LEGISLATIVE UPDATE
Colorado Rule 11 Proposed Changes
Under the preliminary draft of Rule 11, the parties submit raw medical records to the Division. A Division team will then generate a final DIME packet using submissions from respondents and the claimant. That packet, and a separate packet with any unused files, are sent to the parties for review and approval. The Division has stated that the policy of this change is to reduce process delays, provide more consistent packets assembled with less effort and ease the physician review process. However, it may come at the expense of respondents as the proposed fee structure now requires respondents to pick up the invoice beyond a $1,500 flat fee deposit made by the requesting party. For any DIME that requires substantive medical review, the cost may be more comparable to an IME with the proposed rule change.
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Pollart Miller Attorney
SPOTLIGHT
MEET KATHERINE LEE
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Associate Katherine Lee joined Pollart Miller in July 2024.
Mrs. Lee has focused her practice on civil litigation, including representing companies and insurance carriers in workers’ compensation and liability matters.
During law school, Mrs. Lee was on the founding board of Wake Forest Law’s Asian Pacific American Law Student Association (APALSA) and has since continued to promote and uplift diversity within the legal profession.
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To all our clients, associates and friends, we share our gratitude and best wishes for Joyous Holidays and a Wonderful New Year from all of us at Pollart Miller | |
Omission of Prior Work Injury and Overcoming the DIME
The claimant sustained an admitted injury to her right knee while working for the employer just two weeks after her hire. As a result of this injury, the claimant was placed on off work status and ultimately had the knee surgically repaired. After her surgery, she began reporting low back and SI joint pains, which the treating doctors linked to an allegedly compensable limp mechanism. ...[more]Text Link
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Williams v. Amazon.com, Inc., W.C. No. 5-196-505-002 (April 29, 2024).
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Mental Health Injury Must Be Supported By Psychiatrist or Psychologist and Cannot Be Based on Litigation
The claimant, a security guard, alleged a work injury arising out of a restraint of a patient in a hospital. The claimant sustained very minor physical injuries to his elbow, which resolved very quickly without lost time and minimal medical attention. As a result, the injury was properly treated as a medical only claim and no filings with the State occurred. Over two years later, the claimant alleged a PTSD claim arising out of this incident, because he was involved in murder charges and civil wrongful death litigation arising out of the death of that patient. ...[more]
Vialpando v. St. Mary Corwin Hospital, W.C. No. 5-254-576-001 (June 25, 2024).
[more]ext Link
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COLORADO CASE LAW UPDATES
Katherine Lee
Colorado:
Division IME – Scope of Evaluation
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THE COLORADO COURT OF APPEALS (the Court) determined in Peitz, as a matter of first impression, that Rule 11-5 of the Workers’ Compensation Rules of Procedure (WCRP) does not prohibit a physician performing a DIME from evaluating all aspects of a worker’s injury in determining whether the worker has obtained maximum medical improvement (“MMI”).
In February 2020, the claimant sustained an admitted work injury to his lower back while working as a mechanic for the Board of Water Works of Pueblo. Initial treatment of the injury resulted in a diagnosis of a strain of muscle, fascia, and tendon in claimant’s lower back. Respondents eventually requested an independent medical examination (IME), wherein the claimant additionally complained of right hip pain, with a burning sensation in his groin. The IME doctor opined that the hip issues should be mitigated before the claimant received further treatment for the lower back injury. ...[more]
Peitz v. Indus.l Claim Appeals Office, No. 24CAO0250 (Colo. App. Sep. 12, 2024)
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Colorado:
Recoupment of Overpayment – No Need to Reopen the Claim
In Atencio, the Colorado Court of Appeals (the Court) held that respondents were not required to reopen claimant’s case after filing their final admission of liability to recoup an overpayment.
In this case, the claimant suffered an admitted work-related injury to his right shoulder in February 2020. The claimant was placed at maximum medical improvement approximately two years later with a 17% upper extremity impairment rating. The respondents’ final admission of liability, filed in January of 2022, admitted to partial disability benefits based on a scheduled impairment and overpayment of approximately $500 to be collected from the partial disability benefits. No other overpayments were noted on the final admission. ...[more]
Atencio v. Indus. Claims Appeals Office, Rio Grande County, and County Workers’ Compensation Pool, No. 23CA2245 (Colo. App. Aug. 1, 2024)
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Colorado:
Authorization of Housekeeping Services as Medical Benefit
In Dery, the Industrial Claim Appeals Office (the Panel) affirmed the decision of the ALJ to deny housekeeping services as a medical benefit.
The claimant, proceeding pro se, sustained an injury to her left knee at work on July 3, 1991, and subsequently underwent a meniscectomy. Due to her prolonged use of crutches, the claimant developed additional conditions that included thoracic outlet syndrome and nerve damage under the right arm. The claimant was ultimately diagnosed with Complex Regional Pain Syndrome (CRPS) in her lower left extremity. Respondents admitted and began paying permanent disability benefits in 2001. ...[more]
Dery v. ABC Nursery School, LTD & Junior Academy and Pinnacol Assurance, W.C. No. 4-104-954 (Aug. 15, 2024).
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UTAH CASE LAW UPDATE
Jakub Lewandowski
Utah:
Aggravating Factors in Idiopathic Falls
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In Ackley, the claimant challenged the Utah Labor Commission’s (the Labor Commission) denial of her claim for worker’s compensation benefits, contending that the Labor Commission mis-applied the idiopathic fall doctrine in her claim.
The claimant fell to a concrete floor while working at Lowe’s (respondent) after a ganglion cyst burst, causing such pain, that the claimant lost consciousness and fell to the ground, suffering multiple injuries as a result. The claimant filed a claim for benefits with the Labor Commission. The respondents did not deny that the claimant fell and was injured while at work but argued that the fall was caused by a pre-existing condition; and therefore, not compensable. ...[more]
Ackley v. Labor Comm'n & Lowe's, 2024 UT App. 119 (Utah Ct. App. 2024)
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