Division Independent Medical Examination (DIME)

March 24, 2020: You are strongly encouraged to send documents, reports, etc. via email to imeunit@state.co.us 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.

DIME Resources

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.

  • #11A - Follow-up Division Independent Medical Examinations
  • #5 - "Limited Issue" IMEs
  • #1 - A Guide to H.B. 01-1116 (Admissions of Liability and Closure of IME Cases)

View Director's Interpretive Bulletins

DIME Forms for Physicians
  • WC076 - Request for Appointment to the Independent Medical Examination Panel
  • WC132 - DIME Examiner's Summary Sheet
  • WC179 - Division IME Summary Disclosure Form (Insurer or Self-Insured Employer) 
  • WC180 - Division IME Physician Summary Disclosure Form (Claimant) 
  • WC201 - DIME Report Template 

DIME Forms for Injured Workers
  • WC035 - Application for Indigent Determination
  • WC077 - Notice and Proposal and Application for a Division Independent Medical Examination (DIME)

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 & Upper Extremity (used with permission from the AMA)
  • Lower Extremity
    • Part 1
    • Part 2
  • Mental
  • Vision
  • Hearing

  • Impairment Rating Tips - Desk Aid #11
  • Apportionment Calculation Worksheet - Desk Aid #14
  • Evaluation of Previous Spinal ROM Impairment​ - Desk Aid #10

Please Note: The forms in this section are solely intended for DIMEs with any Notice and Proposal and Application with a Certificate of Mailing dated prior to January 1, 2019.

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Contact Us

Division of Workers' Compensation
Division Independent Medical Exam Unit
633 17th Street, Suite 300
Denver, CO 80202
303-318-8655
303-318-8659 (Fax)
imeunit@state.co.us