Opinion
W.C. No. 4-210-386
March 17, 2000
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Schulman (ALJ) which awarded medical benefits in the form of prescribed apparatus. We affirm.
In 1994, the claimant suffered compensable injuries to her knees and hips when a 200 pound keg fell on her. The claimant underwent two knee surgeries and hip surgery. Dr. Papilion placed the claimant at maximum medical improvement (MMI) on September 8, 1998. The respondents subsequently admitted liability for permanent total disability and future medical benefits in accordance with Grover v. Industrial Commission, 759 P.2d 705 (Colo. 1988).
As a result of the injuries the claimant suffers significant difficulties walking and depression. The claimant has used various assistance devices including crutches to stabilize her gait. However, the ALJ found that the claimant is unsteady on crutches, and that she has fallen and sustained additional injuries. The ALJ also found that extended use of crutches causes pain in the claimant's back, hip, knees and upper extremities.
Dr. Papilion prescribed use of a wheelchair, and recommended that the claimant's home be modified to include handicapped railings and ramps. The claimant obtained a wheelchair and sought an order requiring the respondents to reimburse her for its cost. The claimant also requested medical benefits in the form of wheelchair accessible ramps on the exterior of her home and hand railings in the bathroom and the stairs to her laundry facilities.
The ALJ awarded the wheelchair, and a wheelchair accessible ramp at the front of the claimant's house as recommended by Dr. Papilion. In support, the ALJ found that the wheelchair provides "therapeutic relief" from the effects of the injury by reducing the claimant's pain level and decreasing the claimant's depression. The ALJ also found that the wheelchair reduces the potential of further injuries associated with use of the crutches. Further, the ALJ determined that it is reasonable and necessary to install handrails in the claimant's bathroom, at the front and back doors to the claimant's house, and down the rear steps to the basement of the home so that the claimant has a safe access to those locations which provide for her health and medical necessities.
I.
The respondents contend the ALJ misapplied the law in awarding the prescribed apparatus. They argue that because the claimant has reached maximum medical improvement (MMI) the ALJ erroneously awarded medical benefits designed to "improve" the claimant's condition. We disagree.
Under § 8-42-101(1)(a), C.R.S. 1999, the respondents are required to provide medical services "as may reasonably be needed" to "cure and relieve" the effects of the industrial injury. See Colorado Compensation Insurance Authority v. Nofio, 886 P.2d 714 (Colo. 1994). Based upon this statute employers have been required to provide services which are either medically necessary for the treatment of a claimant's injuries or incidental to obtaining treatment. Industrial Commission v. Pacific Employers, 120 Colo. 373, 209 P.2d 980 (1949).
As argued by the respondents, MMI terminates the claimant's right to medical treatment designed to "cure" the injury. In fact, by definition, a claimant reaches MMI when "no further treatment is reasonably expected to improve the condition." § 8-40-201(11.5), C.R.S. 1999; McLane Western Inc. v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 99CA0473, December 9, 1999) ; Reynolds v. Industrial Claim Appeals Office, 794 P.2d 1080 (Colo.App. 1990). However, MMI does not terminate the claimant's right to all medical benefits. Rather, the claimant is entitled to ongoing medical benefits to relieve the effects of the injury. Stollmeyer v. Industrial Claim Appeals Office, 916 P.2d 609 (Colo.App. 1995). Treatment designed to maintain the claimant's condition or prevent a further deterioration is considered treatment which "relieves" the effects of the injury. See Bellone v. Industrial Claim Appeals Office, 940 P.2d 1116 (Colo.App. 1997) (award of child care services upheld because the services allowed the claimant to rest and rest was necessary for the claimant to deal with fatigue symptoms associated with her head injury and seizure disorder); Stollmeyer v. Industrial Claim Appeals Office, supra; Milco Construction v. Cowan, 860 P.2d 539 (Colo.App. 1992). In fact, the respondents admitted liability for Grover type medical benefits. Accordingly, the ALJ was not precluded from awarding additional medical benefits to relieve the effect of the injury.
