2021 Workers’ Compensation Rule and Statute Updates

Spring is in the air – it must be time for Colorado legislative and Division of Workers’ Compensation updates.  As always, L&B is here to ensure you are aware of and understand them all.  Below is our review of the April 30th changes, the upcoming changes effective July 1st, as well as proposed legislation. 

Round 1. Rules first:

Rule 2: Workers’ Compensation Insurance Premium and Payroll Surcharge (EFFECTIVE 7/1/21)

Last year, Of Counsel Frank Cavanaugh pointed this rule out, as an approved rate reduction in “loss costs” had occurred. This year it again went down.   Loss costs are the average cost of lost wages and medical payments paid to or on behalf of the injured worker.  This is a component of an employer’s premium calculation.  Rule 2 changes do not have anything to do with claim handling and, therefore, do not require coverage.

 

Rule 4: Carrier Compliance (EFFECTIVE 4/30/21)

4-1(A): The changes in this section are primarily removing language and have little practical effect; however, it is important to understand the content. Believe it or not, some of the terminology throughout the rules did not match.  So efforts were made to apply clarity.

4-1(C): In this section again, language was removed, and it was clarified that fines can be imposed if the carrier does not meet 90% or higher compliance in each of the 10 categories audited.

4-1(D): The change under this section requires that after the carrier receives the preliminary audit they may request an extension of time beyond the 30-day time frame  to disagree with the findings. The request, however, must be submitted in writing within the 30 calendar days from receipt of the report to respond. If the response is not submitted in writing, it will be considered a “waiver of the right” to file a disagreement with the audit.

There were some additional changes under this section; however, these changes were not substantive.

4-2Fines for Claims Audits

4-2(E): The change to this section removed the fines per audit deficiency per compliance category. The rule provides for a fine for deficiencies in each category; however, they removed the increased fine for “subsequent finable occurrences”.

 

Rule 5: Claims Adjusting Requirements (EFFECTIVE 7/1/2021)

 5-1:  Completion of Division Forms

 5-1(D): This was an added section requiring electronic filing. It specifies that there can only be one file per electronic submission and all attachments must be included. You must include the claimant’s first and last name and the type of document being filed with a certificate of the date it was submitted. It is specific that admissions, petitions to modify, terminate, suspend, request for lump sum payments, and motions to close for lack of prosecution must be sent to  CDLE_DOWC_FILINGS@STATE.CO.US.  It also formalized a requirement recently added that all motions to close must have email addresses for all parties or they are to be submitted via regular mail.

All motions, other than those to close a file, and submissions for prehearings and settlements must be submitted to CDLE_DOWC_PREHEARINGS@STATE.CO.US. All other communications are to be submitted to CDLE_WORKERS_COMPENSATION@STATE.CO.US.

 

5-2: Filing of Employers First Report of Injury

5-2(B)(1): This change requires the filing of a First Report of Injury within 3 days of notice to the insurance carrier or the self-insured when a fatality occurs, or when 3 or more employees are injured in the same accident.

5-2(B)(2): Language was added to emphasize that a First Report of Injury must be filed no more than 10 days after notice to an employer or self-insured of an occupational disease resulting in lost time from work in excess of 3 shifts or calendar days, occurrence of permanent physical impairment, or contraction of a specified occupational disease.

 

 5-5(A): Admissions of Liability

 The language changed to specifically require that the narrative report and the worksheets should include a statement from the authorized treating physician regarding the date of maximum medical improvement, permanent impairment, and the need for maintenance medical benefits. Under paragraph (1), if maintenance medical benefits are being denied,  a reference must be made to the date of the medical report which supports your denial, along with the physician’s name. The DOWC has already changed the FAL forms. Under paragraph (3) (dealing with medical-only claims that have been reported to the Division), if no impairment, either a narrative report or the physicians report of workers’ compensation injury form can be used as long as they are attached.

 

5-8: Admission for Permanent Total Disability Benefits

In this section (B)(2) was removed, which required receipt or proof of payment of compensation to the claimant through the date of death.

 

5-9: Revising Final Admissions

 The change to this rule removed paragraph (C), which dealt with admissions of liability on or after July 1, 1991- and before August 5, 1998. This change appears to be more housekeeping in nature.

 

Rule 6: Modification, Termination or Suspension of Temporary Disability Benefits  (EFFECTIVE 7/1/2021)

The changes in this rule are to clarify terminology. Under paragraph 6-1(A)(2), there was a change from the term “regular employment”  to “full or regular duty.”  Paragraph 6-1 (A)(3)  changed “report” to “Statement” and added language regarding claimant returning to work “at full wages and hours.”  The other changes clarified language but did not substantively change the rule.

 

6-4: Suspension, Modification or Termination of Temporary Disability Benefits by Petition

The significant change in this rule is under paragraph (B). When retroactively decreasing temporary benefits but with a previously filed admission of liability, the petition must be filed within 30 days of the original admission and this process cannot be used for a safety rule violation. The right to set a hearing remains and is usually needed for the denial of the petition.

 

7-1: Closure of Claims and Petitions to Reopen (EFFECTIVE 7/1/2021)

7-1(C)(1):  This was added confirming the Division’s position that they will not allow case closure for failure to prosecute if a claimant is receiving temporary disability benefits. Under paragraph (2), they have also emphasized the motions or petitions to close can be submitted via email if there are email addresses for all parties. If not, they are to be filed by mail.

 

7-2: Petitions to Reopen

The change in this rule outlines that the process to reopen a claim is by filing an application for hearing endorsing the issue of reopening. It effectively took away the process of a petition to reopen on a standard Division form.

 

Round 2. Legislation:

Legislation is a yearly struggle, given the makeup of the legislature in Colorado. We see a continual battle to shift the control of claims to the claimants which, of course means, to their attorneys. Each year there are behind-the-scenes negotiations to try to compromise what could be drastic changes, and this year is no exception.

 

SB21-096: Sunset Workers’ Compensation Classification Appeals Board

Most of you would not be involved with this process. This board was set up to hear grievances brought by employers against insurers concerning the calculation of experience modification factors and classification assignment decisions. This board was due to expire and it has now been continued with clarification. This was signed by the Governor on April 15, 2021 and is the law.

 

HB21-1213: Conversion of Pinnacol Assurance

This bill was introduced to change Pinnacol from a political subdivision of the state to a stock insurance company. It is now postponed indefinitely.

 

HB21-1207: Overpayment of Workers’ Compensation Benefits

There has been a push through legislative actions and through the case law to dramatically alter the ability of respondents to collect overpayment of benefits. This bill defines overpayment in a very restrictive manner, to include only benefits paid as a result of fraud, or duplicate benefits that are resultant of offsets regarding disability or death benefits. It does still allow for offsetting and taking credit for any indemnity benefits paid beyond the date of MMI. If the error was a miscalculation issue, it can be remedied within the 30 days allowed for an objection to the admission. This bill is still under consideration.

 

HB21-1050 Workers’ Compensation

 This bill has been referred to as the compromise bill. There are some major inclusions, which in the past have given flexibility, but now the outcome is defined.

  1. In the present form, if passed, the bill will require appointment of Guardian ad litem and conservators to the list of medical aid that an employer must furnish.
  2. This bill also limits credit for Social Security benefits to those benefits which the claimant was not receiving at the time of injury. In the past, we have been able to take credit for SSDI benefits even though they were being received at the time of injury.
  3. The ability to take apportionment against TTD, TPD and medical benefits is gone. The ability to reduce PPD and PTD is still at issue.
  4. There are also specific limitations when selecting IME physicians.
  5. One of the more drastic changes that will affect benefits is changing the percent of impairment needed to exceed the first PPD cap from 25% to 19%.
  6. Respondents will now be unable to withdraw an Admission of Liability when two years have passed from the admission, with the exception of fraud.
  7. For the purpose of appeals, this bill would require the Director or the ALJ to award benefits when compensability or liability are at issue. This does help respondents, as claimants can’t get an order that a case is compensable and prevent an appeal of that decision as the ALJ didn’t order benefits paid. There are also discussions regarding appeals, orders, and the review process.
  8. The amount that a claimant must earn for respondents to reopen a prior determination of PTD is increased from $4,000 to $7,500.
  9. The claimant will now have to submit mileage reimbursement within 120 days and the carrier has 30 days to pay or dispute.

This bill is currently still being considered so the final version is unknown.

 

SB21-197: Workers’ Compensation Physician

This bill is probably the most dangerous of them all. Over the past several years, claimants’ bar has pushed to reduce and change respondents’ ability to control medical care. This bill, if enacted, will give all control of choice of physician to the claimant.

