Posted on July 12, 2017
The Industrial Claims Appeals Office (ICAO) held that if a Final Admission of Liability (FAL), which applies a MMI finding, but does not include the payment of indemnity benefits, does not close the claim. An ineffective FAL will not close a claim, nor will it trigger the 30-day period claimants have to request a DIME review.
Here, the claimant worked for the employer as a ski instructor. On April 1, 2013, she fell while working and sustained a concussion. The claimant continued working but experienced hearing loss due to her fall. In August 2015, the claimant visited her audiologist. The audiologist diagnosed deteriorating hearing loss and prescribed hearing aids. The claimant contacted the workers’ compensation claims administrator concerning this prescription and was informed her claim had been closed by a FAL filed by the respondent on September 6, 2013. The claimant objected and requested a DIME review on September 21, 2015. The respondent refused to provide additional benefits to the claimant asserting her claim was closed by the September 2013 FAL. The Administrative Law Judge (ALJ) agreed and held that the claimant’s request for a DIME review made in 2015 was not timely filed pursuant to C.R.S. 8-43-203(2)(b)(II).
However, the ICAO determined that respondent’s 2013 FAL did not admitted for temporary disability benefits or for permanent impairment benefits. Applying Harman-Bergstedt, Inc. v. Loofbourrow, 320 P.3d 327 (Colo. 2014), the ICAO determined that respondent’s FAL, premised on a finding of MMI and which found that no disability benefit was payable, could not implicate the statutory consequences of a finding of MMI, as “those apply only to injuries as to which disability indemnity is payable.” Therefore, the ICAO reversed and set aside the ALJ’s order that the claimant’s objection to the FAL and request for a DIME were not timely, since no time period ever began to run.
Kazazian v. Vail Resorts, W.C. No. 4-915-969-03 (ICAO Apr. 24, 2017).
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