For a particular apparatus to be a compensable medical benefit it must provide "therapeutic relief" from the effects of the injury. Cheyenne County Nursing Home, v. Industrial Claim Appeals Office, 892 P.2d 443 (Colo.App. 1995). The Cheyenne court defined the terms "relieve the effects of the injury" and "therapeutic benefit" narrowly. Under the facts of that case the court denied the request of a wheelchair restricted quadriplegic for a stair glide to obtain access to her basement during dangerous tornado weather. The court concluded that the stair glide provided no therapeutic benefit and that benefits designed to increase the claimant's peace of mind were beyond the scope of the Workers' Compensation Act.
In ABC Disposal Services v. Fortier, 809 P.2d 1071, 1072 (Colo.App. 1990), the court held that a medically prescribed snowblower was not a compensable medical "apparatus" because it did not cure or relieve symptoms of the industrial injury, and only provided an easier method to perform a household chore. Similarly, in Hillen v. Tool King, 851 P.2d 289 (Colo.App. 1993), the court denied a request for lawn care services because the services were not medical in nature, even though they were prescribed by an attending physician. The court concluded that lawn care did not cure or relieve the symptoms of the injury and only relieved the rigors of yard work. Therefore, the court concluded that it was not sufficiently related to the claimant's physical health to be a compensable medical service.
Furthermore, expressly relying on Cheyenne, the court in Bogue v. SDI Corporation, Inc., 931 P.2d 477 (Colo.App. 1996), denied a wheelchair-accessible van to a quadriplegic claimant because the van did not provide therapeutic medical relief from the symptoms of the industrial injury. Moreover, the Bogue court concluded that avoiding risks associated with the claimant's exposure to inclement weather while waiting for public transportation does not render the specialized van sufficiently related to the claimant's physical condition to be a compensable medical apparatus. However, in City and County of Denver v. Industrial Commission, 682 P.2d 513 (Colo.App. 1984) the court upheld the award of a medically prescribed hot tub because it relieved pain symptoms from a back injury.
Ultimately, the determination of whether a particular apparatus provides a therapeutic benefit to the claimant is a question of fact for resolution by the ALJ. Hillen v. Tool King, supra; Edward Kraemer Sons, Inc. v. Downey, 852 P.2d 1286 (Colo.App. 1992). We must uphold the ALJ's factual determinations if supported by substantial evidence in the record. § 8-43-301(8), C.R.S. 1999. Furthermore, this standard requires that we defer to plausible inferences drawn from the record. Suetrack USA v. Industrial Claim Appeals Office, 902 P.2d 854 (Colo.App. 1995).
Here, the claimant testified the residual effects of the injury necessitate her use of walking aides. (Tr. p. 39). She stated that using crutches causes her to experience pain in her arms, knees and hip and that she has fallen repeatedly. (Tr. pp. 15, 17, 21, 24, 29). She stated that one time she fell and injured her shoulder. (Tr. p. 19). The claimant further stated that her pain is lessened using a wheelchair. (Tr. p. 29).
Dr. Hilton opined that the claimant's depression is "driven by pain" from the industrial injury. (Hilton report, February 24, 1999. He testified that the depression is difficult to treat without relieving the pain. (Tr. p. 49). Dr. Hilton opined that using a wheelchair reduces the claimant's pain and thus, provides a therapeutic relief from the effects of the industrial injury. Therefore he concurred with Dr. Papilion's recommendation for a wheelchair. (Tr. p. 53; Hilton January 7, 1998).
Accordingly, there is substantial evidence in the record from which the ALJ reasonably inferred that the wheelchair provides therapeutic relief from the symptoms of the injury. The ALJ also found that the prescribed apparatus are designed to prevent further deterioration of the claimant's condition which may result from additional falling injuries. The respondents arguments notwithstanding, evidence the claimant has suffered additional injuries while using canes and crutches, supports the ALJ's finding that the claimant's condition will further deteriorate without the additional medical benefits.
