A Review of Medical Issues in Worker's Compensation

• Publication year: 1990
• Pages: 667

19 Colo.Law. 667 Colorado Lawyer 1990.

1990, April, Pg. 667. A Review of Medical Issues in Worker's Compensation

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667

Vol. 19, No. 4, Pg. 667

A Review of Medical Issues in Worker's Compensation

by Craig C. Eley and Pepe J. Mendez

New Part VIII of the Worker's Compensation Rules of Procedure ("New Part VIII"), which is effective for all applications for hearing filed on or after September 1, 1989, requires medical and lay hearings to be combined.(fn1) In light of New Part VIII, it is appropriate to review the medical issues involved with worker's compensation cases.

Employee's Rights and Responsibilities

Medical Care Required to Cure Injury

Every employer must furnish reasonable medical, surgical, dental, nursing or hospital treatment and supplies as needed at the time of the employee's injury or occupational disease. Such treatment and supplies also must be furnished during the disability to cure and relieve the employee from the effects of the injury.(fn2)

Excess Fee Void

It is unlawful, void and unenforceable as a debt for any health care provider to charge any patient for services rendered in connection with the worker's compensation claim fees that are in excess of the Fee Schedule,(fn3) unless such charges are approved by the Director.(fn4)

Independent Medical Examination

On written request of the employer or insurer, a claimant must allow himself or herself to be examined by a physician or a vocational rehabilitation counselor of the employer's or insurer's choice. If the employee refuses to submit to the medical examination or the vocational evaluation or obstructs it in any way, his or her right to compensation will be suspended.(fn5)

Election of Surgery

The claimant may decline, without penalty, to undergo surgery if (1) the surgery is not free from unusual risk, (2) the surgery is not calculated to effect a cure and (3) the claimant's refusal is reasonable. The burden of proof to establish that the tendered operation is simple, safe and reasonably certain to effect a cure is on the employer.(fn6)

Related Injury Compensable

Any injury suffered during the course of medical treatment for a work-related injury is considered a direct and natural consequence of that injury and is compensable to the employee.(fn7)

Ongoing Medical Treatment

If there is no ongoing medical treatment prescribed at the time of maximum medical improvement, no continuing award of medical benefits is proper.

However, where an injured worker reaches maximum medical improvement but requires periodic medical care to prevent his or her condition from deteriorating, it is permissible to leave medical benefits open subsequent to the final award Thereafter, medical benefits may remain ongoing until a carrier files a petition to end the benefits.(fn8)

Mileage Expense

The respondents are required to pay transportation expenses incurred in attending necessary medical treatment, even though mileage expenses are not specifically mentioned in the statute.(fn9) Internal Revenue Service Revenue Ruling 88-92 states that...