On January 1, 2021, the revamped WCRP 16 and 18 became effective. The central changes to Rule 16 are clarifications of the pre-authorization process: Under the new Rule, again effective January 1, 2021, respondents shall have 10 days (rather than the prior seven business days) to review a request for pre-authorization. The other main change [...]
Respondents are not directing medical care or treatment by setting demand appointments with the authorized treating provider.
In Fitzsimmons, the authorized treating provider (“ATP”) had determined that the claimant was at MMI; however, the ATP did not provide an impairment rating. Respondents set several demand appointments and there was evidence that the claimant was properly notified of each appointment. After claimant failed to attend the demand appointments twice, Respondents filed a motion [...]
In Flores, the ALJ ordered that the average weekly wage (“AWW”) calculation for the claimant include a fringe benefit. Here, the ALJ included the value the claimant derived from boarding his multiple horses with his employer. Respondents sought review of this order with the Industrial Claim Appeals Office (the “Panel”). Respondents argued that the claimant’s [...]
In Essary, the claimant worked as a Senior Network Engineer, and his duties included working with client to resolve various technical issues. The claimant’s typical schedule was 6:00am to 2:00pm. However, the claimant was “on-call” during all other hours he was not working his typical schedule. The claimant typically received a call five to ten [...]
The Industrial Claim Appeals Office (the “Panel”) issued a decision affirming Respondents’ obligation to continue paying workers’ compensation benefits to Claimant without an offset from money received from a third party settlement. In Teti, the claimant had been involved in work-related motor vehicle rollover accident resulting in severe injuries in June 1989. The claimant at [...]
Once Respondents admit to an open period of temporary total disability (“TTD”) benefits, Respondents must ensure such benefits are properly terminated upon a statutory triggering event, such as return to modified or regular employment, physician release to return to modified or regular employment, or placement at maximum medical improvement. See C.R.S. § 8-42-105(3). In Aguilera, [...]
In a claim successfully defended by this firm, the claimant appealed a denial of temporary total disability benefits (“TTD”) and penalties for failure to pay said payments. The Industrial Claim Appeals Office (the “Panel”) affirmed the ALJ’s decision. In Sullivan, the claimant was a delivery driver who had a long history of symptomatic pre-existing cervical [...]
ALJ finding that a claimant did not overcome the Division IME (“DIME”) by clear and convincing evidence will be upheld so long as supported by substantial evidence.
In Corley, the claimant sustained an admitted injury to his lower back in 2015. The claimant’s authorized treating provider (“ATP”) placed him at maximum medical improvement (“MMI”) in January, 2016 and assigned a 7% whole person rating. Respondent employer filed a Final Admission of Liability based on the report. Claimant timely objected to the admission [...]
In Stanfield, the administrative law judge (“ALJ”) issued an order that assessed penalties against Respondent for failure to deposit money with the Trustee of Colorado Division of Workers’ Compensation or post a bond in the same amount. In this case, Claimant’s injury was found compensable and Respondent was required to pay Claimant benefits and pay [...]
In Muramatsu, an administrative law judge (“ALJ”) ordered that Claimant be able to change his authorized treating physician (“ATP”) after he had already been treating elsewhere. Respondents sought review of this order with the Industrial Claim Appeals Office (“Panel”). Respondents argued that Claimant should not be able to change his ATP, because Claimant had been [...]