Colorado Division Independent Medical Examination (DIME) physicians record their conclusions on this summary sheet: whether the claimant is at maximum medical improvement and the date, and impairment ratings for the spine, each extremity converted to whole person, psychological and other impairment, the final combined unapportioned rating and, if applicable, an apportioned rating.
The DIME physician completes and signs it. The DIME Unit pre-fills the sheet with the case details and sends it to the physician.
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DIME Examiner's Summary Sheet
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Within 20 days of the examination. The DIME physician sends the invoice, WC132 summary sheet, WC201 report and all applicable impairment rating worksheets, in that order, to every party listed on the summary sheet and to the DIME Unit.
Check 'No' on item 3 and provide a provisional impairment rating and report, with the treatment recommended to reach MMI. A follow-up DIME is scheduled after the worker completes that treatment and is placed at MMI again by a treating provider.
Desk Aid 14, the Apportionment Calculation Worksheet, is required whenever apportionment is performed. The apportioned final combined rating goes in item 5, separate from the unapportioned rating in item 4.