Summary
In Childers v. Noah's Ark Whitewater Rafting, supra, we concluded that once a claimant proves an entitlement to temporary disability benefits, the duration of those benefits is governed by § 8-42-105(3)(a)-(d), C.R.S. 1998, and Rule IX.
Summary of this case from In re Beuke, W.C. NoOpinion
W.C. No. 4-392-209
April 7, 1999.
FINAL ORDER
The Colorado Compensation Insurance Authority (CCIA) seeks review of an order of the Director of Workers' Compensation (Director) which required them to reinstate temporary total disability benefits. We affirm.
The claimant suffered a work-related injury on July 31, 1998. The CCIA filed a General Admission of Liability for the payment of temporary total disability benefits commencing August 1, 1998, and terminating August 20, 1998.
In an order dated November 3, 1998, the Director determined that an insurer may only terminate temporary disability benefits in accordance with the Rules of Procedure, Part IX(C)(1)(a)-(f), 7 Code Colo. Reg. 1101-3 at 34, or § 8-42-105(3)(a)-(d), C.R.S. 1998. The Director also determined that the CCIA's General Admission unilaterally terminating temporary disability benefits on August 20, 1998, did not comply with Rule IX(C)(1) or § 8-42-105. Therefore, the Director ordered the CCIA to reinstate temporary disability benefits until it complied with Rule IX or obtained a proper order terminating benefits. The CCIA timely appealed.
On January 20, 1999 the Director issued a Supplemental Order in which she further detailed the basis for the November order, and rejected the arguments raised in the CCIA's brief in support of the petition to review. The CCIA filed a timely petition to review the Supplemental Order.
As asserted by the CCIA, it had no legal duty to admit liability for temporary disability benefits. See Allison v. Industrial Claim Appeals Office, 916 P.2d 623 (Colo.App. 1995); Woods v. Cz Courier Ltd., W.C. No. 4-274-394 (May 22, 1998). Rather, it was only required to timely admit or deny liability, and pay benefits "according to admitted liability." Section 8-43-203(1)(a), (2)(d) C.R.S. 1998. However, we reject the CCIA's contention that § 8-43-203(2)(d) supports its General Admission of Liability for the termination of temporary disability benefits effective August 20, 1998.
The rules of statutory construction require that statutes be given their legislative intent. Industrial Claim Appeals Office v. Orth, 965 P.2d 1246 (Colo. 1998). Furthermore, statutes must be construed to give a consistent, harmonious, and sensible effect to all of the parts. Monfort Transportation v. Industrial Claim Appeals Office, 942 P.2d 1358 (Colo.App. 1997). We conclude that the CCIA's interpretation of § 8-43-203 is inconsistent with the statutory provisions concerning temporary disability benefits.
Temporary disability benefits are payable if the industrial injury causes a disability and as a result of the disability the claimant suffers a temporary wage loss. Section 8-42-103(1), C.R.S. 1998 ; PDM Molding, Inc. v. Stanberg, 898 P.2d 542 (Colo. 1995). The claimant bears the initial burden to prove the entitlement to temporary disability benefits. Lymburn v. Symbios Logic, 952 P.2d 831 (Colo.App. 1997). However, § 8-42-105(3), C.R.S. 1998, provides that once the claimant has established an entitlement to temporary disability benefits, benefits "shall continue" until the occurrence of one of the events listed in subsections (a) through (d). In other words, once the claimant establishes that the industrial injury has caused a compensable wage loss, the burden shifts to the employer to establish grounds for the termination of benefits. See Atlantic Pacific Insurance Co. v. Barnes, 666 P.2d 163 (Colo.App. 1983) (party seeking to change status quo bears burden of proof).
We agree with the Director that once the CCIA filed an admission for temporary disability benefits, it admitted the claimant sustained her burden to prove her entitlement to temporary disability benefits. As a result, the CCIA was required to pay continuing temporary disability benefits until terminated in accordance with § 8-42-105(3).
Where the insurer seeks to terminate temporary disability benefits without a hearing, the insurer is required to comply with Rule IX. The requirements of Rule IX are designed to ensure that where the insurer desires to terminate benefits without a hearing, the insurer is able to make a preliminary evidentiary showing which demonstrates a high degree of probability that they will succeed when the issue is tried on the merits.
Where the insurer is unable to proceed without a hearing, Rule IX(D) requires the insurer to file a Petition to Suspend and continue paying benefits until the Petition is adjudicated. Rule IX(H)(2) at 36.01, states that if the Director concludes that the insurer has not met the requirements of Rule IX, she may order the insurer to continue the payment of temporary disability benefits until the requirements of the rule are satisfied or until a hearing is held on a Petition to Suspend.
