Public Service Co. of Colorado v. Industrial Claim Appeals Office

40 P.3d 68, 2001 Colo. J. C.A.R. 3252, 2001 Colo. App. LEXIS 1002, 2001 WL 693903
CourtColorado Court of Appeals
DecidedJune 21, 2001
DocketNo. 00CA1991
StatusPublished
Cited by1 cases

This text of 40 P.3d 68 (Public Service Co. of Colorado 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
Public Service Co. of Colorado v. Industrial Claim Appeals Office, 40 P.3d 68, 2001 Colo. J. C.A.R. 3252, 2001 Colo. App. LEXIS 1002, 2001 WL 693903 (Colo. Ct. App. 2001).

Opinion

Opinion by

Judge KAPELKE.

In this workers' compensation proceeding, Public Service Company of Colorado (employer) seeks review of the final order of the Industrial Claim Appeals Office (Panel) upholding an order by an Administrative Law Judge (ALJ). That order awarded medical impairment benefits to Lindsay Heyer (claimant) based upon a whole person impairment and included a determination that apportionment would be inappropriate. We affirm.

Claimant sustained an admitted low back injury in 1998. Previously, he had suffered a work-related low back injury in 1991 and a reinjury to his back in 1995. As a result of the 1991 injury, for which he underwent surgery, he received a permanent impairment rating of 16%. He was also placed under [70]*70permanent medical restrictions. The reinju-ry in 1995 resulted in no additional impairment.

After the 1998 injury, claimant underwent nerve root decompression surgery. His treating physician placed him at maximum medical improvement (MMI) on May 21, 1999, and rated his permanent medical impairment at 28% of the whole person. However, because of claimant's previous impairment, the treating physician reduced the rating to 8%. The division-selected physician who performed the independent medical examination (IME) reached the same result.

Claimant requested a hearing, arguing that while the whole person impairment rating of 28% was correct, apportionment was inappropriate because he was not suffering any disability from the 1991 injury at the time of the 1998 injury. Employer argued that the rating assigned by the division-selected physician who performed the IME involved a matter of causation, rather than apportionment, and therefore had to be overcome by clear and convincing evidence pursuant to § 8-42-107(8)(c), C.R.S.2000.

The ALJ agreed with claimant that apportionment was not warranted. In addition, the ALJ found that the issue of pre-existing disability pertained to apportionment, rather than causation. Consequently, he held that the preponderance of the evidence standard applied, rather than the clear and convincing standard.

On review, the Panel affirmed the unap-portioned award of benefits based upon a whole person impairment rating of 23%. This appeal followed.

I.

Employer initially contends that, in rejecting apportionment, the Panel erred in relying upon Lambert & Sons, Inc. v. Industrial Claim Appeals Office, 984 P.2d 656 (Colo.App.1998), because the holding in that case conflicts with the rule in Askew v. Industrial Claim Appeals Office, 927 P.2d 1333 (Colo. 1996). We disagree.

Apportionment based on pre-existing impairment is not proper unless the impairment was independently disabling at the time of the industrial injury. See Colo. Sess. Laws 1990, ch. 62, § 8-42-104(2) at 490 (now amended at § 8-42-104(2)(c), C.R.8.2000, to provide that an award of benefits for an injury shall exclude any previous impairment to the same body part).

In Askew v. Industrial Claim Appeals Office, supra, the supreme court determined that, for purposes of apportionment of permanent partial disability benefits, a "medical impairment" cannot be equated to a "disability." Relying on the American Medical Association Guides to the Evaluation of Permanent Impairment (8d ed. 1990)(A4MA Guides), the Askew court concluded that "impairment" relates to an alteration of an individual's health status as assessed by medical means, while "disability" pertains to an individual's ability to meet "personal, social or occupational demands" and is assessed by nonmedical means. The court held that apportionment of medical impairment under § 8-42-104(2) is appropriate only if the preexisting condition constitutes a disability.

The Askew court further recognized that the AMA Guides allow apportionment only when a prior impairment has been sufficient ly identified, treated, or evaluated to be rated as a contributing factor in the subsequent disability. The court therefore concluded that a pre-existing condition that was dormant or asymptomatic prior to the industrial injury, such as the degenerative back condition suffered by the claimant in that case, could not be evaluated adequately to support apportionment.

In Lambert & Sons, Inc. v. Industrial Claim Appeals Office, supra, a division of this court addressed a situation similar to that here. An impairment rating had been assigned for a prior industrial injury, but there was no pre-existing disability manifested at the time of the later work injury. Applying $ 8-42-104(2), which provides that only the percentage of the previous disability "as it existed at the time of the subsequent injury" is to be deducted from the overall percentage of the entire disability, the division held that apportionment is improper where a claimant's pre-existing condition has [71]*71resolved to the extent that he or she was asymptomatic at the time of the later injury.

Employer argues that the procedures for apportionment under the AMA Guides require that a physician consider any change in the prior impairments and that Lambert thus creates a conflict by requiring that a previously measured and evaluated impairment be disregarded. However, the holding in Lambert merely gives effect to the language of § 8-42-104(2) requiring a showing of some residual effect of the prior disability. Furthermore, both Askew and Lambert recognize that apportionment under § 8-42-104(2) depends not only upon the presence of a prior disability, but also upon a showing that the prior condition or injury contributed to the subsequent disability.

Thus, if a claimant's condition has improved to the extent that a disability is no longer present when the later injury occurs, that prior disability cannot be considered a contributing factor. The fact that apportionment under the AMA Guides concerns impairment rather than disability does not change this requirement.

Consequently, we reject the argument that the holding in Lambert is inconsistent with the analysis in Askew. Further, because we agree with the analysis and holding in Lambert, we reject employer's request that we decline to follow that decision.

IL.

Employer next contends that the Panel erred in upholding the ALJ's application of a preponderance of the evidence standard. We disagree.

The impairment rating assigned by the division-selected physician is binding unless overcome by clear and convincing evidence. Section 8-42-107(8)(c), C.R.S 2000; Metro Moving & Storage Co. v. Gussert, 914 P.2d 411 (Colo.App.1995). In assessing the impairment, the rating physician must identify and evaluate all the losses and restrictions resulting from the industrial injury. To the extent that process involves the determination of causation, it is an inherent part of the impairment rating, and the party challenging the IME physician's rating must show that it is highly probable that the rating is incorrect. Qual-Med, Inc. v. Industrial Claim Appeals Office, 961 P.2d 590 (Colo.App.1998).

Under the AMA Guides ch.

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40 P.3d 68, 2001 Colo. J. C.A.R. 3252, 2001 Colo. App. LEXIS 1002, 2001 WL 693903, Counsel Stack Legal Research, https://law.counselstack.com/opinion/public-service-co-of-colorado-v-industrial-claim-appeals-office-coloctapp-2001.