The Victory Lap
Cases You Should Know
Time period to reimburse mileage: Claimant was awarded penalties for Respondents’ failure to reimburse the Claimant for medical mileage within 30 days for alleged violation of W.C.R.P. 16-11 and C.R.S. §8-43-401(2)(a). However, ICAO held that the 30-day period to pay medical bills in Rule 16-11 and C.R.S. §8-43-401(2)(a) was applicable to uncontested medical bills submitted by a provider. Rule 18-6(E) does not specify a time limit within which to reimburse an injured worker for mileage. Therefore, ICAO held no penalties were to be awarded. Richardson v. Pizza Hut, Inc. and Zurich, W.C. 4-560-586 (ICAO February 7, 2014).
Conflicting DIME reports regarding MMI: In Simpson v. Safeworks LLC, and Insurance Company of the State of Pennsylvania, W.C. 4-877-091, (ICAO January 23, 2014), Claimant pursued a DIME and the DIME physician opined he had reached MMI. However, afterwards, the DIME physician issued an addendum DIME report and concluded the Claimant was not at MMI. The ALJ determined that the record contained conflicting MMI determinations by the DIME physician but that the DIME physician ultimately found Claimant not at MMI. As such, the ALJ placed the burden on Respondents to overcome the DIME opinion by clear and convincing evidence. The ALJ opined Respondents failed to overcome the DIME opinion. ICAO noted that if the DIME physician offers ambiguous or conflicting opinions concerning MMI, it is for the ALJ to resolve the ambiguity and determine the DIME physician’s true opinion as a matter of fact. ICAO upheld the ALJ’s determination.
Increased work restrictions do not always indicate worsening condition: In this Colorado Court of Appeals case, Claimant sustained an injury to his right shoulder. He did not immediately seek medical attention. The next day Claimant reported the injury to his employer. Claimant was seen by the physician assistant who released him to return to work with no restrictions. He was also given a drug test which was positive for morphine. Claimant was terminated. Afterwards, Claimant returned to the same clinic where the doctor ordered him “off work.” Claimant sought TTD benefits despite his termination, alleging his condition worsened after he was terminated and therefore his wage loss was attributable to his injury and not his termination. See Anderson v. Longmont Toyota, Inc.102 P.3d 323 (Colo. 2004); C.R.S. §8-42-105(4). The Court noted that the ALJ may consider several factors when considering whether a condition has worsened. An increase in work restrictions alone is not per se evidence of a worsening of condition. The Court upheld the ALJ’s order denying Claimant’s request for TTD benefits. Apex Transportation Inc. v. Vigil, W.C. No. 4-850-101 (Colo. App. March 13, 2014)(nsfop).
Injured worker lacks credibility when providing inconsistent mechanisms of injury: Claimant reported different mechanisms which caused her shoulder injury, including closing a truck door and lifting a heavy fish tank. Claimant also had a prior workers’ compensation injury to her right shoulder which had settled. Due to the numerous inconsistencies in the Claimant’s versions of events, the ALJ denied the Claimant’s claim for compensation, and ICAO upheld the determination. Wilcox v. JHCI Holdings and Zurich American Insurance, W.C. No. 4-884-343 (ICAO January 23, 2014).