Here, the CCIA asserts that its General Admission for the termination of temporary disability benefits is based on the claimant's status as a "seasonal employee," whose job was scheduled to end August 20, 1998. However, the claimant's alleged status as a "seasonal employee" is not a ground for the unilateral termination of temporary disability benefits under Rule IX or § 8-42-105(3). In fact, the mere assertion of seasonal employee status is not dispositive of the claimant's entitlement to continuing temporary disability benefits. City of Aurora v. Dortch, 799 P.2d 462 (Colo.App. 1990). Rather, the respondents' assertion of this potential defense creates a factual question which can only be resolved after a hearing. Cf. A R Concrete Construction v. Lightner, 759 P.2d 831 (Colo.App. 1988).
Furthermore, the CCIA does not assert that it's General Admission complied with the requirements of Rule IX(C) or § 8-42-105(3). Consequently, the CCIA is required to pay continuing temporary disability benefits and the Director correctly ordered the CCIA to reinstate temporary disability benefits. See Monfort Transportation v. Industrial Claim Appeals Office, supra; A R Concrete Construction v. Lightner, supra.
In reaching this conclusion, we note that § 8-43-203(2)(d) has been interpreted to mean that once the insurer admits liability, and the insurer is unable to meet the requirements for the unilateral termination of benefits under Rule IX, the insurer must continue to pay temporary disability benefits until a hearing is held to determine whether there is sufficient evidence to permit the termination of benefits under § 8-42-105. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). Further, in A R Concrete Construction v. Lightner, supra, the court held that "once an admission of liability for temporary disability benefits is filed, neither the employer nor its insurer is entitled to suspend payments unilaterally," except as provided by Rule IX. 759 P.2d at 833.
We also recognize that § 8-43-203(b) requires an admission of liability to state the amount of compensation to be paid, and the period for which compensation will be paid. However, we agree with the Director that where the insurer admits liability for a closed period of temporary disability benefits, the date listed for the termination of benefits must conform to the statutory grounds listed in § 8-42-105(3) and be documented in accordance with Rule IX.
In contrast, the CCIA's construction would allow an insurer to file multiple admissions for limited periods of disability benefits, and thus, shift the burden of proof to the claimant to reestablish her entitlement to continuing benefits for each succeeding period. We do not believe the legislature intended this result. See Brownson-Rausin v. Colorado Hospital Association Trust, W.C. No. 3-101-431 (August 27, 1997).
The CCIA's interpretation would also increase the frequency and cost of litigation, which is inconsistent with the legislative goal of assuring the quick and efficient delivery of disability benefits to injured workers at a reasonable cost to employers "without the necessity of any litigation." Section 8-40-102(1), C.R.S. 1998. Therefore, we decline to adopt the CCIA's construction.
The cases cited by the CCIA do not compel a contrary result. Griffith v. Miller Brothers, Inc., W.C. No. 4-153-811 (December 31, 1996) , is factually distinguishable because in that case the admission of liability for a closed period of temporary disability benefits was based on an agreement of the parties, and the issue was whether the employer was liable for a subsequent period of disability benefits. Similarly, in Butler v. Bridgemaster Inc., W.C. No. 4-267-417 (March 31, 1998) and Gonsalves v. The Aspen Branch Floral Arts, W.C. No. 4-234-403 (May 1, 1998), there was no dispute that temporary disability benefits had been properly terminated. Instead, the issue was whether the employer had a subsequent duty to voluntarily reinstate benefits based upon changed circumstances. Relying on Allison v. Industrial Claim Appeals Office, supra, we concluded in those cases that the insurer has no duty voluntarily to admit for additional benefits and may require the claimant to prove his entitlement to further temporary disability benefits. However, we did not hold that the insurer may terminate benefits in violation of Rule IX or § 8-42-105.
IT IS THEREFORE ORDERED that the Director's order dated November 3, 1998, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ David Cain ______________________________ Kathy E. Dean
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, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date this Order is mailed, pursuant to section 8-43-301(10) and 307, C.R.S. 1998.
Copies of this decision were mailed April 7, 1999 the following parties:
Ali Childers, Wheaton College-Evans Dorm, CPO 386, Wheaton, IL 60187
Noah's Ark Whitewater Rafting Co., Post Office Box 850, Buena Vista, CO 81211
Michael Steiner, Esq., Colorado Compensation Insurance Authority (Interagency Mail)
BY: AP