The current designation of physician process would be gone. The employer would have 7 business days after notice of the injury to give the employee or claimant an authorized physician designation form developed by the Director. At that point, the claimant would be able to designate any level I or level II accredited physician as the authorized treating physician. They are able to make this designation up until the time they reach MMI. The claimant can also make a request to have his/her personal physician or chiropractor be the treating physician. If the treating physician will no longer treat the claimant, the insurer or self-insured must advise the claimant that they need to choose a new physician.

This bill is currently in the Senate Business, Labor, and Technology Committee so the final version is unknown.

If you have any questions about the updated Rules, or any employment or workers’ compensation related question, please contact Lee & Brown, LLC.

 

New OSHA Guidance for Implementing a COVID-19 Workplace Prevention Program

The Occupational Safety and Health Administration (“OSHA”) has finally published updated guidance on implementing safe workplaces during the COVID-19 pandemic.  On January 29, 2021, the guidance titled  “Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace” was published. (U.S. Dept. of Labor – OSHA) “Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace.”

It is important to note that this remains only general guidance from OSHA.  The guidelines do not create a standard or regulations that legally obligate employers to comply.  The below guidelines have been issued to assist employers in either continuing to provide or transitioning into a safe COVID-19 workplace.  OSHA has indicated that these guidelines can be used to mitigate the spread of COVID-19 and implement proper protection procedures.  The Guidance provides that the following measures should be taken:

  1. Create a workplace coordinator responsible for COVID-19 issues on the employer’s behalf.
  2. Identify where and how workers might be exposed to COVID-19 at work, including a thorough hazard assessment identifying potential workplace hazards related to COVID-19.
  3. Identify a combination of measures that will limit the spread of COVID-19 in the workplace, in line with the principals of the hierarchy of controls: elimination/substitution, engineering controls, administrative controls and safe work practices.
  4. Consideration of protections for workers at higher risk for severe illness through supportive policies and practices.
  5. Establishment of a system for communicating effectively with employees in a language they understand.
  6. Educating and training workers on the employer’s COVID-19 policies and procedures, which includes having accessible formats and in a language they understand.
  7. Instructing workers who are infected or potentially infected to stay home and isolate or quarantine.
  8. Minimize the negative impact of quarantine and isolation on workers.
  9. Non-discriminatory isolation of workers who show symptoms at work.
  10. If not already, the indoctrination of enhanced cleaning and disinfection after people with suspected or confirmed COVID-19 have been in the facility.
  11. Provision guidance on screening and testing.
  12. Recording and reporting COVID-19 infections and deaths to OSHA.
  13. Implementing protections from retaliation and setting up an anonymous process for workers to voice concerns about COVID-19-related hazards.
  14. Making a COVID-19 vaccine or vaccination series available at no cost to all eligible employees.
  15. Not distinguishing between workers who are vaccinated and those who are not.

If you have any questions about employment or workers’ compensation issues, please contact one of the attorneys at Lee & Brown, LLC.

2020 Workers’ Compensation Rule Updates

The Division of Workers’ Compensation seems to be on a constant mission to tweak various workers’ compensation rules of procedure.  Some of these changes are directed at situations that clearly need attention, while others are less clear.  This year is no different.  There have been several rule changes from the Division of Workers’ Compensation that take effect at the first of the year or have already taken effect.  I will try to break down the rule changes as briefly and clearly as I can.

 

Rule 2: Workers’ Compensation Insurance Premium and Payroll Surcharge EFFECTIVE 7/1/20

As you may or may not be aware, an approved rate reduction in “loss costs” occurred this year.  Loss costs are the average cost of lost wages and medical payments paid to or on behalf of the injured worker.  This is a component of an employer’s premium calculation.  Rule 2 changes do not have anything to do with claim handling and, therefore, do not require coverage.

 

Rule 16: Utilization Standards EFFECTIVE 1/1/21

16-2 Standard Terminology for Rules 16, 17 and 18

Believe it or not some of the terminology throughout the rules did not match.  Here are some housecleaning efforts.

16-2(E): You may not have known this, but a “certified medical interpreter” had a specific definition.  They were individuals with certification from the Certification Commission for Healthcare Interpreters or the National Board of Certification for Medical interpreters.  16-2E struck the definition of a Certified Medical Interpreters.  If you recall, several years ago there were concerns raised that medical conditions referenced by the injured worker were not making it into reports based on language barriers.  This requirement had the unintended consequence of making it hard to find a certified medical interpreter, hence the change.

16-2G: There has been inconsistency throughout the rules in that some rules used “business days” for time measurement while others simply used “days.”   This particular change clarifies that “day” is a calendar day unless otherwise noted.  So now day means day unless the rules says business day, or some other type of day.  This really does clarify things.

16-2H:  If I used the term designated provider list in the workers’ compensation setting what you think it would mean?  If you struggled for an answer other than the doctor list the employer provides to an injured worker join the club.  Well never fear, this change clarifies that “designated provider list” means the physician list as required under Section 8-43-404(5)(A)(1), C.R.S.

16-2N & Q:  This rule change better defines a non-physician provider to include a surgical assistant.  It also defines a “Physician Provider” as someone who is board licensed in their area of practice.  For instance, a physician provider would need to be licensed by the Colorado Medical Board, a dental provider would have to be licensed by the Colorado Dental Board, etc.  It is recommended to simply review this rule if the question is encountered.

16-3A:  This requires that any provider not listed in 16-2 as a “Physician Provider” requires prior authorization to provide services for a work injury.

16-3B, C & D:  This now requires that all providers have a referral from a physician provider managing the claim (or NP/PA working under that physician provider).  It used to be that only non-physician providers had to have a referral from a physician provider, but now it is everybody.

16-6:  This rule deals with a provider’s notification to treat an injured worker.  It basically sets forth the way in which a provider advises a payer of the treatment to get paid for that treatment.  This year’s change requires the payer’s response time to a notification to treat.  It goes from 5 business days to 7 calendar days.  Although this makes the rule more uniform, in certain circumstances, such as determining a holiday that would otherwise not be included as a business day, this could make it difficult to respond to such a request.

16-7:  Prior Authorization issues are always difficult.  This section of Rule 16 changes the payer’s response time from 7 business days to 10 calendar days.  Once again, while making the rule more uniform in certain circumstances, such as determining a holiday that would otherwise not be included as a business day, this could make it difficult to respond to such a request.

16-7-1:  Deals with prior authorization denials – when a denial is made based upon a medical report that predates the request. Under this change, an IME or report from an ATP used to deny a prior authorization request based solely on relatedness to the injury cannot be older than one year from the date of the prior authorization request.  Further, such a report can only be used if there is not an admission of liability filed admitting the relatedness of the requested treatment, or a final order has not been entered finding that the specific medical condition is related to the admitted injury.  Otherwise, the IME report or ATP opinion must be after the prior authorization request.  The thinking behind this rule change is that a stale report cannot be used to deny prior authorization request.  One wonders what happens when the request is for the same treatment over and over.  Can the requests get stale too?

16-7-2:  This section deals with appeals of a prior authorization denial.  Now the requesting party has 10 days from the date of the denial to appeal the denial.  By the same token the payer has 10 days from the date of the appeal to issue a final decision.

16-9A & B: This section deals with required medical record documentation to get paid.  This rule was modified so that a claimant’s functional response to treatment no longer needs to be documented.  There is also no longer a requirement that the documentation reference specifics for a treatment plan.

16-10A:  This section deals with payment requirements for medical bills.  There was a suggested change that would have no longer required bills be submitted by a provider but could be submitted by anybody.  Fortunately, over these suggested changes that would have allowed submission by the attorney or party, the rule remains that the submission must be made by the provider.

16-10-2A:  This section deals with denying payment of billed treatment for non-medical reasons.  This change to this section now allows for denial for non-medical reasons for improper use of a CPT code.

16-10-2C:  When denial for non-medical reasons the payer’s denial does not have to be made within 30 days of receipt of the bill.

16-10-4: this section deals with appealing billed treatment that has been denied.  The billing party has 60 days from the date of the written notice to request reconsideration to appeal.  The appeal now has to have the specific code being appealed.

 

Rule 18 Medical Fee Schedule EFFECTIVE 1/1/21

18-4(I): Telemedicine:  This provides guidelines and requirements for telemedicine.  Telemedicine must comply with requirements found under the Colorado Medical Practices Act and the Colorado Mental Medical Board and the Colorado Board of Psychologist Examiners.  A physician-patient relationship must be established for telemedicine to occur.  The same documentation required of an in-person evaluation is required of telemedicine.

