Berg v. Industrial Claim Appeals Office of the State

128 P.3d 270, 2005 Colo. App. LEXIS 1279, 2005 WL 1903825
CourtColorado Court of Appeals
DecidedAugust 11, 2005
Docket04CA1130
StatusPublished
Cited by523 cases

This text of 128 P.3d 270 (Berg v. Industrial Claim Appeals Office of the State) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Berg v. Industrial Claim Appeals Office of the State, 128 P.3d 270, 2005 Colo. App. LEXIS 1279, 2005 WL 1903825 (Colo. Ct. App. 2005).

Opinion

PICCONE, J.

In this workers' compensation proceeding, Randy Berg (claimant) seeks review of the final order issued by the Industrial Claim Appeals Office (Panel) which denied his petition to reopen. We set the order aside and remand with directions.

L.

In January 2002, claimant sustained a com-pensable back injury. His treating physician placed him at maximum medical improvement (MMI) on October 23, 2002, with a ten percent whole person impairment rating. The treating physician reported that claimant had experienced little, if any, improvement from epidural steroid and facet joint injections; opined that he was not a candidate for surgery because he had no significant radicular symptoms and multilevel involvement; noted claimant's complaints of continuing pain; and recommended only limited maintenance care and an active exercise program with proper posture and body mechanics.

United Parcel Services and its insurer, Liberty Mutual Group (collectively employer), requested a division-sponsored independent medical examination (DIME). In a February 4, 2008, report, the DIME physician agreed with the date of MMI, but assigned a whole person impairment rating of twelve percent. The DIME physician reviewed claimant's medical records and noted that he had received two opinions recommending against surgery and that claimant had obtained a second opinion on his own from a neurosurgeon who recommended surgical exploration. The DIME physician, however, did not recommend surgery based upon the lack of neurological findings and the localized myofascial pain claimant had been experiencing.

On March 7, 2003, employer filed a final admission of liability (FAL) based upon the DIME report. On March 12, 2008, claimant underwent surgery performed by his own surgeon.

The following day, claimant's attorney filed a response to the FAL accepting the permanent medical impairment rating assigned by the DIME physician, but contesting the remainder of the FAL. Claimant did not file an application for hearing within thirty days of employer's FAL. Claimant filed a petition to reopen the claim on May 21, 2008, alleging that claimant's treating physicians and the DIME physician were mistaken as to the actual cause of his back symptoms, which *272 was not discovered until the surgery. The petition to reopen was based upon a May 2003 letter from the surgeon stating that during surgery he found a prominent dise herniation causing compression, which was the likely cause of the right- and left-side radiculopathy and back pain experienced by claimant.

Following an evidentiary hearing, the administrative law judge (ALJ) granted claimant's petition to reopen, awarded additional temporary disability and medical benefits, and authorized claimant to change physicians. The ALJ found that claimant proved his treating physician mistakenly believed he was at MMI on October 28, 2002, that no further treatment would cure or relieve him of the effects of the industrial injury, and that claimant's medical providers were under a "mutual mistake of fact" about the nature of claimant's condition.

On review, the Panel set aside the ALJ's order. The Panel found that claimant was, in effect, challenging the FAL and the DIME physician's determination of MMI, but that he had not followed the requirements of § 8-48-208(2)(b)(II), C.R.S.2004. Therefore, the Panel determined that claimant was precluded from cireumventing the conclusive effect of the DIME by seeking to reopen the MMI determination based upon mistake of fact under $ 8-48-808(1), C.R.S.2004.

IL

Claimant contends the Panel erred in determining that a DIME physician's uncontested finding of MMI cannot be reopened under § 8-43-803(1) based on a mistake of fact. We agree.

Disputes related to MMI are governed by § 8-42-107(8), C.R.S.2004, which requires an independent medical examination (IME) when either party disputes the MMI determination of an authorized treating physician. See Cordova v. Indus. Claim Appeals Office, 55 P.3d 186 (Colo.App.2002)(under § 8-42-107(8)(b) and (c), C.R.S.2004, a treating physician's determination as to MMI and medical impairment cannot be disputed in the absence of an IME). The opinion of the IME physician has presumptive effect unless overcome by clear and convincing evidence. Section 8-42-107(8)(b)(III), C.R.S.2004; Magnetic Eng'g, Inc. v. Indus. Claim Appeals Office, 5 P.3d 385 (Colo.App.2000).

If the employer or insurer files a FAL based upon the DIME, the case automatically closes after thirty days as to the issues admitted unless the claimant files a written contest and requests a hearing on any disputed issues that are ripe. Section 8-48-203(2)(b)(II); see also Dyrkopp v. Indus. Claim Appeals Office, 30 P.3d 821 (Colo.App.2001)(the language "as to the issues admitted" in § 8-48-208(2)(b)(II) must be interpreted as referring to issues on which the employer affirmatively takes a position, either by agreeing to pay benefits or by denying liability to pay benefits). Once a case has closed, the issues resolved by the FAL are not subject to further litigation unless they are reopened pursuant to § 8-48-308, C.R.S. 2004. Section 8-48-208(2)(d), C.R.S.2004; Cibola Constr. v. Indus. Claim Appeals Office, 971 P.2d 666 (Colo.App.1998).

Pursuant to § 848-803, "any award" may be reopened on the grounds of error, mistake, or change in condition. The intent of this statute is to provide a remedy to claimants who are entitled to awards of any type of benefits, whether medical or disability. Cordova v. Indus. Claim Appeals Office, supra.

The claimant has the burden of proof in seeking to reopen a claim. Richards v. Indus. Claim Appeals Office, 996 P.2d 756 (Colo.App.2000). The reopening authority is permissive, and whether to reopen a prior award when the statutory criteria have been met is left to the sound discretion of the ALJ. Renz v. Larimer County Sch. Dist. Poudre R-1, 924 P.2d 1177 (Colo.App.1996).

Here, the Panel determined the term "mistake" in the reopening provisions of § 8-48-303(1) does not include a mistake concerning an uncontested DIME physician's finding of MMI. The Panel concluded that it was impossible to give effect to the requirements of the DIME procedure and allow reopening of the MMI determination after closure based upon a mistake. The Panel reasoned that a contrary interpretation of § 8-48-808 would in *273 vite litigation on the issue of MMI by subjecting a DIME physician's determination of MMI to collateral attack under a diminished burden of proof. According to the Panel, if § 8-43-303 were read to allow a claimant to wait until after a claim closed before challenging a DIME on the issue of MMI, the claimant would then be able to overcome the conclusive effect of the DIME by presenting only a preponderance of evidence that the DIME physician "mistakenly" found the claimant at MML.

In construing a statute, we must determine and give effect to the intent of the General Assembly.

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Cite This Page — Counsel Stack

Bluebook (online)
128 P.3d 270, 2005 Colo. App. LEXIS 1279, 2005 WL 1903825, Counsel Stack Legal Research, https://law.counselstack.com/opinion/berg-v-industrial-claim-appeals-office-of-the-state-coloctapp-2005.