Opinion
W.C. No. 4-677-547.
March 26, 2007.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Martinez (ALJ) dated October 12, 2006 that denied and dismissed her claim for benefits. We affirm.
This matter went to hearing for a determination of whether the claimant sustained a compensable injury and was, therefore, entitled to disability and medical benefits. Several of the ALJ's findings of fact are summarized as follows. The claimant alleged she fell off a chair at work on October 12, 2005 and injured her upper back, neck, right shoulder, and right arm. She sought treatment from her personal physician the next day. Instead of advising her physician that she fell at work, she said she suffered from symptoms related to hormonal imbalances. She did not mention symptoms related to her upper back, neck, right shoulder, and right arm. She received additional treatment on November 2 and November 9, 2005 and did not report suffering symptoms from a fall at work. The claimant advised another personal physician, Dr. Sever, on November 16, 2005, that she fell at work. She had previously advised Dr. Sever on November 2, 2005, that she had right subscapular pain.
After exhausting her short-term disability benefits for unrelated medical problems, the claimant filed a claim for workers' compensation benefits on February 22, 2006. Dr. Lockwood examined the claimant at the employer's request. After reviewing certain medical records of the claimant, he stated that too many inconsistencies in the claimant's statements to medical providers prevented him from opining as to whether her complaints and conditions were related to her alleged fall at work. However, he opined that the claimant's medical records did not support such allegations. The claimant's treating physician, Dr. Pineiro, echoed Dr. Lockwood's opinions. Dr. Pineiro further opined that the claimant's late reporting of the alleged accident and symptoms contradict her allegations that her medical condition and symptoms were caused by a fall at work.
Dr. Hompland however, opined that he claimant's neck injury symptoms were due to her work. Dr. Yamamoto examined the claimant at her counsel's request and opined that the claimant's neck injury and myofascial pain in the right upper back were caused by her fall at work. Nonetheless, the ALJ credited the opinions of Dr. Pineiro and Dr. Lockwood and determined that the claimant failed to establish a compensable injury.
On appeal the claimant asserts that the ALJ erred in not finding that she suffered a compensable injury. In support of this contention the claimant reviews evidence supporting her claim and argues that the ALJ placed undue emphasis upon credibility determinations when the record fails to show that she was anything but honest and forthright regarding her claim. She notes that her testimony about falling from a chair at work was not challenged at the hearing. It is true that credibility determinations become necessary when testimony is controverted. Regal Coal Co. v. Jackvich, 105 Colo. 479, 483, 99 P.2d 196, 198 (1940). However, even uncontroverted testimony is not required to be accepted as uncontroverted facts. Id.
As pointed out by the claimant, much of the ALJ's compensability determination stems from his evaluation of the claimant's testimony and statements to various medical providers. Several corresponding findings in the ALJ's Findings of Fact, Conclusions of Law, and Order (Order) are as follows. The day after the claimant states she fell at work, she advised her physician she suffered from a worsening of symptoms related to hormonal imbalances and advised him the onset of her symptoms started prior to the date she later claimed that she fell. Order at 1, ¶ 2. Doctors examined the claimant on November 2, 2005 and November 9, 2005, but she did not mention a fall at work or corresponding symptoms. Order at 1, ¶ 3. The claimant first advised a physician about the accident five weeks after the fact. Order at 2, ¶ 5. Because of "too many" inconsistencies in the claimant's statements to providers, Dr. Lockwood was unable to state within a reasonable degree of medical probability that the claimant's condition was related to a fall at work. Order at 2, ¶ 9. Dr. Pineiro reached similar conclusions. Order at 2, ¶ 10. Dr. Pineiro also opined that the claimant's allegations that her condition and symptoms were caused by a fall at work were contradicted by her late reporting of the accident and those symptoms. Order at 2, ¶ 11. The contrary opinions of Dr. Hompland and Dr. Yamamoto were not persuasive because they were based, to a large extent, on the claimant's "unreliable statements" about her accident, medical history, condition, "and the temporal relationship of her alleged injury to the onset of her symptoms." Order at 3, ¶ 16. The claimant made inconsistent and unreliable statements to medical providers and made a late reporting of the accident and symptoms, thereby resulting in her testimony not being found credible. Order at 3, ¶ ¶ 19-20.