18-9D: App-Based Interventions:  This new subsection allows the provider to write an order for an app-based intervention for the injured worker.  For instance, as part of biofeedback perhaps the apps Hello Mind or Mindspring could be prescribed.  For more physiologic app, perhaps some sort of activity tracker would be prescribed.  Such an order is to have a designated time frame for use and must be payable by invoice and billed directly to the payer the maximum allowable charges $25 a month and the maximum duration is three months per order. Anything over this amount requires prior authorization.

 

If you have any questions about the updated Rules, or any employment or workers’ compensation related question, please contact Lee & Brown, LLC.

The Legal Buzz – Lee & Brown Newsletter and Case Law Update Nov 2020

Lee and Brown Partners
Thank you for taking the time to read our Firm newsletter. Our newsletter provides a monthly update
on recent developments within our Firm, as well as in the insurance defense community in
Colorado, Arizona and Utah.
Lee and Brown Denver AttorneysFollow us on LinkedIn

 


In The News

Lee & Brown is happy to announce the opening of our Arizona office located at 4742 N. 24th St., Suite 300, in Phoenix.  Our University of Colorado Law School Graduate, Michael Salazar, who has been clerking on our Arizona cases over the past year has relocated back to his home state of Arizona and is our local presence in Phoenix.  Mr. Salazar will be working closely with our Colorado-based attorneys licensed in Arizona – Joseph Gren, Emily Miller, Timothy Murphy and Jens Omdal.  Together, we are ready to diligently represent you, our clients, in the state of Arizona, just as you have come to depend on us in the state of Colorado.  Through the years, our approach in the practice of law has been quite simple:  provide  aggressive representation and protection of clients’ interests, with a goal of bringing all cases to resolution in the most cost-effective and expeditious manner possible.  We are happy to be able to expand this same philosophy to our employers and insurers who need us in the state of Arizona.


A Day in the Life of the Partners during COVID

Quarantining during a pandemic can change things.  We thought we would check in with our Lee & Brown Partners to see how each of them are handling their new reality …

 
 

Katherine Lee – Life during a pandemic for anyone presents challenges.  Life during a pandemic as a business owner and parent of two graduating high school seniors in their transition to  college freshmen has provided our family with quite the roller coaster ride … complete with all the twists, turns and inverted corkscrews that may leave even the most resilient of us begging to get off the ride.  Who would’ve guessed 6 months ago the state of our world as it is today?  Not many … perhaps not any.  Yet, here we are.

 

Professionally, our Firm and personnel have successfully transitioned from a very social and personally interactive work environment to a remote office space through which we had to, willing or not, learn new work processes, navigate through a multitude of various video conferencing platforms and find new ways to stay connected.  We couldn’t be prouder of our attorneys and our staff for their commitment and fortitude in meeting the challenge so unexpectedly placed before them.  Our ability to provide the best quality legal representation to our clients has not been even marginally compromised at any time during this unprecedented time of uncertainty.  And most importantly, we have been able to maintain our standard of quality without compromising the physical and mental health and wellness of our employees and their families.

 

Our family story, like many others, has been radically different than was planned prior to this pandemic.  Our sons, Dane and Seth, both graduated from high school this spring, turned 18 this summer and are off to college this fall – all without any of the pomp and circumstance or celebratory traditions that are supposed to appropriately mark their hard-earned accomplishments and milestones.  There has been disappointment.  There has been heartache.  There has even been some anger, bitterness, frustration, and tears – and not just from the adolescents.  Alternatively, there has also been golfing, baking/cooking, hiking numerous fourteeners, golfing, making music, spending time with close friends and family, puzzles, remote learning, golfing, endless (and sometimes it feels endless) passing of the time just being together – without the chaos.  It is refreshing to actually have the time to feel and be present in the moments instead of passing and rushing through them to get on to the next thing.  Hopefully, when we have all moved on to the other side of life with COVID, the passing of time and a return to some form of the lifestyle to which we all knew as “normal”, we will find our memories of the present, although void of the grand celebrations, the travel, vacations and parties, are happy ones.  In the end, I’ve decided that enjoying the ride – no matter the challenges that come along with it – is the WAY better alternative.

 
 

Joshua BrownMy family’s quarantine can be summarized in four words:  “a collection of moments.”  Three boys create many moments that are hard to summarize.  Sure, there are holes in the wall, and a box of 1000 Gold “Phish” crackers showering the kitchen floor.  Let’s not forget the tantrums at the end of screen time.  Wow, cute kids no more!  And yes, broken toys and banisters, stains on the hardwood floors and challenges to our sanity.  But the best is that it brought our family together for new board games, puzzles, morning golf ball hunting adventures and food.  We’ve really got it Simple because we’ve got a band.  I love my band! 

 
 

Karen Gail Treece –  I am loving being at home with my husband, Reno, and our boys, James and Jon, who have been home from college since spring break.  Jon has had very limited leave from the US Naval Academy, so it has been a gift to have them both at home.  Jon has spent his summer at the dining room table studying Calculus III and Military Ethics online.  James has been carefree and built his own computer.  Reno makes lunch for everyone, so we have two meals a day together as a family.  I have been stuffed into a very small corner of Reno’s office, but the commute is stress-free.  It has been amazing to try cases on Google Meets, not so fun to try an 8-hour, 6 witness case on the phone, however.  I’ve come a long way since starting my practice using a typewriter and carbon paper.  I guess you can teach an old dog new tricks!

 
 

Joseph Gren – During this time of isolation, I have been taking advantage of running and competing in virtual marathon and half marathon races (the next one being the full San Francisco marathon which was cancelled earlier this year), mountain biking in the Colorado hills, frequently cycling nowhere on the Peloton, reinventing gourmet recipes way too late at night, and expanding my knowledge of old world wines; specifically, of the Rhone Valley in France and of eastern Spain.  I continue my quest to paddle board every lake in the Front Range and have avoided getting a sunburn so far even with my bad habit of not applying enough sunscreen, which I would be doing anyway despite the global pandemic.  Quarantine has also provided an opportunity for creative vacation planning.  In lieu of cancelled trips to Thailand, Costa Rica, and Ireland, we instead camped on remote beaches in the Southeast, which greatly improved my ukulele skills, as well as traveling to interesting wineries across the county in an effort to support their businesses.  In my free time, I listen to others’ opinions on the new Netflix and Amazon shows, as well as hearing from my secretary about the joys of reconciling less vigorous travel expense reports!

 
 

John AbrahamI’ve been working from home and spending time with my family.  Early on, remote learning was very challenging.  We are glad summer came quicker than expected.  There has been a lot of family time spent baking, playing board games and re-visiting old video games from the past.  There have also been many lemonade stands, water balloon fights and a new puppy, Gumbo, to keep everyone occupied during quarantine.  Gumbo keeps us very busy, but the time together and coming up with creative ways to have fun as been nothing short of memorable and special.  I have enjoyed spending lots of time bonding and trading war stories with many adjusters and employers through weekly Zoom conference calls and phone calls through this COVID experience. 

 
 

Fran McCracken – My COVID experience has actually been quite educational.  I’ve learned a lot about toilet paper, face masks and foster dogs.  You might be surprised to learn that when ordering toilet paper from China, it takes as long as twelve weeks to arrive.  When it does show up, it’s in party colors (think lime green, shocking orange and black).  There is also no cardboard place holder.  A case of toilet paper, twelve two-ply rolls, is compressed to the size of a 6-pack of Coke.  Who knew?  As far as face masks – while necessary, I am not a big fan.  However, from now on, I am always going to wear a face mask when going to the grocery store.  I want to be disguised when buying obscene amounts of junk food.  In “stay-at-home” mode, I also decided it would be a great time to foster a dog.  Thirteen dog beds, two comforters, several pillows, a leather couch and one cell phone later, I am pretty sure I know the reason this guy was surrendered to the shelter.  The happy ending is he was adopted to a wonderful family that adores him.  Despite his path of utter destruction, I miss the nut job.  Lesson learned that things are just things.  What matters most now, and always, is that we show kindness, love and support to each other.  We are all struggling to deal with this, in one way or another.  And while our experiences differ, we truly are all in this together.

 
 

 


Colorado recently took steps to increase the salary threshold for employees falling under the “white collar” exemptions.  On January 22, 2020, the Colorado Department of Labor adopted the Colorado Overtime and  Minimum Pay Standards Order #36 (“COMPS Order”), with most of its provisions becoming effective on March 16, 2020.   The new minimum salary thresholds for exemption from overtime began on July 1, 2020.  The COMPS Order makes significant changes for both exempt and non-exempt employees, and further outlines critical Colorado wage rights and responsibilities.  Continue reading the full article.

