Williams v. Kunau
| Decision Date | 06 November 2006 |
| Docket Number | No. 06SC93.,06SC93. |
| Citation | 147 P.3d 33 |
| Parties | Bruce A. WILLIAMS, Petitioner v. Timothy R. KUNAU, d/b/a Kunan Drilling; Pinnacol Assurance; and the Industrial Claim Appeals Office of the State of Colorado, Respondents. |
| Court | Colorado Supreme Court |
Spencer & Spencer, P.C., Patrick C.H. Spencer, II, Colorado Springs, Colorado, Attorneys for Petitioner.
Alexander and Ricci, P.C., William A. Alexander, Jr., Colorado Springs, Colorado, Attorneys for Petitioner.
Pinnacol Assurance, Harvey D. Flewelling, Denver, Colorado, Attorneys for Respondents, Pinnacol Assurance and Timothy R. Kunau, d/b/a Kunau Drilling.
John W. Suthers, Attorney General, Vincent E. Morscher, Assistant Attorney General, Civil Litigation and Employment Law Section, Denver, Colorado, Attorneys for Respondent, Industrial Claim Appeals Office.
Ritsema & Lyon, P.C., T. Paul Krueger II, Denver, Colorado, Attorneys for Amicus Curiae Colorado Self Insurers Association.
Pepe J. Mendez and Associates, P.C., Michelle L. LaForett, Denver, Colorado, Attorneys for Amicus Curiae Workers Compensation Education Association.
We granted certiorari in this workers' compensation case to review the court of appeals' decision in Williams v. Industrial Claim Appeals Office, 128 P.3d 335 (Colo. App.2006). This case concerns whether, following a determination by an independent medical examiner that a claimant has not reached maximum medical improvement ("MMI"), an employer or insurer may close the case by filing a final admission of liability ("FAL") when the treating physician determines a second time that the claimant has reached MMI, or whether the employer or insurer must return the claimant to the independent medical examiner for a follow-up examination and determination of MMI prior to filing an FAL.1
In this case, Williams' treating physician made a finding of MMI. Williams requested and underwent a Workers' Compensation Division independent medical exam ("DIME") resulting in the independent medical examiner determining that he was not at MMI. Williams received further treatment and the treating physician concluded that he was at MMI. The insurer, Pinnacol Assurance ("Pinnacol"), filed an FAL that included an assertion that he had exceeded the $60,000 statutory benefits cap. Williams objected to the FAL and sought a hearing at which he received an Administrative Law Judge ("ALJ") determination that he had not reached the benefits cap. The employer then filed a revised FAL to incorporate the ALJ's finding. The ALJ ruled that Williams had not timely reinitiated the DIME process within thirty days of when Pinnacol filed its FAL; thus, the case was automatically closed pursuant to section 8-42-107.2(2)(b), C.R.S. (2006).
Williams argues that the procedures required by section 8-42-107.2(1)(b), C.R.S. (2006) to select the independent medical examiner, including the time limit following the employer's or insurer's filing of an FAL, do not apply to a follow-up examination by an independent medical examiner after the treating physician's second determination of MMI. We agree.
We hold that, once a claimant has successfully challenged a finding of MMI through the DIME process, the DIME process remains open and, when the treating physician makes a second finding of MMI, the employer or insurer may not file an FAL to close the case prior to returning the claimant to the independent medical examiner for a follow-up examination and determination of MMI. Accordingly, we reverse the judgment of the court of appeals.
In June 1996, Williams injured his back at his drilling job. Williams improved over the weekend, but upon returning to work on Monday, his back pain increased to such severity that he visited the emergency room. Williams attempted to continue working on light duty but was eventually laid off.
Williams received physical therapy as well as other treatment through workers' compensation, but his range of motion remained limited. Pain interrupted his sleep and prevented him from sitting or standing in one position for any length of time.
Williams was incarcerated from April 17, 1998, to May 11, 2000, and underwent treatment for his back pain during his incarceration. An authorized treating physician found Williams to be at MMI in May 2000. Williams challenged this finding and underwent a DIME on September 21, 2000, resulting in the independent medical examiner finding that Williams was not at MMI. As a result, the ALJ ordered Pinnacol to pay temporary disability benefits commencing May 12, 2000.
Williams received additional treatment from several other physicians and a chiropractor, reporting no significant improvement in his pain. On August 12, 2002, Williams' treating physician again determined that he had reached MMI.
