Worker’s Compensation Rules of Procedure Changes
The Division of Workers’ Compensation recently changed and revised several Rules. These changes became effective September 14, 2016. Employers and carriers participated in public comment, voicing concerns over this change since it will certainly create overpayments. Frank Cavanaugh of Lee + Kinder, LLC participated in these public comments on behalf of the Colorado Self-Insured Association.
Several changes are more substantive than others and track statutory amendments adopted by the legislature in the last session. For example, changes to Rule 5-5 regarding the filing of final admissions of liability will affect day-to-day claims handling. Rule 5-5 now requires the physician’s narrative report, along with the M164 and measurement sheets, be attached to the final admission of liability. In addition, this Rule now requires that the final admission of liability state a position on maintenance medical benefits, making specific reference to the medical report including the name of the physician and the date of the report. Failure to properly abide by these requirements may void a final admission of liability and potentially lead to imposition of penalties by the Director and/or audit issues. Rules 8-6 and 8-7 also track legislative changes over requests for a change of physician. An original treating physician’s role remains in place and does not terminate until there is an initial visit with the new physician. Further, a request for change of physician and a response to the request must now be on a specific form, WC197. Please also be aware that Rules 16 and 18 are undergoing changes and have not yet been finalized. We will apprise you of these additional changes once they occur.
- Rule 1:
1-1 “Service” is now defined as delivery by US mail, hand delivery, facsimile or, with consent of the party being served, email.
Rule 1-2 contains language from Civil Rule of Procedure 6 over computation of time. It outlines that you do not count the day of the act; however, you do count the last day in the time period unless it is a Saturday, Sunday or legal holiday. If that is the case the timeframe moves to the next day.
Rule 1-4 now states that unless it is specifically allowed by the Division documents may not be filed with the division by email.
- Rule 5
Rule 5-2 still requires a statement regarding liability for any claim assigned a WC number, or when the first report of injury should have been filed; however, the first report of injury has to be filed before a notice of contest will be accepted by the Division.
Rule 5-5 requires that the final admission of liability include the M164 form, the physician’s narrative report and the rating sheets.
Rule 5-5 requires that an MMI report include a position on maintenance medical and that a final admission of liability state a position on maintenance medical benefits making specific reference to medical report, including the physician’s name and date of the report.
Rule 5-5 allows for medical only claims, that have been reported to the Division with no PPD, only require the attachment of a narrative report and worksheets if they were supplied by the physician.
Rule 5-5 now requires any safety rule reduction must include the specific facts supporting the reduction on a separate sheet of paper.
- Rule 6
Rule 6-1 organized the requirements for a modified duty offer. It still requires a copy of the written inquiry to the physician over the modified duty be provided to claimant at the same time as it is provided to the physician and that the claimant be provided 3 business days from the date of the receipt of the offer to return to work or respond.
Rule 6-6 governing terminating temporary disability benefits due to confinement, no longer requires a certified copy establishing confinement.
- Rule 7
Rule 7-1 governing closure of a claim through abandonment requires that a new general admission be filed in the event that there is an objection to the final admission of liability file to close the claim for abandonment.
Rule 7-1 does not allow closure of a claim for failure to prosecute to be submitted by email.
Rule 7-1 governing closure by voluntary abandonment no longer requires notification to the claimant of the reopening provisions.
- Rule 8
Rule 8-6 governing when there is a transfer of medical care at claimant’s request, states that the treating relationship with the prior physician terminates upon the initial visit with the new physician.
Rule 8-7 requires a written request for change of physician, and denial of that request, be made under a specific form, WC197.
- Rule 9
Rule 9-2 allows the addition of any prehearing issue by any party without permission within 2 business days of setting.
Rule 9-3 allows motions for consideration by the PALJ to be submitted by email.
Rule 9-9 does not allow settlement document amounts to include consideration for issues outside of the jurisdiction of the DOWC.
Rule 9-9 allows that only pro se claimants may withdraw a waiver of advisement hearing within 3 days of signing the settlement documents.