Notice Of Reschedule Or Termination Of DIME {WC198}

WC198 - NOTICE OF RESCHEDULE OF THE DIVISION INDEPENDENT MEDICAL EXAMINATION (DIME). This form is used to officially inform the Colorado Division of Workers’ Compensation and all involved parties that a scheduled DIME appointment has been changed to a new date. The form requires details such as the workers’ compensation claim number, the claimant’s name, the new date of the rescheduled exam, and the reason for rescheduling. It also outlines the rescheduling fee structure based on how close to the original appointment date the change is made—ranging from no fee if rescheduled more than 14 days in advance, to $500 if rescheduled five days or less before the appointment. The DIME physician must receive the appropriate rescheduling fee before the exam can be officially moved. If the DIME physician cancels the exam, the full base fee must be refunded to the paying party. The form must include a certificate of service, listing all parties who received copies, including the DIME Unit, claimant or their attorney, insurer or their attorney, and the DIME physician. www.FormsWorkflow.com