A PUBLICATION BY THE LAW FIRM OF

Clifton, Mueller & Bovarnick, P.C.

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ATTORNEYS AT LAW

2007

FEBRUARY

ICAO overturned an ALJ’s decision in the case of Tearsa Sloan v. Safeway, Inc., W.C. Number 4-606-665 (December 22, 2006) and held that respondents are obligated to reimburse claimant for medical mileage submitted beyond the 120 day limit found in Rule 16-11(A)(1), W.C.R.P.

At hearing, an ALJ initially determined that the claimant was a “medical provider” for purposes of Rule 16-11(A)(1) and therefore subject to the “120 day rule” because she provided medical transportation by driving herself to medical appointments.

On appeal, the panel disagreed and held that the claimant was not a medical provider for purposes of Rule 16-11(A)(1).  The panel supported its opinion by citing numerous inconsistencies within the Act and Workers’ Compensation Rules of Procedure.

Thanks to a recent appellate court opinion, claimants have new motivation to attend medical appointment with their authorized treating physicians.

On December 28, 2006, the ICAO issued its decision in Sigala v. ICAO, __ P.3d__ (Colo. App. 2006).  The panel held that a claimant who fails to attend an appointment with his ATP and then fails to attend the rescheduled appointment forfeits TTD until he eventually attends another rescheduled appointment with his ATP.

If a claimant fails to attend a medical appointment with his authorized treating physician, follow these steps precisely to suspend benefits:

1.      Reschedule the claimant’s appointment with the ATP.

2. Write a letter to the claimant notifying

“I Object to Your Objection!”

The story of Leewaye v. Harrison School District #2,

W.C Number 4-649-073 (October 13, 2006)

 

Respondents filed a final admission on October 10, 2005.  On October 20, 2005 the Division notified respondents that TTD was miscalculated on the final admission.  Therefore, respondents filed a corrected final admission on October 26, 2005.

On November 23, 2005, the claimant objected to the October 26 FA and filed application for hearing on PPD and MMI.  An ALJ denied his request for further benefits and concluded that the claim closed with respect to all issues admitted or denied in the final admission of October 10, 2005 except for TTD.

Affirming the lower court’s decision, ICAO held, “The Division’s correspondence to the respondents noting that there appeared to be an arithmetical, typographical, or clerical error with regard to the calculation of TTD benefits did not invite a general reopening of all issues admitted or denied in the October 10 final admission.”

 

him of the rescheduled appointment. Include the following sentence in your letter: “Your temporary disability benefits may be suspended if you fail to appear at the rescheduled appointment.”

3.      Send the letter to the claimant (to his attorney if he has one) VIA CERTIFIED MAIL return receipt requested.

If the claimant then fails to attend the rescheduled medical appointment, you may terminate TTD benefits without a hearing.  (*Please, file a general admission and attach the appropriate documents to terminate TTD*) You must reinstate TTD immediately upon the claimant’s return to his ATP for an examination.

If you have any questions about this process, please call CMB for assistance.

Two Strikes and Yer’ Out…

Mileage Reimbursement Not

Subject to 120 Day Denial Rule

 

 

 

RECENTLY PROPOSED:

SB 07-038, would amend C.R.S. § 8-42-106 by adding a new subsection authorizing respondents to terminate TPD without a hearing if the claimant fails to show for a rescheduled appointment with his ATP.

HB 07-1176, would allow an injured employee to participate in the selection of the authorized treating physicians.

HB 07-1008, would mandate that if a firefighter contracts cancers of certain body parts, the condition or impairment shall be deemed to have occurred within the course and scope of employment unless a physical examination shows evidence that the condition predated the employment.