 
 

Cases You Should Know

Won’t You Be MMI Baby Tonight?: In Destination Maternity v. Burren, 463 P.3d 266 (Colo. 2020),  Claimant sought review of an ALJ’s determination of the date she reached MMI, despite there being no finding of MMI by her ATP or the DIME physician. The ICAO upheld the ALJ’s Order and Claimant petitioned for review. The Colorado Court of Appeals set aside the ALJ’s Order and remanded. The employer and its insurer petitioned for certiorari review to the Colorado Supreme Court, which was granted, and the Supreme Court held that once an ALJ concludes that an employer or an employer’s insurer has overcome a DIME doctor’s MMI opinion, the ALJ may determine the claimant’s MMI status and permanent impairment rating as questions of fact.

 

Moral of the story:  If the DIME is overcome, the ALJ may determine MMI and permanent impairment rating as a question of fact.

 
 

Risky Business – Neutral Risk or Special Hazard?: In Richardson v. Gronedyke Transport, W.C. No. 5-109-865 (May 8, 2020), Respondents sought review of the ALJ’s Order which determined, among other issues, that the claim was compensable. Respondents challenged the ALJ’s finding that Claimant’s injury (which occurred when Claimant reportedly mis-stepped off a curb) sufficiently established the causal connection required by the “arising out of” component of §8-41-301(1), C.R.S. Instead, Respondents argued the injury was idiopathic in nature due to a preexisting condition and that the “special hazard” doctrine therefore applied. Under this doctrine, employees must not only demonstrate that there were specific connections to employment in cases not involving “neutral risks,” but also that he or she was exposed to an additional “special hazard” of employment. The ICAO Panel held that the special hazard doctrine only applied to cases involving an idiopathic condition and that the existing disease of an employee does not disqualify a claim if the employment “aggravates, accelerates, or combines” with the disease to produce the injury. The Panel concluded the ALJ did not err in determining that Claimant’s injury was not idiopathic, and that the special hazard analysis was inapplicable.

 

Moral of the story: If an employee’s injury/disability was not idiopathic, the “special hazard” doctrine cannot apply because a claimant may still seek benefits if his/her employment compounded or exacerbated a preexisting condition.

 
 

Health is Wealth: AWW and Health Insurance: In Varela v. Umbrella Roofing, W.C. No. 5-090-272 (May 8, 2020), Claimant sought review of an ALJ’s Order that denied his request to increase his AWW by the cost of health insurance premiums paid by Claimant and his employer. Claimant opted out of the health insurance coverage offered by the employer when he could no longer afford to pay his portion of the premiums while on TTD benefits. Claimant argued that his AWW should be increased by the cost of the contributions to his health insurance made by the employer and Claimant.

 

The ALJ relied upon Plute v. Home Depot, which held that that the cost of continuing health insurance benefits is not included in the AWW if a claimant has not been terminated. In this case, Claimant continued to be eligible for health insurance because he was not terminated by the employer. Additionally, §8-40-201(19)(b), C.R.S., excludes the cost of health insurance from the AWW calculation if the employer continues to pay its portion of the health insurance premium after the injury. The ICAO affirmed the ALJ’s Order, holding Claimant failed to prove an entitlement to an increase in AWW. This case stands to uphold many years of preceding cases, all of which conclude that health insurance costs are not factored into the AWW calculation so long as a claimant is still employed, and can continue to engage in the employer’s group health plan.

 

Moral of the story: The cost of continuing health insurance is not added to the AWW calculation if the claimant remains employed and the health insurance continues to be available through the employer.

 
 

To Be or Not To Be… The Story of an Independent Contractor: In Holsinger Drywall Inc. v. ICAO, 19CA1013 (Colo. App. 2020), the Court of Appeals remanded the decision of the ALJ to apply Pella Windows & Doors, Inc v. ICAO, 2020 COA9. Claimant was injured while installing drywall for employer and sought workers’ compensation benefits. The ALJ determined that because Claimant was an independent contractor, he was not entitled to benefits. Upon appeal, the ICAO set aside the ALJ’s  Order and decided that the claim was compensable.

 

The ICAO focused on three questions based on ICAO v. Softrock Geological Services, Inc., 2014 CO 30. First, did the employer use Claimant as a member of its work force similar to an individual employee? Second, did Claimant work the number of hours for the employer characteristic of a full-time job? Third, did Claimant ever look for work from another employer? The first two questions were answered in the affirmative, and the last question was answered in the negative. The ICAO found that the answers to these questions suggest that Claimant was not an independent contractor. In Pella Windows & Doors, the Panel held that the factors articulated in the Softrock case, apply to workers’ compensation cases. The Appellate Court concluded that the ICAO did not err in applying the Softrock factors and analysis to the issue of whether Claimant was an independent contractor. The case was remanded by the Panel to the ALJ for additional findings of fact consistent with Pella Windows. A worker status as an independent contractor is a factual determination for the ALJ.

 

Moral of the story: The decision in Pella Windows effectively applies Softrock to workers’ compensation cases expanding the analysis for determining whether a worker is an employee or an independent contractor beyond the factors enumerated in §8-70-115(1)(c), C.R.S.  The determination is a question of fact for the ALJ.

 
 

Weakened Condition and Subsequent Injury Cause and Effect: In City of Colorado Springs v. ICAO, (nsfp), the City of Colorado Springs sought review of an Order from the ICAO upholding an award of benefits to Claimant. An ALJ determined that Claimant’s spinal infection and resulting paralysis were related to his work injury and compensable. The appellate court affirmed, finding that substantial evidence existed to support the ALJ’s determination. Claimant initially sustained a muscle and tendon strain of the thorax while carrying equipment for work. Claimant required hospitalization for severe back pain and lower extremity swelling, which resulted in an infection of the disc in between the vertebrae and paraplegia in his lower extremities. The City argued that the infection and paraplegia were caused by an intervening event and were not compensable. The ALJ rejected this argument and awarded Claimant medical and TTD benefits. The Court of Appeals highlighted the chain of causation analysis, whereby symptoms that develop later may also be compensable. This analysis is reserved for cases in which the industrial injury leaves the body in a weakened condition, which plays a causative role in the subsequent injury. The Court relied upon Jarosinski v. ICAO, which supports that it is not necessary for the work conditions to have directly caused Claimant’s infection if Claimant’s weakened condition was a contributing cause of the infection.

 

Moral of the story: A subsequent injury or symptom may be compensable if a claimant’s initial injury leaves he/she in a weakened condition; thus, contributing to the subsequent symptom or condition.

Colorado Overtime & Minimum Pay Standards Order

Colorado recently took steps to increase the salary threshold for employees falling under the “white collar” exemptions.  On January 22, 2020, the Colorado Department of Labor adopted the Colorado Overtime and  Minimum Pay Standards Order #36 (“COMPS Order”), with most of its provisions becoming effective on March 16, 2020.   The new minimum salary thresholds for exemption from overtime began on July 1, 2020.  The COMPS Order makes significant changes for both exempt and non-exempt employees, and further outlines critical Colorado wage rights and responsibilities.  The COMPS Order replaces the Minimum Wage Orders previously issued by the Division and supplements the thresholds  provided by federal law, under the Fair Labor Standards Act.  Under the Order, whenever employers are subject to it, as well as to federal and/or local labor laws, the law providing the greatest protection to employees shall apply.  Contrary to previous wage orders, under the COMPS Order virtually all private employers, in all industries, will be subject to Colorado’s minimum wage, overtime and working condition rules, unless they fall into one of the specifically enumerated exceptions.  The Order requires employers to track, record, and compensate all non-exempt employees for all “time worked”.  The Order redefines “time worked” as all the time for which the employer requires or permits an employee:

 

To be on the employer’s premises, on duty, or at a prescribed workplace (but not merely permitting an employee completely relieved from duty to arrive or remain on-premises) — including but not limited to, if such tasks take over one minute, putting on or removing required work clothes or gear (but not a uniform worn outside work as well), receiving or sharing work-related information, security or safety screening, remaining at the place of employment awaiting a decision on job assignment or when to begin work, performing clean-up or other duties “off the clock,” clocking or checking in or out, or waiting for any of the preceding. . . .

COMPS Order Rule 1.9.1.

 

Under the Order, beginning July 1, 2020, the annualized salary required for an employee to be considered “exempt” is $35,568.00, with some exceptions for nonprofits and small businesses.  After 2020, the salary threshold for exempt employees will rise every year on January 1st.   The COMPS Order also imposes a wide array of additional requirements relating to a variety of issues, including meal and rest periods, employer-provided uniforms, permissible wage deductions, calculation of non-hourly pay for overtime, and posting and distribution requirements for ease of employee access.  Employers have only one month to comply with all documentation and notices required by the Order, such as new posters, employee handbook inserts, acknowledgment forms, etc.  Interpretive Notice & Formal Opinion (INFO)#1: Colorado Overtime & Minimum Pay Standards Order (COMPS Order) #36, which can be found on the Colorado Division of Labor’s website, summarizes key parts, interpretations of, and exemptions to, COMPS Order #36.

