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Changes in Colorado Workers Compensation Act

On Behalf of | Jun 28, 2011 | Medical Benefits |

The Colorado Workers Compensation Act went through some changes during the last legislative session. They are not the kind of sweeping changes that were put into effect by industry back in 1990. However, since then, we’ve been able to battle back a little at a time. This year’s changes were small, but they were all good for injured workers. Here is a summary:

Senate Bill 11-199

Section 1 of this bill solves a long-standing problem with carriers not admitting for medical benefits after maximum medical improvement or carriers admitting but limiting the benefits to those recommended by a certain doctor. Claimants attorneys were forced to set hearings on the issue of medical benefits to keep those benefits open. If the case closed on a final admission that did not admit for ongoing medical benefits, the injured worker would usually have to reopen the case to get further medical treatment.

Under the new changes, the carrier must admit for reasonable, necessary and related medical benefits if such benefits are recommended by an authorized treating physician and there is no medical opinion to the contrary. This forces the insurance carrier to either admit for medical benefits without other limitations or provide medical evidence as to why it isn’t necessary.

Section 2 is helpful for attorneys who want to get information through discovery. The law had been that attorneys had to either agree to provide information through discovery or have discovery ordered by an administrative law judge. The new change does not require agreement. If both sides in the case have attorneys, then discovery may proceed. However, the prohibition against serving discovery requests on unrepresented parties without an ALJ’s order still stands. This goes for both unrepresented claimants and unrepresented insurance companies. Penalties have been assessed for the failure to abide by this prohibition.

Section 3 requires insurance carriers to provide traveling expenses in advance when they require a claimant to attend an insurance IME. This prepayment is only required when requested by the claimant. If the requested prepayment is not provided, the claimant may refuse to attend the IME. If payment is provided and the claimant still does not attend, the money can be recouped by the carrier through future indemnity benefits owed to the claimant. Please note that this does not apply to Division IMEs, but only for IME’s scheduled by insurance carriers with there selected doctors.

Section 4. This extends the applicability of SB 10-182, enacted in 2010, to all claims regardless of the date of the injury. SB 10-182 had to do with the up to $60,000 lump sum of permanent partial disability which a claimant could request. Prior to its enactment, the receipt of the lump sum was conditioned upon the claimant not going forward with a claim for permanent total disability. Now there is no such prohibition. The claimant can get the first $60,000 of PPD owed and still go forward with a claim for PTD. This helps the claimant survive while his PTD case is pending and also can help fund the costs of going forward with the PTD case.


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