Kelly v. Industrial Claim Appeals Office

214 P.3d 516, 2009 Colo. App. LEXIS 322, 2009 WL 540668
CourtColorado Court of Appeals
DecidedMarch 5, 2009
Docket07CA0970
StatusPublished

This text of 214 P.3d 516 (Kelly 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
Kelly v. Industrial Claim Appeals Office, 214 P.3d 516, 2009 Colo. App. LEXIS 322, 2009 WL 540668 (Colo. Ct. App. 2009).

Opinion

Opinion by

Judge FURMAN.

In this workers compensation claim brought against Western Eagle Ambulance District and its insurer, Pinnacol Assurance (collectively employer), Thomas Kelly (claimant) seeks review of a final order of the Industrial Claim Appeals Office (Panel) denying benefits for an injury sustained in a motor vehicle accident he alleges occurred in the quasi-course of his employment. We affirm.

*517 I. Background

Claimant required knee replacement surgery to treat an admitted industrial injury he sustained in 2008. The surgery was initially anticipated for October 2004, but employer's authorization for that surgery had not been granted. However, in the meantime, the surgeon had a cancellation resulting in an opening for an August 2004 surgery date, and therefore his office sought to reschedule claimant's surgery.

The rescheduling issue arose while claimant was traveling away from home on vacation. Claimant had previously driven from his residence in Gypsum, Colorado, to California, and then arrived in Reno, Nevada, on August 4. The next morning, claimant's wife called claimant and told him that he was scheduled to attend a preoperative appointment in Denver on August 6 at 10:20 am. Within an hour of the August 5 call from his wife, claimant began driving, and he testified that he intended to drive from Reno directly to his medical appointment in Denver because he would not have enough time to stop at his home in Gypsum. However, he also testified that he intended to take a longer route, which took him past his home in Gypsum, even though there was a shorter, more direct, route.

After driving about 300 miles, at approximately 1:05 p.m. Nevada time, claimant sustained multiple injuries in a motor vehicle accident near Elko, Nevada. Alleging that he was en route to an authorized medical appointment to treat his 2008 industrial injury, claimant asserted entitlement to workers' compensation benefits for the injuries from the 2004 motor vehicle accident.

The ALJ denied the claim, concluding that claimant failed to prove that he was within the quasi-course of his employment while driving in Nevada. This determination was based on a two-pronged analysis: (1) claimant failed to prove he was en route to the medical appointment at the time of the motor vehicle accident; and (2) the medical appointment was not authorized by employer prior to the accident.

As to the first prong, the ALJ found:

Claimant was not injured between his home in Gypsum and his appointment in Denver but was instead involved in an accident after a vacation in Nevada while on his way to Colorado. Claimant's route to his medical appointment in Denver would have taken him past Gypsum and he would have arrived at his appointment several hours before it was scheduled. The length and duration of [cJlaimant's trip from Reno to Denver attenuated the causal connection with his admitted industrial injury to the extent that it exceeded the reasonable range of consequences contemplated by the employment contract.

Regarding the second prong, the ALJ concluded that claimant failed to establish that the August 6 appointment and the August 19 surgery were authorized by employer before the motor vehicle accident occurred. Although authorization for the appointment and surgery was given on August 5, the same day as the accident, the ALJ found that the authorization did not occur until later in the day, after the time of the accident.

The Panel affirmed the ALJ's order based on the conclusion that claimant was not en route to the appointment at the time of the accident. Therefore, the Panel did not reach the authorization issue.

Claimant contends that under the quasi-course of employment doctrine, he is entitled to workers' compensation benefits for his motor vehicle accident. He asserts that the doctrine encompasses travel to a medical appointment even when the employee travels a long distance and does not begin the journey from his home. He also asserts that because he was scheduled for a preoperative appointment by an authorized provider, his appointment was automatically authorized and required no specific preauthorization. Because we conclude that there is no basis for disturbing the ALJ's factual determination that claimant was not en route to the appointment, we, like the Panel, need not reach the issue of authorization. See Schrieber v. Brown & Root, Inc., 888 P.2d 274, 278 (Colo. App.1993)(even though claimant was en route to treatment provider, claimant was not entitled to benefits under the quasi-course of *518 employment doctrine because treatment was unauthorized).

II. The Quasi-Course of Employment Doctrine

-It is well settled in Colorado that the quasi-course of employment doctrine extends workers' compensation benefits to injuries sustained while traveling to and from treatment by an authorized provider. Turner v. Indus. Claim Appeals Office, 111 P.38d 584, 5837 (Colo.App.2004) (expanding the doctrine to include a vocational rehabilitation evaluation). Because an employer is required to provide medical treatment, and an injured employee is required to submit to it, a trip for authorized treatment becomes an implied part of the employment contract. Price Mine Serv., Inc. v. Indus. Claim Appeals Office, 64 P.3d 986, 937 (Colo.App.2003); see Schrieber, 888 P.2d at 277 ("Liability is extended because these activities would not have been undertaken but for the compensa-ble injury ...."); see also 1 A. Larson & Lex K. Larson, Larson's Workers' Compensation Law § 10.07, at 10-20 to 10-23 (2007).

Awarding compensation for a motor vehicle accident becomes more complicated when there is a deviation from the route of travel for medical treatment. The Colorado courts have not yet addressed this issue. See Tur-mer, 111 P.3d at 535 (claimant was injured after stopping for lunch on the way home from an authorized appointment; although the ALJ "found that neither the restaurant stop nor the wrong turn constituted a deviation from the trip home," deviation issue was not appealed).

Other states, at least those which accept the underlying premise that travel for medical treatment is in theory compensable and lack specific statutes on the topic, have reached different resolutions based on various facts. As a general rule, substantial deviations curtail coverage, while minor deviations do not. Compare Kodiak Oilfield Haulers v. Adams, 777 P.2d 1145, 1149 (Alaska 1989) (five-day delay in returning home after work-related treatment ended the com-pensability of claimant's return trip; "at some point the length of an employee's delay in returning home does function to destroy the trip's work connection regardless of whether it increases or lessens the risk of the return journey"), and Joplin v. Indus. Comm'n, VIS Ariz. 524, 858 P.2d 669, 673 (Ct.App.1993)(three-hour delay in returning home after finishing with treatment-related activities ended compensability of claimant's return trip), with Preway, Inc. v. Davis, 22 Ark.App.

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Bluebook (online)
214 P.3d 516, 2009 Colo. App. LEXIS 322, 2009 WL 540668, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kelly-v-industrial-claim-appeals-office-coloctapp-2009.