 

If you have any questions about the requirements of COMPS Order #36, or any employment or workers’ compensation-related question please contact Lee & Brown, LLC.

NEW COLORADO RULE ADDRESSING “USE-IT-OR-LOSE-IT” VACATION POLICIES


As of December 15, 2019, the Colorado Department of LaborUse-It-Or_Lose_It and Employment (CDLE) has a new rule in place clarifying that companies may cap but not take away employees’ earned, unused vacation pay. The viability of “use-it-or-lose-it” vacation policies under the Colorado Wage Claim Act (the “Act”) has been in flux for years, with the latest conflict stemming from a 2019 Colorado Court of Appeals decision upholding a policy under which employees forfeited vacation pay in some circumstances (e.g., if they resigned without providing two weeks’ notice). The CDLE’s new rule (7 CCR 1103-7, Rule 2.15) rejects the Court of Appeals’ holding and clarifies that an employer may have a policy limiting how vacation pay accrues but may not diminish earned vacation days other than through an employee’s actual use of vacation time.

Colorado employers with conditional vacation payout policies should immediately address the application under the new rule.  If needed, consultation should be made with an employment law attorney to address a companies’ needs.  Companies should address the difference between having vacation policies and general “paid-time off” policies.  The new rule is not applicable to the latter type of policies.  Therefore, companies with vacation only policies should address the potential implications of wage exposure to employees under the new rule.  For example, upon termination, under the new rule, an employee with unused vacation time is now entitled to wages for that unused time.  Conversion over to general “paid-time off” policies may be better suited to avoid this type of liability.

As always, if you have any questions regarding employment or workers’ compensation insurance laws, please contact one of the attorneys at Lee & Brown, LLC.

The Legal Buzz – Lee & Brown Newsletter and Case Law Update October 2019

Lee and Brown Partners
Thank you for taking the time to read our Firm newsletter. Our newsletter provides a monthly update
on recent developments within our Firm, as well as in the insurance defense community in
Colorado, Arizona and Utah.
Lee and Brown Denver AttorneysFollow us on LinkedIn

 


 In The News

Lee & Brown was well-represented this year by Members Joshua D. Brown and John Abraham at the NAMWOLF Annual Meeting and Law Firm Expo held in Los Angeles September 22-25th.  A member of the National Association of Minority and Women Owned Law Firms since 2013, Lee & Brown is proud to be a part of this outstanding organization and its efforts to promote diversity in the legal community by connecting companies who support this fundamental initiative with the minority and women-owned law firms and legal vendors who embody it and seek opportunities to succeed.

Josh and John’s very well received contribution to the conference was the screening of their video, “THIS is NAMWOLF”, shown at the conference awards banquet.  The video was an entertaining sequence of NAMWOLF member interviews conducted by the dynamic duo during the conference exposition.  In it, members themselves were able to express and share with all attendees their personal insights into what this national organization means to them and its profound impact in creating a more diverse culture throughout the legal community.  Click here to watch the video.

 

 

Lee & Brown was a platinum sponsor at the Professionals in Workers’ Compensation Annual Golf Tournament, held this year at Raccoon Creek Golf Course on September 20th.  Out representing the Firm in style were Members Katherine Lee and Josh Brown; Of Counsel, Frank Cavanaugh, Jessica Melson and Angela Lavery; as well as Associate Matt Boatwright.  Lee & Brown regularly sponsors this event which promotes the camaraderie and fellowship amongst workers’ compensation professionals from both sides of the Bar and in related fields and businesses.  This year, the PWC held a funniest hole contest, which Lee & Brown took very seriously and won!  Our Caddyshack theme was a huge success and we want to thank everyone who visited us at the Bushwood Country Club, hole no. 17!

 

 

 

 


   Noteworthy Cases – Colorado

 

Member Joshua D. Brown and Associate Kristi M. Robarge successfully defended a claim for TTD benefits and proved Claimant was terminated for cause in Hansen v. J-R Motors Company North, W.C. 5-101-017. Claimant sustained an admitted injury when she slipped and fell in the car sales lot while showing a vehicle to some customers.  When Claimant sought treatment for her injury, she underwent a post-accident drug screen.  Claimant tested positive for marijuana and was terminated by Respondent-employer for violation of the drug policy.  Claimant sought TTD benefits. Respondents argued that Claimant was terminated for cause and was not entitled to TTD benefits.  Claimant argued that her employer knew about her drug use because she took a pre-employment drug screen and was still hired; however, evidence showed that Respondent-employer did not test for marijuana in the pre-employment drug screens.  Since Respondent-employer had a strict drug policy and Claimant admitted knowledge of the policy, the ALJ found that Claimant was terminated for cause and not entitled to TTD benefits.

 

Member Karen Gail Treece, successfully defended a full contest claim in Lopez-Pando v Martin Marietta Materials, W.C. No. 5-081-406. Claimant alleged depression as well injuries to his low back, bilateral shoulders and cervical spine, which he claimed resulted from moving a frozen mud/rock clod from a conveyor belt into a chute on April 9, 2018. Claimant’s testimony of the size of the clod was inconsistent with that described by the credible employer witnesses. Ms. Treece elicited testimony that Claimant was using short term disability and did not report this as a work injury claim until the day after the expiration of his short term disability. Claimant’s testimony attributing his injury to a specific event was inconsistent with what he had told his physicians. Medical records demonstrated Claimant had underlying pre-existing conditions affecting his left shoulder, low back and neck. The ALJ did not find the Claimant’s alleged multiple injuries from the described mechanism of injury credible, and found no persuasive evidence of an acute injury. The ALJ determined Claimant failed to prove he suffered a compensable injury or occupational disease.

 

Member Fran McCracken successfully defended against Claimant’s attempt to reopen his claim in Luszko v. Allied Universal, W.C. 5-034-956. Claimant originally filed a claim for compensation and an Application for Hearing in January 2017. The case was closed following Respondents’ Motion to Close for Failure to Prosecute in January 2018, pursuant to the Director’s Show Cause Order. In June 2019, Claimant filed a second Application for Hearing endorsing multiple issues, including compensability and a petition to reopen on the basis of a change in condition. Because there was no determination of compensability of the injury prior to claim closure, Respondents filed a Motion for Summary Judgement arguing the Claimant was precluded from reopening his case on the basis of a change in condition, having never established a compensable injury for the condition to have changed. The ALJ agreed with Respondents’ interpretation of the facts and law, granted Respondents’ Motion for Summary Judgment and struck Claimant’s June 2019 Application for Hearing with prejudice.


 

Where’s My DIME?

One of the main strategies in workers’ compensation claims involves the selection of a particular venue for the DIME process. For numerous years, Rule 11 was silent on the selection of a location for the Division IME. The party requesting the DIME had the option of selecting any venue in Colorado for the appointment to take place. From there, the DIME unit would select 3 physicians in the geographic location that the selecting party indicated on its Application and the DIME process would move forward. Essentially, any part of Colorado was “fair game”  as the location in which to conduct a DIME. Continue reading the article

 


Cases You Should Know

Keep an Eye on the Statute of Limitations: In Packard v. Industrial Claim Appeals Office of the State of Colorado and City and County of Denver, Colorado, 2019COA146 (Colo. App. 2019), Claimant appealed the Panel’s holding that his claim was barred by the statute of limitations. Claimant claimed a workplace injury arising from his job duties as a firefighter for the City and County of Denver. On August 5, 2013, the City filed a report of Injury. On August 6, 2013, the City filed a Notice of Contest. On October 6, 2017, Claimant applied for hearing seeking medical and TTD benefits. Section 8-43-103 provides a 2-year general statute of limitations. The Court of Appeals held that a Notice of Contest, a First Report of Injury, and assignment of a W.C. number do not constitute notification that a Claimant is claiming entitlement to indemnity benefits within the meaning of the statute of limitations. Thus, the Court of Appeals found that Claimant’s Application for Hearing, filed 4 years after the date of injury, was untimely and his claim for indemnity benefits was barred by the statute of limitations.

Moral of the story: In order to satisfy the statute of limitations, a Claimant seeking compensation must file an Application for Hearing or Claim for Workers’ Compensation within 2 years.

