach an agreement, the insurer must file a Negotiation form and the Division will issue a 3-physician panel.
   1. If no negotiation form is filed after 30 days, notify the DIME unit.
3. The requesting party has 7 days to strike one name from the physician panel.
4. The opposing party then has 7 days to strike one of the two remaining physician names.
5. The DIME unit sends the parties a confirmation notice of the physician selected to conduct the DIME. No confirmation notice will be sent until the Division receives medical records from the insurer.

1. Within 14 days of the confirmation notice, the responsible party must pay the $1000 base fee to the DIME physician.
   1. Exception: if an injured worker has filed the WC35 Application for Indigent Determination form, then the responsible party must pay the fee to the physician within 14 days of the indigent order or physician selection (whichever is later).
2. The party requesting the DIME schedules DIME Appointment within 14 days and notifies the Division.
3. The physician must receive payment of base fee before scheduling the appointment.
4. The appointment should be scheduled within 45-75 days from the date of the confirmation.

1. The injured worker attends the examination.
   1. Failure to attend may result in fees.
2. The DIME physician conducts examination.
3. Within 20 days the DIME physician submits a copy of the report to all parties (injured worker and insurer) and the DIME Unit.

1. The DIME Unit reviews the report and issues one of the following notices:
   1. "concluded" notice to all parties
   2. "incomplete" notice to all parties
   3. "not at MMI" notice to injured worker and insurer
   4. "additional work-up needed" notice to injured worker and insurer if additional assessment is required
2. If concluded, insurer can file a final admission (FA) or file an application for hearing.
   1. Within 30 days, injured worker can object to FA and file an application for hearing.
3. If incomplete, the physician must address the issue(s) and submit a response to all parties and DIME Unit within 20 days.
4. If not at MMI, a follow up DIME shall be requested once recommendations have been completed.

1. The DIME physician submits final invoice to insurer, minus the previously paid $1000 base fee.
2. Invoices not paid timely will be sent to Dispute Resolution and could result in an order for penalties.