Hire Quest, LLC v. Industrial Claim Appeals Office

264 P.3d 632, 2011 Colo. App. LEXIS 1522, 2011 WL 4089980
CourtColorado Court of Appeals
DecidedSeptember 15, 2011
Docket10CA2450
StatusPublished
Cited by5 cases

This text of 264 P.3d 632 (Hire Quest, LLC v. Industrial Claim Appeals Office) 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
Hire Quest, LLC v. Industrial Claim Appeals Office, 264 P.3d 632, 2011 Colo. App. LEXIS 1522, 2011 WL 4089980 (Colo. Ct. App. 2011).

Opinions

Opinion by

Judge GABRIEL.

In this workers' compensation proceeding, Hire Quest, LLC and its insurer, Ace American Insurance (collectively employer), seek review of a final order of the Industrial Claim Appeals Office (Panel) determining that claimant Jimmy Lassiter is entitled to ongoing medical treatment after the date of maximum medical improvement (MMI). Because we perceive no error in the Panel's conclusion that claimant did not waive his entitlement to such benefits, we affirm.

I. Background

In 2007, claimant sustained work-related injuries in a motor vehicle accident. The treating physician determined that claimant was at MMI in 2008, and a physician performing a division-sponsored independent medical examination (DIME) agreed. The DIME physician also issued an impairment rating and recommended further treatment.

Employer filed an application for a hearing on the issues of (1) permanent partial disability (PPD) benefits, (2) a penalty for an alleged safety rule violation by claimant (namely, his failure to wear a seatbelt in violation of employer's policy), and (8) overcoming the DIME physician's impairment rating. Claimant responded to this application and listed the issues to be determined as the safety rule violation, the alleged overpayment of benefits by employer, and overcoming the DIME physician's impairment rating. Employer, however, subsequently withdrew the issue of overcoming the DIME, leaving for determination at the hearing only the issues of a reduction of benefits based on the safety rule violation and a credit for previously paid temporary disability benefits.

In a 2009 order, the ALJ ordered employer to pay PPD benefits based on the DIME physician's uncontested rating. The ALJ, however, denied a reduction for the alleged safety rule violation, finding that employer had failed to prove such a violation, but agreed that employer was entitled to a credit for previously paid temporary disability ben[634]*634efits. The ALJ also stated, "Issues not expressly decided herein are reserved to the parties for future determination." This order was not appealed.

The ALJ's reservation clause became the issue of protracted litigation when claimant later filed an application for a hearing on the issue of his entitlement to ongoing medical benefits after MMI (Grover medical benefits). See Grover v. Indus. Comm'n, 759 P.2d 705, 711 (Colo.1988) (concluding that "future medical benefits may be entered" if "future medical treatment will be reasonably necessary to relieve the injured worker from the effects of the work-related injury or occupational disease"). Claimant argued that because the DIME physician recommended further medical treatment and employer never filed a final admission of liability (FAL) taking a position on that recommendation, Grover medical benefits could be awarded despite claimant's failure to raise the issue earlier.

Employer responded that claimant was not entitled to Grover medical benefits because, as pertinent here, (1) claimant's claim was closed after the 2009 order became final and no petition to reopen had been filed, and (2) by failing to request Grover medical benefits when the issue of PPD benefits was heard, claimant waived his right to those benefits.

A second ALJ agreed with employer that claimant had waived his right to pursue @rover medical benefits by failing to raise that issue at the hearing concerning PPD benefits. This ALJ also concluded that (1) employer was not required to file an FAL under the cireumstances of this case, and (2) the first ALJ's reservation clause was "mere surplus" because the 2009 order addressed PPD benefits and applicable case law "require[d] a claimant to litigate the issue of Grover medical benefits in connection with an award of PPD benefits."

Claimant appealed, and the Panel affirmed as to the ALJ's determination that employer was not required to file an FAL. The Panel, however, set aside the ALJ's finding that claimant had waived his right to Grover medical benefits. The Panel recognized the general rule that such benefits must be requested at the time permanent disability is determined and that claimant did not do so. The Panel concluded, however, that the reservation clause in the ALJ's 2009 order preserved claimant's right to seek Grover medical benefits, In so holding, the Panel disagreed with the second ALJ's characterization of the reservation clause as "mere surplus," stating, "We presume the intent [of the first ALJ] was to reserve unresolved issues such as entitlement to Grover medical benefits." The Panel thus remanded the case to the second ALJ to determine claimant's entitlement to such benefits.

On remand, the second ALJ awarded claimant Grover medical benefits. Relying on the medical evidence presented, including the opinions of the treating physician and the DIME physician, the ALJ found that "future medical treatment will be reasonably necessary to alleviate and prevent deterioration of [claimant's] condition." Employer appealed, and the Panel affirmed.

Employer now appeals the Panel's order affirming the award of Grover medical benefits to claimant.

II. Discussion

Employer contends that the Panel erred in rejecting its contention that claimant waived the issue of Grover medical benefits. Specifically, as pertinent here, employer asserts that (1) claimant waived his right to receive Grover medical benefits by failing to request them when the issue of permanent disability was heard, and (2) the issue of Grover medical benefits was never raised at the initial hearing and thus, could not have been reserved. We are not persuaded.

A. Applicable Law and Standard of Review

"[The right to future medical benefits may be waived if not requested at the time permanent disability is heard." Hanna v. Print Expediters Inc., 77 P.3d 863, 866 (Colo.App.2003). A claim may be litigated without reopening, however, if "an ALJ's award of benefits expressly reserves other issues for future determination." Id.

[635]*635Generally, whether a party has waived his or her rights is a question of fact. In re Marriage of Robbins, 8 P.3d 625, 630 (Colo.App.2000). When an ALJ's factual findings are supported by substantial evidence, we are bound by them. See § 8-43-308, C.R.S.2010; Paint Connection Plus v. Indus. Claim Appeals Office, 240 P.3d 429, 431 (Colo.App.2010). An agency's decision that misconstrues or misapplies the law, however, is not binding. Paint Connection Plus, 240 P.3d at 431. We review de novo questions of law or the application of law to undisputed facts. See Camp Bird Colo., Inc. v. Bd. of Cnty. Commrs., 215 P.3d 1277, 1281 (Colo.App.2009).

B. Application

Applying these principles here, we reject each of employer's above-noted assertions in turn.

1. Alleged Waiver Under Hanna

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Hire Quest, LLC v. Industrial Claim Appeals Office
264 P.3d 632 (Colorado Court of Appeals, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
264 P.3d 632, 2011 Colo. App. LEXIS 1522, 2011 WL 4089980, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hire-quest-llc-v-industrial-claim-appeals-office-coloctapp-2011.