 

If Benefits are Granted, File the GAL: In Miller v. Industrial Claim Appeals Office of the State of Colorado and City and County of Denver, Colorado, 18CA1894 (Colo. App. 2019), Claimant appealed the Panel’s affirmation of the denial and dismissal of her claim for penalties. The parties had gone to hearing on Claimant’s claim for entitlement to medical and indemnity benefits. The ALJ ruled in Claimant’s favor. Under Rule 5-5(C)(1) of the Colorado Workers’ Compensation Rules of Procedure, an employer has thirty days to file a general admission of liability following an ALJ’s resumption or increase of benefits. The Employer filed the GAL more than thirty days after the ALJ’s Order. Claimant subsequently applied for hearing on penalties for the Employer’s alleged failure to comply with Rule 5-5(C)(1). The Court of Appeals held that the rule was not triggered because the ALJ’s Order did not cause a resumption or increase in benefits, as no benefits had been previously paid to Claimant. Thus, the Court of Appeals affirmed that Claimant was not entitled to penalties.

This opinion is an unpublished opinion of the Court of Appeals meaning it is not binding upon lower courts. Nevertheless, following its issuance, an amendment to the rule was proposed altering its language to state that a GAL must be filed “[f]ollowing any Order (except for Orders which only involved disfigurement) becoming final which alters OR AWARDS benefits.” A public hearing regarding the adoption of this rule has not been set as of the publication of this newsletter.

Moral of the story: To avoid exposure for penalties, file a GAL after an ALJ’s order instituting payment of benefits to claimant.

 

Can you earn it?: In Jose Cruz Verdeja v. Bakers Transmission Service, W.C. No. 5-047-467 (ICAO August 19, 2019), the Claimant sought review of the ALJ’s Order denying his entitlement to PTD benefits. The Claimant sustained a compression fracture to the low back on May 19, 2017.  The Claimant underwent conservative care; however, surgery was not recommended. The Claimant was placed at MMI on March 29, 2018.  The Claimant was assigned permanent work restrictions in the light duty category.  The Claimant contended that he was permanently and totally disabled and unable to earn any wages. In preparation of hearing, Respondents retained an IME and vocational evaluation.  Respondents’ vocational evaluator identified multiple positions within the Claimant’s permanent work restrictions.  The positions considered the Claimant’s education, skills, and commutable labor market.  The ALJ credited the opinions of Respondents’ experts.  The Claimant argued that the positions identified by Respondents’ vocational evaluator were beyond his work restrictions.  ICAO affirmed the ALJ’s ruling finding that the issue of PTD is primarily factual and that her ruling was supported by substantial evidence in the record.

Moral of the story:  PTD is determined on a factual basis and an ALJ’s order will only be overruled if not supported by substantial evidence in the record.

 

Shifting Burdens and the DIME: In James Jones v. The Mitre Corporation, W.C. No. 5-034-047 (ICAO August 27, 2019), the Pro Se Claimant’s claim was found compensable for injury sustained to the neck and ears in the form of tinnitus, but not for his alleged hearing loss, as the result of being exposed to a loud noise. The Pro Se Claimant was placed at MMI on June 26, 2018 and assessed a 4% whole person permanent impairment rating of the cervical spine.  Respondents requested a DIME.  At the DIME, the Pro Se Claimant, without leave of court, presented the prior ALJ’s Order regarding compensability/causation for review by the DIME doctor. The doctor assessed a 14% whole person permanent impairment award for the cervical spine but did not address causation.   Respondents filed an Application for Hearing to overcome the DIME and requested a Samms conference with the DIME doctor to clarify her opinion and to determine whether she used the prior Order to influence her assessment and opinions on causation pertaining to the cervical spine.  The doctor changed her opinion after the Samms conference and assessed no permanent impairment rating for the cervical spine. At hearing, the ALJ ruled that the Pro Se Claimant improperly influenced the DIME doctor by presenting her with the prior ALJ’s Order. In addition, the ALJ ruled that the Pro Se Claimant reached MMI as of February 26, 2017, with no permanent impairment based on the DIME doctor’s subsequent testimony from the Samms conference.  On appeal, the Pro Se Claimant argued that the ALJ misapplied the burden of proof as it was Respondents who appealed the opinions of the DIME.  ICAO affirmed the ALJ’s Order and indicated that once an ALJ determines the DIME opinion concerning MMI and impairment, then the party seeking to overcome those opinions bears the burden of proof by clear and convincing evidence.

Moral of the story:  When a DIME physician offers conflicting opinions on MMI, impairment or causation, the ALJ is to resolve the conflict and to determine the true opinion of the DIME physician. As such, the burden may shift to the party who disagrees with the ALJ, not necessarily the party who initially sought to overcome the DIME.

 

An Unjoyful, Joy Ride: In Rush v. Enterprise Leasing, W.C. No. 5-081-615 (ICAO September 6, 2019), the Claimant was injured as a  passenger in a motor vehicle accident. The Claimant and a co-worker drovethe company vehicle to another location to pick up more vehicles.  En route, the co-worker drove down a dirt road and took off traction control before accelerating rapidly, which caused the vehicle to flip over several times.  Respondents argued that the Claimant’s activities in the vehicle constituted horseplay and was a personal deviation from his employment.  The Claimant testified that he believed they were traveling to the second location to pick up vehicles and did not have any part in the joy ride down a dirt road.  The ALJ credited the Claimant’s testimony and found the claim compensable.  The Respondents appealed the decision, arguing that the ALJ cannot rely on the Claimant’s subjective beliefs about the joy ride and deviation in her decision.  ICAO disagreed and found that there was substantial evidence to support the ALJs findings that the Claimant was not involved in a deviation from work.

Moral of the story: Non-participating victims of horseplay are entitled to workers’ compensation benefits because the employment placed them in the “zone of danger” created by the horseplay.

 

Covering your tracks: In Hansen v. Bavarian Inn Restaurant, Inc., W.C. No. 5-061-844 (ICAO September 4, 2019), the Claimant appealed a decision of the ALJ that he was terminated for cause and not entitled to TTD benefits.  Claimant worked at a bar in downtown Denver where a fight occurred between employees of the bar and patrons entering the establishment.  During the fight, Claimant was hit in the head several times and a co-worker was shot.  While filling out an incident report, the Claimant was permitted to review the surveillance video of the incident.  The following day, the employer was unable to access the surveillance video and noted that the Claimant’s Google drive was open on the computer.  The Claimant admitted to uploading the surveillance videos to his Google drive account. Claimant was charged with tampering with evidence. The employer had a written policy prohibiting disclosure, distribution, transmission or copying of confidential information and the Claimant had signed a document affirming his knowledge of this policy.  The ALJ found that the Claimant was provided permission to view the surveillance video but not upload any files to his personal Google drive account. The ALJ found that the Claimant’s actions violated the company’s written policy, which led to his termination.  The ALJ denied and dismissed the Claimant’s claim for TTD benefits.  ICAO upheld the ALJ’s Order.

Moral of the story: Having written policies that employees review, with receipt acknowledgment of same, helps prove termination for cause.

Where’s my DIME?

One of the main strategies in workers’ compensation claims involves the selection of a particular venue for the DIME process. For numerous years, Rule 11 was silent on the selection of a location for the Division IME. The party requesting the DIME had the option of selecting any venue in Colorado for the appointment to take place. From there, the DIME unit would select 3 physicians in the geographic location that the selecting party indicated on its Application and the DIME process would move forward. Essentially, any part of Colorado was “fair game” as the location in which to have a DIME. From a strategy perspective, selecting a specific geographical location for the DIME to take place could prove advantageous for the requesting party depending on the pool of physicians within that location. For example, it was not uncommon for residents from Fort Collins to request a DIME in Colorado Springs. One of the most common requests involved residents of Grand Junction traveling to Denver for their DIME appointment.

Respondents in certain geographical regions also had the strategy of requesting a pre-emptive DIME on a claim in which the treating physician placed the claimant at MMI with no impairment. For example, if a claimant in Colorado Springs was placed at MMI without impairment and was almost certain to request a DIME in Colorado Springs, Respondents would have the option of going for the DIME themselves as a pre-emptive measure and to take away claimant’s right to select a particular, more liberal venue to have the DIME.

Rule 11 is still silent on the venue for a DIME to take place. However, the recent changes to the Application for a DIME have added a specific portion to the Application form regarding venue selection. On the Application for a DIME, it states as follows, “preferred geographical location of examination. (The location in which the claimant resides may take precedence over the preferred location).” Of note is the use of the word “preferred” and specifically noting that claimant’s residence may take precedence instead of the preferred location selected. This is a new change that the DIME unit is focusing on and it appears in the past several months that the DIME unit is using a reasonableness standard when selecting physicians in a particular geographic location. For example, Respondents may want to challenge a treating physicians’ rating from the western slope and request a DIME in Denver. Gone are the days in which a three-doctor Denver panel was guaranteed. Instead, the DIME unit may put a combination of Denver and western slope physicians on the panel for selection. The process involves many variables as to which physicians are on the panel, including but not limited to, available physicians, specialties, current physicians performing DIMEs, timing, etc.