Pinnacol then filed an FAL on September 3, 2002, admitting liability for temporary benefits through August 11, 2002, and 24 percent permanent impairment benefits. The FAL asserted that Williams had reached the $60,000 cap on benefits and therefore was entitled to no further benefits.
Williams objected to the FAL on September 18, 2002, but he did not reinitiate the DIME process. Instead, he applied for a hearing on the issue of Pinnacol's assertion that he had met the $60,000 cap on benefits. Williams prevailed on this issue.
Pinnacol filed a revised FAL on November 14, 2003, reflecting the ALJ's determination that Williams' benefits were not at the $60,000 benefit cap. Williams objected to the revised FAL and requested that the independent medical examiner redetermine MMI. Pinnacol moved to strike this request as untimely. On June 11, 2004, the ALJ concluded that Williams' request was untimely filed and the claim was closed.
Williams sought review by the Industrial Claim Appeals Office ("ICAO"), arguing that he was not required to reinitiate the DIME process when the initial DIME process had resulted in an independent medical examiner's determination that he was not at MMI. The ICAO affirmed the ALJ's ruling on October 4, 2004.
The Colorado Court of Appeals, citing section 8-42-107.2(2)(b), ruled that the claimant must reinitiate the DIME process within thirty days of when the employer or insurer filed the FAL.
We hold that, once a claimant has successfully challenged a finding of MMI through the DIME process, the DIME process remains open and, when the treating physician makes a second finding of MMI, the employer or insurer may not file an FAL to close the case prior to returning the claimant to the independent medical examiner for a follow-up examination and determination of MMI.
We are primarily concerned in this appeal with three statutes within the Workers' Compensation Act: sections 8-42-107 (), 8-42-107.2 (selection of the independent medical examiner), and 8-43-203, C.R.S. (2006)(final admission of liability). We find that these statutes, when read together, are ambiguous with respect to the issue on appeal to us, necessitating application of statutory construction principles. Applying these principles, we conclude that the employer or insurer may not file an FAL prior to returning the claimant to the independent medical examiner for a follow-up examination and determination of MMI when the treating physician makes a second determination that the claimant has reached MMI.
We review the proper construction of statutes de novo. Lobato v. ICAO, 105 P.3d 220, 223 (Colo.2005). We extend deference to the agency's interpretation of its own statutes, but we are not bound by it. Id. When the agency's interpretation is not uniform or consistent we do not owe deference to that interpretation; but we can look to alternative statutory construction aids and consider the agency's rationale for consistency with the stated purposes of the Workers' Compensation Act. Anderson v. Longmont Toyota, Inc., 102 P.3d 323, 331 (Colo.2004).
If statutory language is clear, we apply its plain and ordinary meaning. Lobato, 105 P.3d at 223. If the statute is reasonably susceptible to multiple interpretations, it is ambiguous and we determine the proper construction by examining the legislative intent, the circumstances surrounding its adoption, and possible consequences of various constructions. Id. at 223-24.
The exclusive remedy available to employees for workplace injuries in Colorado is the Colorado Workers' Compensation Act (the "Act"). § 8-40-102(1), C.R.S. (2006). The remedial purpose of the Act is to provide treatment and compensation to injured workers; this aim is to be accomplished efficiently and at reasonable cost to employers. Id.
To provide care to an injured employee under the Act, the employer or the employer's insurer selects an authorized treating physician. § 8-42-107(8)(b). Following this care, the treating physician determines when the employee has reached MMI and the degree of any permanent impairment. § 8-42-107(8)(b)(I). Once the treating physician has determined the claimant to be at MMI, the employer or insurer may file an FAL. § 8-42-107.2(2)(a)(I)(A). Unless the claimant requests the selection of an independent medical examiner within thirty days, the treating physician's findings and determinations are binding on all parties and on the Division. § 8-42-107.2(2)(b).
Thus, if the claimant disagrees with the treating physician's finding of MMI, the claimant may challenge that finding by initiating the selection of an independent medical examiner. Id. The employer or insurer may also initiate the selection of an independent medical examiner. §§ 8-42-107.2(2)(a)(I), (b)-(c). The statute provides that the party requesting the DIME must pay the full cost of the examination ten days prior to the date of the exam.2 § 8-42-107.2(5)(a).
The independent medical examiner examines the claimant and makes an independent finding of the claimant's condition. This finding may...
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