The Road to Longmont Toyota: Starting and Stopping Temporary Disability Benefits - Workers' Compensation Report
| Publication year | 2005 |
| Pages | 87 |
| Citation | Vol. 34 No. 5 Pg. 87 |
2005, May, Pg. 87. The Road to Longmont Toyota: Starting and Stopping Temporary Disability Benefits - Workers' Compensation Report
May 2005
Vol. 34, No. 5 [Page 87]
Workers' Compensation Report
The Road to Longmont Toyota: Starting and Stopping Temporary Disability Benefits
by Curt Kriksciun
This column provides information about workers' compensation updates on decisions of the Colorado Supreme Court and Court of Appeals. It intends to help practitioners keep up with both the appellate interpretations of the Workers' Compensation Act and the potential ramifications of those interpretations.
Column Editor:
Ralph Ogden, Denver, of Wilcox & Ogden - (303) 399-5005
About The Author:
This month's article was written by Curt Kriksciun, Denver, who was a prehearing Administrative Law Judge for the Division of Workers' Compensation at the time this article was written. He is now an examiner at the Industrial Claim Appeals Office ("ICAO") - curt.kriksciun@state.co.us. Nothing in this article should be taken as an official pronouncement of the Division or ICAO.
In 1999, the Workers' Compensation Act was amended to preclude wage loss benefits where an injured worker was terminated from employment for cause. This article explores the amendments and case law that has construed them, including Longmont Toyota, which held that terminated benefits could sometimes be reinstated.
In Anderson v. Longmont Toyota, Inc.,1 the Colorado Supreme Court construed the 1999 amendments to the Colorado Workers' Compensation Act ("Act"), which are also referred to as the "termination statutes."2 Those statutes denied temporary disability benefits to the injured worker whose employment was terminated for cause.
The Court in Longmont Toyota ruled that the bar against benefits was not permanent and that entitlement could be revived where the claimant's condition worsened following the termination from employment. The road leading to Longmont Toyota has been a long one, and there are likely to be many twists and turns in the road ahead.
This article provides an overview of temporary disability benefits available to injured employees. It reviews several cases that have addressed these issues, as well as the legislation that created the termination statutes. Finally, the article discusses Longmont Toyota and outlines a number of issues that remain unresolved.
Temporary Disability Benefits Overview
Temporary disability benefits have been a mainstay of the Act since it first went into effect in 1915.3 Disputes about the payment of such benefits have arisen almost since the enactment.4
Temporary disability benefits compensate an injured worker for time lost from work prior to the attainment of maximum medical improvement ("MMI"). At the point MMI is reached, the worker's medical condition becomes stable and no further treatment is reasonably expected to improve his or her condition.5 Hence, temporary disability benefits are intended to compensate an injured worker for the actual wage loss temporarily experienced during treatment of and recovery from the injury.6 The Act requires the payment of temporary disability benefits if three conditions are satisfied: (1) the work-related injury caused disability;7 (2) the claimant left work as the result of the injury; and (3) the temporary disability is total and lasts for more than three working days.8
The benefits generally are required to continue until the occurrence of one of several events specified in the statute. As noted, temporary disability benefits are terminated when the employee reaches MMI.9 Under CRS § 8-42-105(3), such benefits also end when the employee returns to regular or modified employment, receives a written release from the attending physician to return to regular employment, or receives a written release to return to modified employment and that employment is offered.10
Intervening Cause
In addition to the grounds for termination of temporary disability benefits specified in CRS § 8-42-105(3) and in the Workers' Compensation Rules of Procedure,11 insurers and employers have long argued that the benefits are not payable where some intervening event cuts off the causal connection between the injury and the temporary wage loss.
