Opinion
W.C. No. 4-736-538 4-730-751.
October 2, 2008.
FINAL ORDER
The respondent American Compensation Insurance Company ("American") seeks review of an order of Administrative Law Judge Felter (ALJ) dated April 10, 2008, that ordered American to pay temporary total disability benefits and medical benefits in connection with an injury that occurred on September 20, 2007. We affirm.
The disputed issue in this case was which of the employer's two successive insurers was liable for the claimant's injury of September 20, 2007 (W.C. No. 4-736-538). The claimant had sustained a compensable injury on June 1, 2007, when the employer was insured by American (W.C. No. 4-730-751). He then sustained a subsequent injury on September 20, 2007, at which time the employer's insurer had changed to Pinnacol Assurance ("Pinnacol"). However, Pinnacol asserted that the September 20, 2007, injury was in the "quasi-course" of the claimant's employment and was therefore attributable to the June 1, 2007, injury, which was the liability of American.
A hearing was held on that issue, following which the ALJ entered findings of fact that for the purposes of this order may be summarized as follows. The claimant sustained a work-related injury to his right shoulder on June 1, 2007. At the time of this injury the employer was insured by American, which admitted liability for the injury and paid medical benefits and temporary disability benefits. The claimant's medical treatment included surgery, which temporarily resulted in restrictions that included no use of the right arm. In September 2007 the claimant returned to modified work with the employer. On September 20, 2007, the claimant left work at 1:45 p.m. to attend a physical therapy appointment for his June 1, 2007, right shoulder injury. On that date the employer was insured for purposes of the Workers' Compensation Act by Pinnacol Assurance. When the claimant attempted to enter his vehicle in the parking lot, he slipped on the running board of the truck. Because his right arm was in a sling and he was unable to use it, the claimant was required to grasp the door of the truck with his left arm to prevent his falling. As a result he injured his left shoulder, which was subsequently diagnosed as a torn left rotator cuff.
Based upon his factual findings, the ALJ concluded that the claimant's injury of September 20, 2007, occurred within the "quasi-course" of his employment, since the claimant was on the way to a medical appointment in connection with his June 1, 2007, injury. The ALJ therefore ruled that as the insurer liable for the June 1, 2007, injury, American was liable for benefits payable for the September 20, 2007, injury.
American appealed the ALJ's order and argues that the ALJ erred in ruling that American was liable under the "quasi-course" doctrine, where the claimant sustained an injury for which Pinnacol should have been liable under the general principles of compensability. American also argues that at a minimum Pinnacol should have been ordered to contribute to the payment of benefits and compensation for the September 20, 2007, injury. We are unpersuaded that the ALJ erred.
Under the "quasi-course of employment" doctrine, compensation is awarded when a claimant is injured while seeking authorized medical treatment. Excel Corp. v. Industrial Claim Appeals Office, 860 P.2d 1393 (Colo.App. 1993). The basis for the doctrine is that, although such injuries occur outside employment-related activities, an employer has a quasi-contractual obligation to provide treatment for the compensable injury and the claimant has an obligation to submit to such treatment. Therefore, trips to receive authorized treatment constitute an implied condition or expectation of the employment contract. Excel Corp. v. Industrial Claim Appeals Office, supra.
Here, given his factual findings, the ALJ did not err in applying the "quasi-course" doctrine. Initially, we note that we do not understand any party to be contesting that the record contains support for the ALJ's factual findings. In any event, there is ample support for those findings in the claimant's undisputed testimony concerning the circumstances of his injury, including the finding that he was on the way to a medical appointment and the finding describing the mechanism of the injury to his left shoulder. See Tr. at 15-16. That testimony constitutes substantial evidence and therefore we are bound by the ALJ's factual findings. 38-43-301(8), C.R.S. 2008; Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995).
The ALJ also correctly applied the relevant law regarding the "quasi-course" doctrine. It is undisputed that the claimant was on his way to a physical therapy appointment at the time of the injury. Indeed, American concedes that "this case would fall within the quasi-course of employment doctrine" if the claimant were not at work at the time of his injury. Brief in Support of Petition to Review at 7. Therefore, the ALJ did not err in applying that doctrine to the facts of this case.
