Division Independent Medical Examinations

The claimant worked for the employer as an engineer performing tasks related to robotic programming when he was injured after being struck in the face.

He was diagnosed with traumatic brain injuries, including narcolepsy, and was prescribed stimulants to keep him awake and productive; however, the dosage continued to increase until it reached dangerous levels. The claimant’s ATP placed him at maximum medical improvement (“MMI”) with a 67 percent whole person impairment and recommended that he stop working.

Thereafter, the respondents requested a Division independent medical examination (“DIME”).  The DIME physician agreed with the date of MMI and determined the claimant had injury-related narcolepsy. The respondents filed a final admission of liability (FAL) consistent with the DIME physician’s opinions and denied liability for ongoing medical benefits.

The claimant requested a hearing on the issues of PTD and maintenance medical benefits.  Respondents defended the claim, including presenting expert testimony/ evidence that claimant did not have injury-related narcolepsy.

The ALJ ultimately denied claimant’s request for PTD  and maintenance medical benefits related to the treatment of the narcolepsy.

On appeal, the claimant argued that ALJ was bound by the DIME physician’s findings regarding the narcolepsy and could not reach a different conclusion at hearing. The Panel disagreed, nothing that  under C.R.S. § 8-42-107(8), a DIME physician’s opinions concerning MMI and permanent medical impairment are binding unless overcome by clear and convincing evidence; however, the DIME’s opinions  are not binding to issues outside of MMI and permanent medical impairment.

The Panel held that because neither of the parties were challenging MMI or impairment;  the DIME physician’s opinion concerning the causation of the narcolepsy was not entitled to presumptive weight. The Panel went on to affirm the ALJ’s order denying both PTD and maintenance care related to the narcolepsy.

Yeutter v. CBW Automation, Inc., W.C. No. 4-895-940-03 (ICAO Feb. 26, 2018).

 

Claims Representation Practice Tip:

In a claim where there is an unfavorable Division IME which relates highly questionable conditions and an application for PTD is an inevitability, it may be  strategically advantageous to consider accepting the unfavorable opinion. This will lower the burden of proof to disprove the PTD at hearing. *Consult counsel  prior to considering this avenue.

Would you like to know more? Contact Eric J. Pollart at epollart@pollartmiller.com or 720.488.9586.

 

From the March 2018 Pollart Miller Newsletter

2019-01-29T09:12:35-07:00