Following the enactment of the first Act, the courts occasionally referred in workers' compensation cases to the tort concept of an intervening cause severing the employer's liability. For example, in 1922, the Colorado Supreme Court affirmed an award of benefits to a worker injured when a piece of coal struck his face.12 He later developed a malignant growth and died from the cancer that resulted. In affirming the award of death benefits, the Industrial Commission noted that "[n]o intervening cause is shown that would, or does, account for the sudden change in decedent's condition."13
In 1934, the Colorado Supreme Court did more than merely mention the concept of the intervening cause. It applied the doctrine to cut off the employer's liability for a subsequent injury.14 The claimant sustained an injury to his right knee, which was treated and resolved to the point that the claimant was able to return to work. During a severe snowstorm the claimant slipped and fell, breaking his ankle. The claimant sought benefits on the ground that the compensable injury had left him in a weakened condition and that, therefore, the subsequent fracture was the natural result of the compensable injury. The court rejected that theory, ruling that
[u]pon the happening of a latter accident like the one involved here, due to an efficient intervening cause . . . the law does not contemplate that the original compensation shall be increased merely because the later accident might or would not have happened if the employee had retained all his former physical powers.15
A 1986 case, Monfort v. Husson,16 formed the focus of much discussion about entitlement to temporary disability benefits after a discharge from employment. In Monfort, the claimant was injured in a compensable accident and was later terminated for failing to report to work. The Colorado Court of Appeals addressed the broad issue of whether a claimant who is temporarily disabled and then terminated from his or her employment may receive temporary disability benefits. The court concluded that the answer to that question depended on whether the claimant was terminated for fault. The court held:
Where a temporarily disabled employee is determined to be at fault for his [or her] termination, subsequent wage loss is caused not by the injury, but rather by the employee's act which led to the termination.17
The reason for the wage loss was thus fixed by the reason for the termination. If the termination was for fault, the wage loss was not attributable to the injury.
With Monfort setting the stage for termination of temporary disability benefits based on intervening events, insurers and employers sought to apply that principle in a variety of circumstances. For example, in Roe v. Industrial Commission,18 the Colorado Court of Appeals noted that suspension of temporary disability benefits was appropriate "if intervening events indicate the wage loss or impaired earning capacity results from factors other than the compensable injury."19 The Roe court affirmed the suspension of temporary disability benefits where a claimant's vocational rehabilitation plan was delayed on account of a surgery unrelated to the compensable injury.20 The contention that an unrelated injury or accident intervened to cut off entitlement to temporary disability benefits was probably the most common argument used by employers and insurers to cut off benefits.
However, other factual circumstances also lent themselves to this argument. For instance, in Zanandrie v. Castle Nursing Home,21 the administrative law judge ("ALJ") suspended temporary disability benefits during the claimant's pregnancy, reasoning that the pregnancy constituted a "separate and distinct incident" that delayed the attainment of MMI.22 The Industrial Claim Appeals Office Panel ("Panel") affirmed the order, stating that "pregnancy may, under some circumstances, constitute an intervening event terminating the causal relationship between the injury and a wage loss."23
The courts have found a number of other intervening events justifying termination of temporary disability benefits. These have included a return to school,24 voluntary retirement during a period when the claimant was able to perform modified work,25 the end of seasonal work,26 and a claimant's relocation based on a spouse's transfer to another job.27
This principle that intervening events could sever the causal connection between the injury and the wage - and terminate entitlement to temporary disability benefits - became the battleground for numerous disputes in varied factual circumstances. Although resolution of those disputes usually was reduced to a factual matter for the ALJ, the general legal principle that an intervening event could end liability for benefits persisted.
PDM Molding v. Stanberg
The landscape changed in 1995 with the announcement by the Colorado Supreme Court of PDM Molding, Inc. v. Stanberg.28 In PDM Molding, the Court created what it later conceded might be viewed as a "loophole" in the benefit system.29 The broad holding of PDM Molding was that a termination from employment for cause does not automatically disqualify an injured employee from receipt of temporary disability benefits.
The PDM Molding Court ruled that a claimant was entitled to temporary disability benefits following a termination for fault if the injury contributed "to some degree" to the wage loss.30 This standard permitted awards of temporary disability benefits in a wide variety of situations in which the claimant was terminated...
To continue reading
Request your trial