Update of Recent Colorado Appellate Decisions Concerning Workers' Compensation
| Publication year | 1996 |
| Pages | 71 |
| Citation | Vol. 25 No. 1 Pg. 71 |
1996, January, Pg. 71. Update of Recent Colorado Appellate Decisions Concerning Workers' Compensation
In the 1988 case of Grover v. Industrial Commission,(fn1) the Colorado Supreme Court held that the medical benefits statute, then CRS § 8-49-101(1)(a), now codified without relevant change at CRS § 8-42-101(1)(a), allows awards of post-maximum medical improvement ("MMI") medical care if there is "substantial evidence in the record to support a determination that future medical treatment will be reasonably necessary to relieve the injured worker from the effects of the work-related injury or occupational disease."(fn2) This determination must be made at the time permanent impairment or disability is decided. Although the court did not discuss whether post-MMI medical care could also be awarded when a petition to reopen is granted, that is very likely the case.(fn3)
There were four holdings in the Grover decision:
1) an injured employee can obtain post-MMI medical benefits if he or she produces "substantial evidence" of his or her "need" for treatment to "cure and relieve" the effects of the injury;
2) by applying the substantial evidence standard of review, the decision is left to the sound discretion of the administrative law judge ("ALJ");
3) once the showing of need has been made, an employer can challenge the reasonableness or necessity of specific treatment on the ground that the treatment is unrelated to the injury, but the opinion states no other basis for challenging the claim; and
4) the employer can file a petition to reopen for the purpose of limiting or terminating benefits on grounds not specified in the opinion.
Stollmeyer involved a professional soccer player who had severely injured his ankle and was diagnosed at MMI as having ankle instability with degenerative changes. His physician stated that as time went on, he would continue to have pain and arthritic changes that would cause him problems. On this evidence, the ALJ left future medical benefits open, but did not specify the kind of treatment that should be provided.
The Industrial Claim Appeals Office ("ICAO") relied on this language in Milco Construction to reverse:
We hold, therefore, that if the evidence in a particular case establishes that, but for a particular course of medical treatment, a claimant's condition can reasonably be expected to deteriorate, so that he will suffer greater disability than he has sustained thus far, such medical treatment, irrespective of its nature, must be looked upon as treatment designed to relieve the effects of the injury or to prevent deterioration of the claimant's condition.(fn6)
The Court of Appeals in Stollmeyer affirmed the ICAO, but disapproved of its reading of Milco Construction:
To the extent that the panel interpreted Milco as mandating that a "particular" or specific course of treatment be anticipated or articulated at the time of the order, we disapprove that interpretation.
[A]lthough the specifics of that treatment may be articulated, as in Milco, specificity is not required.
There, [in Milco] a particular course of anticipated treatment---knee surgery---was at issue, and thus the holding [in Milco] was tailored to those facts.(fn7)
This language in Stollmeyer suggests some inconsistency between what it requires and what is required by Milco to obtain post-MMI medical care.
CRS § 8-43-102(1)(a) provides in part that injured workers must notify their employers in writing that they have been injured, and must do so within four working days of their injury. It also provides a
In Postlewait, the Court of Appeals first held that since the penalty reduced the employer's liability, it was an affirmative defense. Thus, the employer bears the burden of proving that it did not receive written notice.
The court then rejected the claimant's argument that because his employer told him not to file a claim, he was prevented from giving written notice of an injury:
Inasmuch as filing a claim and giving written notice of an injury are two distinct actions under the Workers' Compensation Act, we fail to understand this line...
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