This new approach by the DIME unit is a topic of discussion and poses many issues. One issue is whether the venue preference will be applied equally to both parties and if bias is removed from the panel selection process. If Respondents are getting physicians from a select geographical location but claimants are not, (and vice-versa), it doesn’t present fairness to the DIME process for both parties. Another issue is the amount of physicians present in one geographic location and whether the pool of DIME physicians throughout the state are performing examinations routinely. For example, if Colorado Springs is frequently selected as a venue, and physicians within that pool are performing DIMEs more frequently than other physicians, does it eliminate the concerns that the new changes to the Rule hoped to address in having a wider variety of physicians participate in the process? Yet another issue is either party wanting a specific venue due to a fact specific reason in the claim, and not particularly receiving it despite the request of one or both parties. The new Rule allows the parties to agree to a number of issues, including the physician to perform the DIME and the cost. However, can the parties agree to a venue when there is a disagreement to the physician and cost?

Major changes to any Rule are usually met with many questions about its implementation. Venue selection for the DIME process has always been a strategic focus for both parties and now poses even more questions based on the changes to the Application for DIME. Now that the DIME unit is exercising some control over the venue selection, it may change the focus of the strategy for the DIME in a different direction. Respondents may want to rely upon the fact that a DIME panel may not entirely be composed of physicians within one region, but instead, focus on the potential for obtaining a panel with more variety that could ultimately impact the case in different ways. Employers and carriers may want to focus the fight on a different aspect of the DIME such as cost. In light of the changes to Rule 11, it is important to discuss the DIME strategy with counsel and the client to ensure that all of the facts and potential options are being discussed to best forward the claim to resolution. Always remember that the Prehearing Unit retains jurisdiction to resolves issues pertaining to the DIME. Once a Motion is filed, the DIME is held in abeyance pursuant to Rule 11. If the parties are able to agree on the venue, it may be worthwhile to reduce the agreement to a stipulated Order and provide a copy of it to the DIME unit so that there is no question as to which physicians can be selected from a certain geographical region.

If you have any questions regarding the changes to the Rules or the updated statutes, feel free to contact any of the attorneys at Lee & Brown, LLC.

The Legal Buzz – Lee & Brown Newsletter and Case Law Update September 2019

Lee and Brown Partners
Thank you for taking the time to read our Firm newsletter. Our newsletter provides a monthly update
on recent developments within our Firm, as well as in the insurance defense community in
Colorado, Arizona and Utah.
 
Lee and Brown Denver AttorneysFollow us on LinkedIn

 


 

   Noteworthy Cases – Colorado

 

Members John Abraham and Fran McCracken successfully defended against Claimant’s claim of a compensable occupational disease in Vargas v. Cargill Meat Solutions, W.C. 8-093-534-001.  Claimant worked as a snout trimmer and alleged to have suffered bilateral carpal tunnel syndrome as a result of an occupational disease.  At hearing, Ms. McCracken elicited testimony from Respondents’ expert that Claimant’s duties as a snout trimmer did not meet the causation requirements for carpal tunnel syndrome.  Furthermore, Claimant’s job duties lacked the sufficient force to cause a work-related condition pursuant to Rule 17, Exhibit 5 of the Division’s Medical Treatment Guidelines. The ALJ credited the opinion of Respondents’ expert and found Claimant failed to prove that he suffered an occupational disease in the form of bilateral carpal tunnel syndrome.  The claim was denied and dismissed.

 

 In Gammill v. Walmart Associates Inc., Member Fran McCracken successfully defended against Claimant’s claim of compensability for a back injury. Respondents sought to withdraw a General Admission of Liability, based on prior medical records indicating that Claimant’s back injury was pre-existing. Respondents’ medical expert also testified that Claimant’s congenital deformity was an incidental finding not related to the work injury and that  fusion surgery to treat low back pain should only be considered after conservative treatment was exhausted. The ALJ found that Claimant failed to meet his burden of proving entitlement to workers’ compensation benefits by a preponderance of the evidence. Respondents were therefore permitted to withdraw the GAL as improvident.

 

Member Fran McCracken also successfully defended against a claim for penalties for the alleged failure to timely pay a lump sum settlement amount to Claimant within fifteen days in McDonald v. Walmart Associates Inc. The ALJ found that Claimant failed to demonstrate that penalties should be assessed for Respondents’ untimely payment of the settlement check. Specifically, the ALJ noted that Respondents acted reasonably in ensuring that Claimant timely received the check by stopping payment on a first check that was issued and requesting a new check be overnighted to Respondents’ counsel while consistently communicating with Claimant’s counsel regarding the arrival of the check. Additionally, the ALJ found that Respondents cured the issue of delayed settlement prior to Claimant filing the Application for Hearing and Amended AFH, which resulted in the curing of the alleged violation as allowed by statute.

 

Noteworthy Cases – Arizona

 

Before The Industrial Commission of Arizona, Associate Daniel Mowrey defended Claimant’s full contest claim in Johnson v. KWD Enterprise, Inc., ICA No. 20183310358.  Claimant alleged a low back injury as a result of her employment as a home health care nurse.  Claimant stated that she was injured while lifting a patient in her bed. At hearing, Mr. Mowrey elicited testimony from Claimant that she did not initially report the injury or seek treatment for over two weeks following the alleged injury.  Claimant further admitted to not filing a claim for workers’ compensation until her unemployment benefits were denied. Mr. Mowrey also submitted an expert medical opinion that the claim was not compensable. The ALJ found the testimony and corresponding medical records did not meet the standard to establish an industrial injury.  The ALJ denied and dismissed the claim.

 


Working from Home and Workers’ Compensation

 While telecommuting is not realistic for every company, many jobs have at least some component that employees can perform flexibly, even if a job requires an employee to be onsite for specific hours. The question then arises, “What is an employer’s liability for injuries occurring at an employee’s home or when traveling between the home and work?”  A compensable injury is one which “arises out of” and “in the course of” the employment.   An injury “arises out of” a work-related activity if it is “sufficiently interrelated to the conditions and the circumstances under which the employee usually performs his job functions that the activity may reasonably be characterized as an incident of employment, even though the activity itself is not a strict obligation of employment and does not confer a strict benefit on the employer.” City of Boulder v. Streeb, 706 P.2d 786 (Colo. 1985). Continue reading the article

 


Cases You Should Know

Enough of this Horseplay!: In Rifle Tequilas, Inc. and Truck Insurance Exchange v. Pena Alvarez, No. 18CA1367 (July 11, 2019), Claimant was a restaurant employee who sustained injuries to his facial area as a result of an altercation with another employee. Claimant, as permitted by the employer, had a beer after the restaurant closed. The altercation regarding the beer arose while Claimant was washing dishes. The ALJ found the claim to be compensable, notwithstanding the Respondents’ argument that Claimant was engaged in horseplay at the time of injury. Specifically, the ALJ used the four factor test from Lori’s Family Dining, Inc. v. ICAO to determine whether the horseplay deviated so substantially that Claimant’s resulting injury was not compensable: (1) the extent and seriousness of the deviation; (2) the completeness of the deviation, i.e. whether it was commingled with the performance of a duty or involved in an abandonment of duty; (3) the extent to which the practice of horseplay had become an accepted part of the employment; and (4) the extent to which the nature of the employment may be expected to include some horseplay. The ALJ found the claim to be compensable, noting that Claimant was permitted to drink beer while working, the altercation involved the beer, and there was “no credible evidence” that Claimant was reprimanded for prior altercations. Thus, the ALJ concluded that horseplay was “an inherent part of the workplace.” The Court of Appeals noted that the finding of the extent of a deviation is a question of fact for the ALJ and that a claimant is not required to prove every element of the four-part test. Rather, the ALJ’s finding only needs to be sound and readily discernible based on the factors.

 

Moral of the story: Horseplay may be considered an inherent part of the workplace when there are no consequences for prior acts of horseplay.

 
 

Grant or Deny? The Director Will Decide: In Webster v. Czarnowski Display Service Inc., W.C. No. 5-009-761 (July 16, 2019), Claimant sought to change his physician under C.R.S. § 8-43-404(5)(a). The Director of the Division of Workers’ Compensation denied Claimant’s request, as Claimant sought treatment for injuries and conditions not related to his work injury. The ICAO held that the Director has broad discretionary authority to grant a Claimant’s request for a change of physician. In this case, Claimant’s request was based on his personal dissatisfaction with his physician. The ICAO upheld the Director’s denial of Claimant’s request, as there was no abuse of discretion.

 

Moral of the story: The Director and ALJ have broad discretion in granting a request for change of physician under C.R.S. § 8-43-404(5)(a).

