Barba v. Industrial Claim Appeals Office

Colorado Court of Appeals·Decided March 12, 2026·No. 25CA0859·Unpublished

Opinion

The summaries of the Colorado Court of Appeals published opinions constitute no part of the opinion of the division but have been prepared by the division for the convenience of the reader. The summaries may not be cited or relied upon as they are not the official language of the division. Any discrepancy between the language in the summary and in the opinion should be resolved in favor of the language in the opinion.

SUMMARY

March 12, 2026

2026COA15

No. 25CA0859, Barba v. Industrial Claim Appeals Office — Workers’ Compensation — Medical Impairment Benefits — Final Admission of Liability

A division of the court of appeals addresses a novel issue regarding the impact of section 8-42-107(8)(f), C.R.S. 2025, a provision of the Workers’ Compensation Act of Colorado, on the information employers may include in a final admission of liability. That statute requires employers submitting a final admission of liability to “admit liability for related reasonable and necessary medical benefits by an authorized treating physician” in all claims when “an authorized treating physician recommends medical benefits after maximum medical improvement,” and the record does not contain a “contrary medical opinion.”

The division interprets the statutory provision stating that the “related reasonable and necessary medical benefits” admitted in a final admission of liability “are not limited to any specific medical treatment” to mean that an employer cannot limit maintenance medical benefits to any specific medical treatment and that any attempt to do so is a nullity. In addition, the division concludes that section 8-42-107(8)(f) neither prohibits an employer from referring to a physician’s report in a final admission of liability when admitting liability for maintenance medical benefits nor implies that such a reference constitutes an impermissible limitation on benefits.

COLORADO COURT OF APPEALS 2026COA15

Court of Appeals No. 25CA0859 Industrial Claim Appeals Office of the State of Colorado WC No. 4-972-041

Fredy Barba, Petitioner, v.

Industrial Claim Appeals Office of the State of Colorado and Cardinal Health 200, Inc.,

Respondents, and Sedgwick Claims Management Services, Inc. TPA, Insurer-Respondent.

ORDER AFFIRMED

Division V

Opinion by JUDGE LIPINSKY Welling and Tow, JJ., concur

Announced March 12, 2026

Elliott & Montgomery, Mark D. Elliott, Erin Montgomery, Arvada, Colorado for Petitioner

No Appearance for Respondent Industrial Claim Appeals Office

Hall & Evans, L.L.C., Douglas J. Kotarek, Matthew J. Hegarty, M. Taylor Feero, Denver, Colorado for Respondent Cardinal Health 200, Inc. and Insurer- Respondent Sedgwick Claims Management Services, Inc. TPA

¶1 This case presents a novel issue regarding the impact of section 8-42-107(8)(f), C.R.S. 2025, of the Workers’ Compensation Act of Colorado (the Act) on the information employers may include in a final admission of liability (FAL). That statute requires employers submitting a FAL to “admit liability for related reasonable and necessary medical benefits by an authorized treating physician” in all claims when “an authorized treating physician recommends medical benefits after maximum medical improvement” and the record does not contain a “contrary medical opinion.” Id.

¶2 The parties dispute the meaning of the statutory language providing that the “related reasonable and necessary medical benefits” admitted in a FAL “are not limited to any specific medical treatment.” Id.

¶3 Claimant, Fredy Barba, sustained a back injury in the course and scope of his employment with Cardinal Health 200, Inc., in 2013. In this appeal, Barba contends that Cardinal’s insurance carrier — XL Specialty Insurance Company — and XL’s third-party administrator — Sedgwick Claims Management Services, Inc. TPA — violated section 8-42-107(8)(f) by adding, next to the FAL’s “Yes” box for maintenance care after maximum medical

improvement, a reference to a physician’s report recommending a specific maintenance program. (We refer to XL and Sedgwick jointly as “insurer.”) He asserts that the administrative law judge (ALJ) who presided over the hearing on his penalty claim (the penalty hearing) erred by not imposing statutory penalties for this alleged statutory violation. Barba’s counsel clarified at oral argument that Barba sought penalties from Cardinal and insurer. Section 8-43-304(1), C.R.S. 2025, permits the assessment of penalties against “[a]ny employer or insurer, or any officer or agent of either, or any employee, or any other person who violates” the Act.

¶4 Barba also contends that the ALJ erred at the penalty hearing by permitting a claims adjuster to explain why she added the reference to the physician’s report to the FAL and that the facts did not support the ALJ’s rejection of his penalty claim. For these reasons, Barba asks us to reverse the order of the Industrial Claim Appeals Office (the Panel) affirming the ALJ’s decision.

¶5 We disagree with Barba’s interpretation of section 8-42-107(8)(f) and his other arguments. Therefore, we affirm the Panel’s order.

I. Background

¶6 Following his back injury, Barba underwent surgery and engaged in physical therapy. Barba’s authorized treating physician placed him at maximum medical improvement (MMI) — the “point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to improve the condition,” § 8-40-201(11.5), C.R.S. 2025 — on December 1, 2015. The authorized treating physician assigned a 25% whole person impairment rating and recommended a specific course of post-MMI maintenance treatment.

¶7 On behalf of Cardinal, insurer filed a FAL form that was consistent with the authorized treating physician’s report. Barba objected to the FAL and requested a Division Independent Medical Examination (DIME). A DIME physician confirmed the MMI date of December 1, 2015, and assigned a 24% whole person impairment rating. In January 2017, insurer filed an amended FAL consistent with the DIME. Barba’s case was then closed.

¶8 Barba continued to receive post-MMI maintenance care from his authorized treating physician. But in October 2018, Barba

reported that his condition had worsened after he bent down to pick up a piece of paper. He sought to reopen his workers’ compensation award. An ALJ determined that reopening was warranted based on proof that Barba had experienced a change in condition causally connected to his original work injury.

¶9 Barba received further monitoring and treatment for his back injury. In 2024, he underwent another DIME, which Dr. Bryan Alvarez performed. In his DIME report dated March 28, 2024 (the Alvarez report), Dr. Alvarez concluded that Barba had reached MMI on December 1, 2015, and assigned a 17% whole person impairment rating. Dr. Alvarez recommended that Barba undergo physical therapy for three months.

¶ 10 In April 2024, the Division of Workers’ Compensation (Division) issued a notice of “DIME Process Concluded” that required “the insurance carrier” either to (1) “admit liability consistent with the DIME report” or (2) “file an application for hearing.” Blayre Spring, a claims adjuster for Sedgwick, filed a FAL on behalf of Cardinal and insurer. The FAL said that Cardinal and insurer admitted liability consistent with the report, including liability for permanent partial disability (PPD) benefits totaling

$62,451.20 and maintenance medical benefits. As relevant to this appeal, on the FAL form, Spring checked the “Yes” box for “[a]dmit[ting] to [m]aintenance [c]are after MMI.” On the same line as the “Yes” box, Spring wrote, “Pursuant to Dr. Bryan Alvarez’s medical report dated 03/28/2024.” On the next line, next to “[r]emarks and basis for permanent disability award,” Springer summarized Cardinal and insurer’s position regarding the PPD benefits to which Barba was entitled “[p]ursuant to” the Alvarez report.

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