Opinion
W.C. No. 4-221-570
April 13, 1999.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Stuber (ALJ) which determined the claim is closed, and therefore, denied his claim for additional medical and temporary disability benefits. We affirm.
On January 31, 1997, the claimant suffered an admitted injury to his right 5th finger. The claimant was subsequently diagnosed and treated for a contusion of the right 5th finger, stretch injury of the right ulnar nerve, and myofascial syndrome of the right upper extremity. Eventually, the claimant began treating with Dr. Stone. In a report dated January 9, 1997, Dr. Stone diagnosed the claimant as suffering from a right hand syndrome, compression neuropathy and impingement syndrome. However, he added that the latter two conditions are not related to the industrial injury. Following an MRI and nerve conduction studies, Dr. Stone reexamined the claimant. In a clinic note dated January 31, 1997, Dr. Stone opined that the claimant suffers from mild carpal tunnel syndrome (CTS), and right impingement syndrome which are unrelated to the industrial injury. He also reported that the claimant's right 5th finger injury had "healed" and that the claimant's hand syndrome was no longer "responsible for her primary symptoms." Therefore, Dr. Stone placed the claimant at maximum medical improvement (MMI) without permanent impairment, and discharged the claimant from further treatment. In a "Physician's Report of Maximum Medical Improvement" dated January 31, 1997, Dr. Stone stated that the claimant has "fully recovered and does not require an impairment rating." Dr. Stone also issued a "Work Status Report" dated January 31, 1997, in which he stated the claimant is at MMI for the "5th finger injury."
On February 27, 1997, the respondents filed a Final Admission of Liability which listed the date of MMI as January 31, 1997, and terminated the claimant's entitlement to further benefits. The claimant did not timely object to the Final Admission, but later sought additional temporary disability and medical benefits. However, the ALJ determined the claimant was closed because of the claimant's failure to object to the final admission.
On review, the claimant argues that a determination of MMI does not terminate medical and temporary disability benefits unless the claimant is at MMI for all compensable components of the injury. Relying on Dr. Stone's "Work Status Report," the claimant contends that Dr. Stone placed the claimant at MMI for the right 5th finger injury only. Therefore, the claimant argues that the respondents' uncontested Final Admission did not close the "issues"of temporary disability and ongoing medical benefits for treatment of CTS, impingement syndrome, stretch injury to the right ulnar nerve and myofascial pain syndrome. The claimant also contends that the respondents previously admitted that these conditions are compensable by voluntarily paying for related treatment. Consequently, claimant argues that the ALJ's determination the claim was closed erroneously allowed the respondents' unilaterally to withdraw the prior admissions. We reject these arguments.
Section 8-43-203(2)(b)(II), C.R.S. 1998, [amended for injuries on or after August 5, 1998], provides that "if the claimant feels entitled to more compensation," he may contest a Final Admission of Liability by filing a written objection within sixty days of the date of the Final Admission. Where no timely objection is filed, the claim is automatically closed as to the issues admitted in the Final Admission. Dalco Industries, Inc. v. Garcia, 867 P.2d 156 (Colo.App. 1993). Where the Final Admission is based upon a medical report, the Rules of Procedure, Part IV(N)(1), Code Colo. Reg. 1101-3 at 6.02, require that the medical report accompany the admission and that the admission specifically reference the medical report relied upon.
The claimant concedes that the Final Admission was accompanied by Dr. Stone's medical report dated January 31, 1997. In fact, the claimant does not contend that the Final Admission was improperly filed. Rather, the claimant merely contends that the uncontested Final Admission closed her entitlement to benefits for the right 5th finger injury but left open issues involving the other conditions. We disagree.
The Final Admission contained a notice advising the claimant that if she disagreed with the amount or type of benefits the insurer agreed to pay, she must object within sixty days of the date of the Final Admission or the claim would be closed on all issues admitted. The Final Admission admitted liability for medical benefits paid "to date" and temporary disability benefits paid to September 9, 1994. The Final Admission also expressly provided that "all benefits or penalties not admitted" were "specifically denied," because Dr. Stone "placed the claimant at maximum medical improvement on 1/31/97 with no disfigurement and does not require and [sic] impairment rating and needs no further treatment to maintain maximum medical improvement." It follows that insofar as the claimant contends she is entitled to further temporary disability and medical benefits she was required to object to the respondents' denial of liability for "all benefits or penalties not admitted." This would include benefits associated with the medical conditions the claimant now asserts are causally related to the injury. Cf. Bast v. Mountain Services, Inc., W.C. No. 3-906-548 (July 6, 1999).
In any event, the claimant's contention that Dr. Stone did not place her at MMI for all compensable components of the industrial injury merely creates a factual dispute concerning the claimant's entitlement to further benefits. In the absence of a timely filed objection to the final admission or a petition to reopen, the ALJ lacks jurisdiction to resolve the dispute. Safeway, Inc. v. Industrial Claim Appeals Office, 968 P.2d 162 (Colo.App. 1998); Lewis v. Scientific Supply Co., 897 P.2d 905 (Colo.App. 1995).
Moreover, the respondents are only liable for emergency medical treatment and treatment which is reasonably necessary to cure and relieve the effects of the industrial injury. Section 8-42-101(1)(a), C.R.S. (1996 Cum. Supp.); Colorado Compensation Insurance Authority v. Nofio, 886 P.2d 714 (Colo. 1994). A general admission of liability for medical benefits is not an admission that all medical treatment thereafter received by the claimant is compensable. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). To the contrary, the respondents remain free to contest the compensability of any particular treatment. Williams v. Industrial Commission, 723 P.2d 749 (Colo.App. 1986). Therefore, unlike temporary disability benefits, the respondents' voluntary admission for medical benefits did not preclude their "unilateral" denial of liability for all further medical benefits based on their interpretation of Dr. Stone's January 1997 medical reports. See Egan v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA0821, November 13, 1998) (treating physician's determination of the cause of the claimant's condition is inherent to the physician's determination of MMI and impairment rating); Snyder v. Industrial Claim Appeals Office, supra; Saurini v. Ice Cream Wagon, Inc., W.C. No. 3-896-179 (July 21, 1995).
The claimant's remaining arguments have been considered and do not alter our conclusions.
IT IS THEREFORE ORDERED that the ALJ's order dated July 13, 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. 1997.
Copies of this decision were mailed April 13, 1999 the following parties:
Cynthia L. Hays, 550 E. 100 South, Price, UT 84501
Hyper Shoppes d/b/a Biggs/Hyper Real Estate, 10001 Grant St., Thornton, CO 80222
Curt Kriksciun, Esq., Colorado Compensation Insurance Authority — Interagency Mail (For Respondents)
William A. Alexander, Jr., Esq., 3608 Galley Rd., Colorado Springs, CO 80909-4349 (For Claimant)
Michele Stark Carey, Esq., 101 N. Tejon, #410, Colorado Springs, CO 80903
BY: AP