The ALJ correctly considered the claimant's contradictory testimony in the context of making credibility determinations. Sullivan v. Beers, 529 P.2d 320, 323 (Colo.App. 1974) (not selected for official publication). However, it does not necessarily follow that because a person's statements and testimony were found not to be credible means that the witness was not honest and forthright. Instead, the trier of fact must, in his "sole province . . . evaluate such alleged inconsistencies and determine the effect, if any to be given them in resolving the facts." Bein Farms, Inc. v. Dale, 137 Colo. 424, 429, 326 P.2d 72, 76 (1958).
The claimant also comments on both evidence in the record that supports her claim and on deficiencies in the medical records upon which the ALJ relied. To the extent that claimant's petition to review is a request that we reweigh the evidence on review, we have no authority to substitute our judgment for that of the ALJ concerning the sufficiency and probative weight of the evidence and we decline to do so. Arenas v. Industrial Claim Appeals Office, 8 P.3d. 558 (Colo.App. 2000); Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990).
Finally, we conclude that the ALJ's decision to deny compensation in this matter is supported by the record and applicable law. The claimant had the burden to prove that her alleged disability was proximately caused by an injury arising out of and in the course of his employment. Section 8-41-301(1)(c), C.R.S. 2006. Whether the claimant met that burden of proof is a factual question for resolution by the ALJ, and his determination must be upheld if supported by substantial evidence in the record. Dover Elevator Co. v. Industrial Claim Appeals Office, 961 P.2d 1141 (Colo.App. 1998). Substantial evidence is that quantum of probative evidence which a rational fact finder would accept as adequate to support a conclusion without regard to the existence of conflicting evidence. Durocher v. Industrial Claim Appeals Office, 905 P.2d 4 (Colo.App. 1995).
Under this standard of review it is the ALJs sole prerogative to evaluate the credibility of the witnesses and the probative value of the evidence. The substantial evidence standard requires that we view evidence in the light most favorable to the prevailing party, and defer to the ALJ's assessment of the sufficiency and probative weight of the evidence. Thus, the scope of our review is "exceedingly narrow." Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 2003). This narrow standard of review also requires that we defer to the ALJ's resolution of conflicts in the evidence, credibility determinations, and plausible inferences drawn from the record. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo.App. 2003). We note that expert medical opinion is not needed to prove causation where circumstantial evidence supports an inference of a causal relationship between the injury and the claimant's condition. Savio House v. Dennis, 665 P.d. 141 (Colo.App. 1983). However, where, as here, conflicting expert opinion is presented, it is solely for the ALJ as fact-finder to weigh the competing evidence and resolve any conflicts. Rockwell International v. Turnbull, supra. We may not substitute our judgment for that of the ALJ unless the testimony the ALJ found persuasive is rebutted by such hard, certain evidence that it would be error as a matter of law to credit the testimony. Halliburton Services v. Miller, 720 P.2d 571 (Colo. 1986). The existence of evidence which, if credited, might permit a contrary result also affords no basis for relief on appeal. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo.App. 2002).
The record contains substantial evidence supporting the ALJ's factual findings as shown by the following examples. The ALJ credited the opinions of Dr. Pineiro. Dr. Pineiro stated in her deposition that inconsistencies in the reports of the claimant's primary care providers prevented her from opining that her condition was caused by falling. Pineiro Depo. at 14-15. She could not state that the claimant's condition or injury was work-related. Tr. at 17. The ALJ also credited the opinions of Dr. Lockwood. After examining the claimant and reviewing various medical records, Dr. Lockwood opined that he did not "feel comfortable within a medical probability relating [the claimant's] complaints to a specific work-related injury." Exhibit J at 57. We conclude that the ALJ could infer that the fall the claimant reported to have occurred on October 12, 2005 did not cause disability or the need for medical treatment and, therefore, was not a compensable injury. Because the ALJ's factual findings are supported by substantial evidence and reasonable inferences from the record and because he correctly applied the relevant law, we may not disturb the order.
IT IS THEREFORE ORDERED that the ALJ's order dated October 12, 2006, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ John D. Baird
____________________________________ Thomas Schrant
Mary Hoffman, 36489 Cheetah Drive, Loveland, CO, Adelphia Communications Corporation, Diane Gray, 5619 DTC Parkway, Greenwood Village, CO, New Hampshire Insurance Company, c/o AIG Claims Services, Inc., Sandra Finnegan, P.O. Box 25971, Shawnee Mission, KS, Ring Associates, P.C., Jess M. Perez, Esq., 2550 Stover Street, Bldg C, Fort Collins, CO, (For Claimant).
Senter, Goldfarb Rice, LLC., Eric W. Truhe, Esq., 1700 Broadway Ave., Suite 1700, Denver, CO, (For Respondents).