MGM Supply Co. v. ICAO, 01CA1200 (March 14, 2002): Claimant sustained an admitted industrial injury to his left shoulder. Claimant underwent two surgeries, but continued to suffer pain. The treating physician recommended injections as a diagnostic tool to determine whether further surgery would be beneficial. Claimant refused any further injections or surgery. As a result, claimant was placed at maximum medical improvement (MMI) with a 0% impairment rating, to which respondents admitted liability.
Claimant requested a Division-sponsored independent medical examination (DIME). The DIME physician agreed with the treating physician's recommendations regarding additional surgery and opined that claimant had not reached MMI. However, because claimant refused the surgery, the DIME physician rated claimant's permanent medical impairment at 23% of the whole person.
Respondents challenged the DIME's rating. An administrative law judge (ALJ) held that respondents did not overcome the DIME by clear and convincing evidence. The ALJ also found that claimant's refusal to undergo further injections and surgery was reasonable and afforded no basis for reduction of benefits pursuant to C.R.S. § 8-43-404(3), which provides for such reduction when a claimant refuses essential medical treatment.
The court of appeals affirmed. Initially, the court rejected respondents' argument that C.R.S. § 8-43-201, which grants ALJs jurisdiction to hear and decide workers' compensation matters, is void because it violates Article VI, § 9 of the Colorado Constitution, which grants district courts original jurisdiction in civil, probate and criminal cases. The court held that respondents did not overcome the presumption that § 8-43-201 is constitutional.
Next, the court was unpersuaded by respondents' argument that the ALJ erred in upholding the DIME where claimant was not at MMI when the rating was assigned. The court recognized that evaluation for permanent disability cannot precede the determination that the claimant has reached MMI. However, the court held that "a claimant is at MMI as a matter of law if he or she refuses to submit to the only treatment currently proposed to improve his or her condition." Thus, under the evidence of this case, the DIME physician properly assigned a permanent disability rating to claimant.
Finally, the court disagreed with respondents' contention that the ALJ erred in determining that claimant's refusal to undergo further treatment was reasonable where there was no finding that the proposed surgery posed unusual risks. The court stated that the question of reasonableness was one of fact for the ALJ and would not be reversed unless there was an abuse of discretion. The court cited claimant's testimony that he did not believe more surgery would provide relief, and respondents' expert's testimony that there was no guarantee the third surgery would be successful. The court held that this testimony was sufficient evidence to support the ALJ's decision.