 
 

IME on My Way: In Wanner v. Patterson UTI Drilling Co, W.C. No. 5-065-967-001 (July 17, 2019), ICAO affirmed an ALJ’s Order that found Claimant’s claim compensable.  Claimant was initially injured at work on December 22, 2017, when he was struck by a board on his left side. Claimant sustained additional injuries on March 28, 2018, while driving home from an IME.  There were two primary issues in this claim: 1) whether the initial injury on December 22, 2017 was a compensable claim; and 2) whether Claimant was entitled to ongoing medical benefits following the motor vehicle accident on March 28, 2018. Respondents argued on appeal that the motor vehicle accident was an intervening event that severed the causal connection.  The ALJ opined that Respondents’ intervening event argument was based on the mistaken premise that an injury during travel to an IME appointment is an intervening event. The ALJ ruled, and the ICAO agreed, that under the “quasi-course of employment” doctrine, an injury occurring during travel to and from authorized medical treatment is compensable.  The ALJ’s Order was affirmed.

 

Moral of the story: Injuries that occur during travel to and from authorized medical treatment are compensable.

 
 

Safety First? Sometimes: In Burd v. Builder Services Group Inc., d/b/a Mato, W.C. No. 5-058-572-01 (July 9, 2019), Respondents sought review of the ALJ’s Order that denied a reduction in disability benefits due to a safety rule violation and increased the average weekly wage (AWW).  Claimant was injured when he fell off a roof while installing fire insulation products.  Claimant was not attached to a safety line, as was required; therefore, Respondents reduced his temporary benefits by 50% due to the imposition of the safety rule penalty pursuant to C.R.S. § 8-42-112(1)(b).  The ALJ found that the employer did not prove Claimant willfully violated the safety rule, as the employer’s management did not consistently understand the rule itself. Additionally, the ALJ found that the employer did not enforce the safety rule.  The ICAO found that there was substantial evidence to support the ALJ’s ruling.  The ALJ’s Order was affirmed.

 

Moral of the story: If the safety rule is not regularly understood and enforced, you will not be successful in taking the 50% safety rule violation reduction.

Working From Home and Workers’ Compensation

In 2019, Colorado earned the top spot for the highest percentage of employees Working From Homewho work from home, according to Flex.Jobs  https://www.flexjobs.com/blog/post/infographic-which-stateshave-most-full-time-telecommuters.  While telecommuting is not realistic for every company, many jobs have at least some component that employees can do flexibly even if a job requires an employee to be onsite for specific hours.  Perhaps the employee reconciles call logs or works on quarterly reports on a Sunday afternoon.  The question then arises, “What is an employer’s liability for injuries occurring at an employee’s home or when traveling between the home and work?”  A compensable injury is one which “arises out of” and “in the course of” the employment.   An injury “arises out of” of a work-related activity if it is “sufficiently interrelated to the conditions and the circumstances under which the employee usually performs his job functions that the activity may reasonably be characterized as an incident of employment, even though the activity itself is not a strict obligation of employment and does not confer a strict benefit on the employer.” City of Boulder v. Streeb, 706 P.2d 786 (Colo. 1985). For example, in Schwindt v. Red Roof Delivery Inc., W.C. No. 4-009-534 (September 14, 1992), the Claimant, a restaurant manager, was injured when she fell down a stairway in her home at approximately 4:30 a.m., sustaining significant injuries.  The Claimant had been working on schedules for the employer, and was authorized, but not required, to do so at home.  The Claimant was performing this work in her living room, but began to fall asleep, so she gathered her materials to go to an office adjoining her bedroom.  Just prior to approaching the stairway, the Claimant closed a door.  The resultant reduced lighting impeded the Claimant’s visibility. Claimant lost her step in the hallway and fell down the stairs.  The Claimant testified she “probably” would have taken a shower and returned to scheduling had the fall not occurred.  The ALJ concluded the injury was compensable.  He found the Claimant’s work demands permitted her to complete administrative work at home, and that, at the time of the fall, the Claimant “would have been asleep in bed” had she not been working on the schedules.  The Respondents made several arguments on appeal, including that the connection between the fall and the Claimant’s employment was too remote, and that the Claimant’s act of closing the door severed the causal connection.  The Panel rejected the Respondents’ arguments, holding there was a sufficient nexus between the conditions of employment and the injury.  The Panel reasoned, the claimant “need only have been acting in a manner consistent with, or incidental to, the employment” to establish compensability.

 

Similarly, in Bates v. Coors Brewing Co., W. C. No. 4-348-224, 1998 WL 872454, (Nov. 13, 1998), the Claimant worked as a plant manager for the employer. On May 14, 1997, the Claimant left the employer’s plant in her personal vehicle to travel home, where she was going review work-related material she was taking on a business trip the following day. On her way home, the Claimant was injured in a motor vehicle accident.  The ALJ found the claim compensable, holding the Claimant’s travel home on this occasion was in pursuit of the employer’s business and conferred a benefit to the employer beyond her own presence at work.  On appeal, Respondents contended that the facts of this case did not fall within the travel status exception because the Claimant was not required to work at home and was not required to bring her personal vehicle to work. The Panel rejected Respondents’ arguments, holding an injury does not have to be the result of a mandatory employment activity to be compensable. University of Denver v. Nemeth, 127 Colo. 385, 257 P.2d 423 (1953);  Rather, it is sufficient if the injury arises out of a risk which is reasonably incidental to the conditions and circumstances of the particular employment.  This includes discretionary or “optional” activities on the part of the employee which are devoid of any duty component.

 

The case Roe v. Alpine Plumbing & Heating, Inc., W.C. No. 3-766-435, 1987 WL59197, (July 20, 19987), had similar facts, but a contrary result.  In Roe, the Claimant who was employed by Respondent as a plumber, was injured in an automobile accident.  The Claimant testified that the accident occurred while he was “driving up to the job” near Boulder. As a result of a previous injury, the Claimant was performing light-duty work for the Respondent.   The Claimant’s duties included working on plans at his home. However, the ALJ found that the Claimant was “allowed to work at home for his own convenience” and that “the Claimant’s home was not an alternative job site.” Consequently, the ALJ concluded that the Claimant was not within the course and scope of his employment at the time of the accident.

 

Finally, in Sedgwick CMS v. Valcourt-Williams, in a 12-2 decision, the District Court of Appeals of Florida, reversed an ALJ’s decision awarding worker’s compensation  benefits to an at home worker.  During working hours on  April 27, 2016, Valcourt-Williams, a workers’ compensation claims adjuster, reached for a cup of coffee in her kitchen and tripped over one of her dogs, fell and sustained injuries to her knee, hip and shoulder.  She filed a worker’s compensation claim, which the employer denied, contending her injuries did not arise out of employment.  The ALJ held the Claimant’s injuries were compensable because the work from home arrangement meant the employer “imported the work environment into the claimant’s home”.  On appeal, the District Court held the Claimant’s non-employment life—her dog, her kitchen, reaching for her coffee cup—caused the accident, not her employment.  The court, however, said their decision would not “immunize” employers from workers’ compensation claims in work-at-home arrangements.  Two judges issued dissenting opinions.  One dissenter said it was “expected that employees who work from home will take periodic breaks and may suffer compensable injuries from falls from a variety of causes”.   The second dissenter argued that workplace injury from a neutral risk has been “undoubtedly compensable” and that the majority erred in their decision.  The judge found that tripping over the dog was “no different than if the claimant had slipped on a liquid substance on the floor” and was consistent with a decade of case law holding that a trip and fall in the workplace is compensable.

 

The trend to allow employees to work from home raises many wrinkles in the event of  injury, including applicability of the “dual purpose doctrine”, travel status, and obvious problems with proof.  In certain factual situations, the dual purpose doctrine has been applied to cover injuries sustained while the claimant is traveling between home and the job site. One such instance exists when the nature of the claimant’s employment is such that “it can genuinely and not fictitiously be said that the home has become part of the employment premises.” In those circumstances “travel between two parts of the employer’s premises is in the course of employment.” 1 Larson’s Workers’ Compensation Law, § 16.10[1]. Larson adds the following at § 16.10[2]:  When reliance is placed upon the status of the home as a place of employment generally, instead of or in addition to the existence of a specific work assignment at the end of the particular homeward trip, three principal indicia may be looked for: the quantity and regularity of work performed at home; the continuing presence of work equipment at home; and special circumstances of the particular employment that make it necessary, and not merely personally convenient, to work at home.

 

The reported cases  suggest compensability of injuries suffered by an employee permitted to work from home are highly fact specific.  If you have questions about the compensability of such an injury, or any injury, contact one of the attorneys at Lee & Brown.