March 24, 2020: You are strongly encouraged to send documents, reports, etc. via email to firstname.lastname@example.org or e-fax to 303-318-8659. To help facilitate a timely response, please avoid sending documents by mail.
A Division Independent Medical Examination (DIME) is required if there is a dispute between the injured worker and the insurance carrier concerning the maximum medical improvement date (MMI) or the impairment rating and the parties wish to bring this dispute before a judge.
This process was established to reduce litigation and to provide an alternative way to address disputes involving MMI and impairment. Because impairment is an issue in the dispute, a Level II-accredited physician must perform the examination. If the parties cannot agree upon a physician, the Division will select an independent medical examiner based on an application submitted by the party who objects to the impairment rating or statement of MMI.
Please do not alter any existing content or formatting within these documents.
An Incomplete Notice will be sent to any party that edits existing contents and/or formatting of these documents.
DIME Forms for Physicians
DIME Forms for Injured Workers
DIME Forms for Insurers
- WC004 - Final Admission of Liability, Notice and Proposal, and Application for a DIME
- WC077 - Notice and Proposal and Application for a Division Independent Medical Examination
- WC165 - Notice of Division Independent Medical Examination Negotiations
- WC178 - Request/Notice for Follow-up DIME
- WC179 - Division IME Summary Disclosure Form (Insurer or Self-Insured Employer)
- WC180 - Division IME Physician Summary Disclosure Form (Claimant)
- WC198 - Notice of Reschedule or Termination of Division Independent Medical Examination
- WC200 - Notice of Agreement to Limit the Scope of the Division Independent Medical Examination
- WC201 - DIME Report Template
- Spine Impairment Rating Worksheets (used with permission from the AMA)
- Lower Extremity
- DIME Physician Panel Member Inventory
- DIME Presentation, Revised 11/28/2018
- DIME Timelines, Revised 11/20/2018
- General DIME Fee Information, Revised 11/20/2018
- DIME Index Example (PDF) | (Word), Revised 12/12/2018
- Level II Accreditation List (Accredited physicians by name, location, or specialty)
- IME Rule (Rule 11)