Moreover, the ALJ's findings support the award of medical benefits in the form of a wheelchair. Consequently, it is immaterial the ALJ found that the wheelchair "may also have a salutary additional impact of providing Claimant with a more independent lifestyle." (Discussion and Conclusions of Law).
II.
The installation of wheelchair accessible ramps is a necessary component of the claimant's use of a wheelchair. Consequently, we perceive no basis to interfere with the ALJ's award of wheelchair accessible ramps. See Kuziel v. Pet Fair, Inc., 931 P.2d 521 (Colo.App. 1996); Cheyenne County Nursing Home, v. Industrial Claim Appeals Office, supra; Stockton v. Fountain Valley Plumbing Heating, W.C. No. 3-953-094 (November 19, 1992) (employer liable for expenses related to operation of medically prescribed hot tub).
III.
Neither do we perceive any error in the award of hand railings down the rear stairway of the claimant's house. In Cheyenne, the court concluded that the employer "must make such improvements or modifications to the residence of a claimant as may be necessary to allow the claimant access to, and the use of those portions of the residence which provide for the claimant's health and medical necessities."
The respondents do not dispute the ALJ's order for the installation of handrails in the claimant's bathroom. Therefore, the respondents apparently concede that access to the claimant's bathroom is essential to her health. Furthermore, the ALJ's order is consistent with Atencio v. Quality Care, Inc., 791 P.2d 7 (Colo.App. 1990), where the court concluded that attendant care to assist a disabled claimant in bathing was essential to the claimant's health. Accordingly, the ALJ could and did, reasonably infer that the claimant's ability to clean her clothes is no less related to the claimant's physical health than cleaning the claimant's body. It follows that unlike the facts in Cheyenne, the claimant's access to the lower level of her house has a direct relation to her physical health, and thus, the handrails are compensable.
In reaching this conclusion, we recognize the evidence that the claimant has access the laundry facilities by sliding down the steps on her seat. (Tr. pp. 22, 23). However, the record supports the ALJ's finding that this method of accessing the laundry facilities aggravates the claimant's pain and risks further injury. Therefore, the ALJ reasonably found that the claimant's health may further deteriorate in the absence of hand railings for her to get to the laundry facilities. (Finding of Fact 12).
Insofar as the respondents have further arguments, they have been considered and do not alter our conclusions.
IT IS THEREFORE ORDERED that the ALJ's order dated September 13, 1999, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL ____________________________________ Kathy E. Dean ____________________________________ Robert M. Socolofsky
NOTICE
This Order is final unless an action to modify or vacate this Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, CO 80203, by filing a petition for review with the Court, within twenty (20) days after the date this Order is mailed, pursuant to § 8-43-301(10) and § 8-43-307, C.R.S. 1999. The appealing party must serve a copy of the petition upon all other parties, including the Industrial Claim Appeals Office, which may be served by mail at 1515 Arapahoe, Tower 3, Suite 350, Denver, CO 80202.
Copies of this decision were mailed March 17, 2000 to the following parties:
Theresa Carlson, 5514 S. Prince St., Littleton, CO 80120
Applebee's R.C.I., 3301 S. Tamarac Dr., Denver, CO 80231-4305
General Accident Insurance Company, _ Lana Hessenius, CGU-Hawkeye Security Insurance, P.O. Box 5150, Denver, CO 80217-5150
General Accident Insurance Company, 5910 N. Central Expressway, #500, Dallas, TX 75206
Steven H. Gurwin, Esq., 1777 S. Harrison St., #906, Denver, CO 80210 (For Claimant)
Stacy J. Tarler, Esq. and Michael J. Decker, Esq., 1660 S. Albion, #425, Denver, CO 80222 (For Respondents)
BY: A. Pendroy