Colorado Division of Workers’ Compensation

On January 1, 2021, the revamped WCRP 16 and 18 became effective.

The central changes to Rule 16 are clarifications of the pre-authorization process: Under the new Rule, again effective January 1, 2021, respondents shall have 10 days (rather than the prior seven business days) to review a request for pre-authorization. The other main change is that respondents can rely upon a medical opinion to deny a procedure that pre-dates the request by one year (365 days) so long as an admission of liability has not been filed admitting the relatedness of the requested treatment. If a medical opinion is not available within 10 days reviewing a request for preauthorization, respondents may schedule an IME to occur within 30 days (or first available appointment not more than 60 days). W.C.R.P. 16-7-2 outlines the process for using an IME to review a pre-authorization requests. Nothing about the rule changes that respondents may still deny requests for pre-authorizations for non-medical reasons, again, within 10 days.

Rule 18 (the fee scheduled) was also modified, recognizing such changes needed in 2020 like need for telemedicine visits. The mileage reimbursement rate has also been reduced to $0.52/mile.

February 2021 Newsletter