In any event, notwithstanding the application of the "quasi-course" doctrine, as we understand the ALJ's order, his factual findings compel the conclusion that American is liable for the results of the September 20, 2007, injury. Thus, the ALJ found that the claimant's condition as a result of the June 1, 2007, injury directly caused the injury to his left shoulder: "Because his right arm was in a sling, Claimant had to grab the door of his truck with his left arm to prevent himself from falling." Full Findings of Fact, Conclusions of Law and Order at 3, 5 (hereinafter "Order") (emphasis added). As we understand this finding, it is equivalent to one that the claimant's grabbing the door with his left arm, which was necessitated by the sling on his right arm, directly caused the injury to his left shoulder. Hence, although we have determined that it was not error to do so, it was unnecessary for the ALJ to rely upon the "quasi-course" doctrine in order to determine that American was responsible for the injury of September 20, 2007. Moreover, as we understand the ALJ's order, he recognized this principle and applied it as an alternative to the "quasi-course" doctrine. Thus, the ALJ concluded that based upon his factual findings, there was a "direct causal link of the left shoulder injury of September 20, 2007, to the admitted injury of June 1, 2007." Order at 4, b. We also note that the ALJ referred to the September 20th injury as "a natural consequence" and a "compensable consequence" of the June 1st injury. Order at 4, 5, , d., e. Although it is true that the determination of whether a reinjury is a proximate result of a prior industrial injury is generally a question of fact for determination by the ALJ, Lutgen v. Teller County School District No. 2, W. C. No. 3-846-454 (June 12, 1996), aff'd, Teller County School District No. 2 v. Industrial Claim Appeals Office, (Colo.App. 96CA1194, December 27, 1996) (not selected for publication), where the facts are undisputed and reasonable minds can draw but one inference, the issue of causation becomes one of law. See Schrieber v. Brown Root, Inc., 888 P.2d 274 (Colo.App. 1993). Here, in our view the ALJ found that the claimant's arm being in a sling directly caused the injury to his left shoulder. Because the claimant's shoulder injury was the direct result of the June 1, 2007, injury, American was liable for it. This is true regardless whether the claimant was on his way to a medical appointment in connection with his June 1, 2007, injury. See Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (Colo. 1970) (subsequent injury is the natural and proximate result of a prior injury where the latter played a "direct causative role" in the later injury).
It follows from this that we reject American's argument that the September 20, 2007, injury was compensable under the usual legal principles pertaining to workers' compensation injuries, and that therefore Pinnacol should have been "primarily" liable. American argues that the "quasi-course" doctrine is an "exception or adjunct" to those general principles, and that there is no need to resort to the doctrine where the injury occurred at work and was compensable without regard to the doctrine. However, in our view, this argument requires us to ignore the ALJ's finding that the claimant's specific injury to his left shoulder was directly caused by the medical treatment that resulted from the June 1, 2007, compensable injury. Thus, although it is certainly arguable that the claimant might have slipped on the running board absent the sling on his right arm, any finding that he would have injured himself in doing so would be entirely speculative. The factual finding entered was that the left shoulder injury was directly caused by the sling on his right arm. Given that the claimant's previous right shoulder injury was a direct causative factor in the left shoulder injury, it was unnecessary for the ALJ to speculate concerning the injury that might have occurred had the previous injury not been the cause of the later injury.
Finally, we are unpersuaded that the ALJ erred in refusing to apportion liability between the two insurers. Apportionment of medical benefits and temporary total disability benefits has been permitted between successive employers where two or more industrial injuries or diseases combine to cause the claimant's need for treatment or entitlement to compensation. E.g., Duncan v. Industrial Claim Appeals Office, 107 P.3d 999 (Colo.App. 2004); University Park Care Center v. Industrial Claim Appeals Office, 43 P.3d 637 (Colo.App. 2001); State Compensation Insurance Fund v. Industrial Commission, 697 P.2d 807 (Colo.App. 1985). However, here, there are not two successive injuries and it is more accurate to characterize American's claim as one for contribution rather than apportionment. However, we agree with the ALJ that the September 20, 2007, injury, whether viewed as in the "quasi-course" of the claimant's employment or as the direct consequence of the June 1, 2007, injury, was properly the sole liability of American. In either case the second injury was the compensable consequence of the first, and American was solely liable for it, without contribution from Pinnacol. Price Mine Service, Inc. v. Industrial Claim Appeals Office, 64 P.3d 936 (Colo.App. 2003).
IT IS THEREFORE ORDERED that the ALJ's order issued April 10, 2008, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
_______________________ John D. Baird
_______________________ Curt Kriksciun
LEROY L QUINTANA, ALAMOSA, CO, (Claimant).
ALAMOSA SCHOOL DISTRICT RE-11J, Attn: MS RHODA GETZ, ALAMOSA, CO, (Employer).
PINNACOL ASSURANCE, Attn: HARVEY D FLEWELLING, ESQ., DENVER, CO, (Insurer).
ERICA WEST, ESQ., DENVER, CO, (For Claimant).
RUEGSEGGER SIMONS SMITH STERN, LLC, Attn: ALEXANDRA E COLEMAN, ESQ., DENVER, CO, (For Respondents).
THOMAS POLLART MILLER, LLC, Attn: MARGARET KECK, ESQ., GREENWOOD VILLAGE, CO, (Other Party).
MR SCOTT SMITH, Attn: RTW, INC., MINNEAPOLIS, MN, (Other Party 2).