Opinion
W.C. No. 4-501-083
May 5, 2004
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Mattoon (ALJ) which denied and dismissed a petition to reopen. The claimant argues the ALJ erred in finding the respondents did not orally agree to reopen the claim. The claimant further contends the evidence establishes there was a mistake concerning her diagnosis at the time the claim was closed and this mistake warrants reopening. Finally, the claimant asserts the ALJ applied an incorrect standard of law in finding that she failed to prove a worsened condition. We affirm the ALJ's order.
The claimant sustained injuries to her head and left arm when she was struck by a piece of falling metal on April 20, 2001. The primary diagnoses were contusion of the left arm and a cervical strain. The treating physician placed the claimant at maximum medical improvement (MMI) with no impairment on January 8, 2002. The claim was closed by the filing of a final admission of liability (FAL).
In July 2002 the claimant returned to the treating physician reporting a "new symptom complex," including increasing discomfort in the neck and right arm with numbness and tingling in the hand and fingers. The ALJ found this was the first time "pain in the right arm is mentioned in the record in any significant way." (Findings of Fact 8, 15).
In September 2002 the claimant was diagnosed with Complex Regional Pain Syndrome (CRPS) of the right upper extremity. The claimant filed a petition to reopen her claim, alleging that the CRPS existed but was unrecognized when the claim was closed, and therefore there was a mistake of fact as to her condition at the time the claim was closed. The claimant also alleged the CRPS represented a worsening of condition caused by the April 2001 injury.
However, the ALJ denied the petition to reopen. In so doing, the ALJ found that although the claimant does suffer from CRPS, she failed to prove CRPS existed on the date of MMI or that CRPS was caused by the industrial injury. The ALJ was persuaded by evidence that the CRPS affected the right upper extremity which was not injured or impacted in April 2001, and by evidence that no "significant"symptoms of CRPS appeared until the summer of 2002, more than a year after the injury.
I.
On review, the claimant first contends the respondents entered into a settlement under which the respondents agreed to reopen the case and pay benefits in exchange for the claimant's agreement to cancel a hearing scheduled for March 21, 2003. The claimant contends this settlement is documented by a letter which claimant's counsel sent to respondents' counsel on March 20, 2003. However, the ALJ ruled there was no "settlement" because the parties failed to meet the requirements of § 8-43-204, C.R.S. 2003.
The claimant first asserts the "agreement" entered into between the parties does not constitute a "settlement" for purposes of the statute, and that § 8-43-204 does not apply. The claimant reasons that she was not settling anything since the respondents were agreeing to reopen the claim and pay compensation. However, § 8-43-204(1) provides that an injured employee "may settle all or any part of any claim for compensation." (Emphasis added). Subsection (2) provides that a settlement "shall be signed by a representative of the employer or insurer and signed and sworn to by the injured employee." Subsection (3) provides the settlement must be "approved in writing by an administrative law judge or the director of the division prior to the finalization of the settlement."
Our courts have consistently held that failure to adhere to these statutory requirements prevents the enforcement of an alleged settlement. Administrative supervision of settlements, which is mandated by the statute, helps to ensure that settlements are fair, clear, understood by the parties, and in accordance with public policy. See Cook v. McLister, 820 P.2d 1167 (Colo.App. 1991); City Market v. Industrial Claim Appeals Office, 800 P.2d 1335 (Colo.App. 1990); Oxford Chemicals, Inc. v. Richardson, 782 P.2d 843 (Colo.App. 1989); Covert v. Navajo Express, Inc., W.C. No. 3-908-058 (December 18, 1995).
We reject the claimant's assertion that the alleged agreement between the parties does not constitute a "settlement" of a part of a claim for benefits within the meaning of § 8-43-204(1). Although the claimant asserts she was not giving up anything in exchange for the respondents' promise to pay benefits, she acknowledges in the brief and in the March 20 letter from her counsel that she was surrendering the right to proceed immediately to hearing and obtain an order establishing her right to benefits as a matter of law. In exchange for avoiding the necessity of going to hearing, the respondents agreed to pay benefits. Thus, the claimant exchanged valuable consideration (the right to proceed to hearing) in exchange for the respondents' promise to pay.
Neither do we agree with the claimant that there was an oral agreement reduced to writing as evidenced by the letter. Section 8-43-204(2) requires that a settlement be signed by a representative of the insurer. The letter was not signed by the insurer or its representative, and it does not constitute a written settlement under the applicable law. In this regard, we note that Godwin-Bevers Co., Inc. v. G.P. Enterprises, Inc., 502 P.2d 1124 (Colo.App. 1972) (not selected for publication), is inapposite. Godwin-Bevers is a civil case not controlled by the specific statutory provisions of the Workers' Compensation Act (Act), including those governing settlements. See Compton v. Industrial Claim Appeals Office, 13 P.3d 844 (Colo.App. 2000); Lewis v. Scientific Supply Co., Inc., 897 P.2d 905 (Colo.App. 1995) (as an administrative tribunal we are limited to exercising the duties, powers and authority conferred by the statute and may not assume other powers).
In reaching this result we should not be understood to hold that parties may never stipulate to certain facts or waive, by words or actions, various legal rights. Indeed, these principles are well established in workers' compensation law. E.g. Schlage Lock v. Lahr, 870 P.2d 615 (Colo.App. 1993) (discussing judicial admissions). However, this case involves an out-of-court agreement to pay benefits in exchange for the surrender of a valuable right. Thus, a partial settlement is at issue.
II.
The claimant next contends the ALJ erred in denying the petition to reopen based on a mistake of fact. The claimant argues that several medical records establish she was suffering from CRPS at the date of MMI, but the condition was simply undiagnosed. Therefore, the claimant argues the FAL was predicated on a mistake of fact concerning her condition and the matter must be reopened. We disagree.
The claimant is correct in arguing that under some circumstances misdiagnosis may constitute grounds for reopening a claim based on a mistake of fact. See Standard Metals Corp. v. Gallegos, 781 P.2d 142 (Colo.App. 1989). However, reopening is discretionary with the ALJ, and we may not interfere unless an abuse of discretion is shown. Renz v. Larimer County School District, 924 P.2d 1177 (Colo.App. 1996). An abuse of discretion is not shown unless the ALJ's order is beyond the bounds of reason, as where it is contrary to law or unsupported by the evidence. Pizza Hut v. Industrial Claim Appeals Office, 18 P.3d 867 (Colo.App. 2001).
The question of whether a mistake was made concerning the claimant's diagnosis was one of fact to be resolved by the ALJ. See Standard Metals Corp. v. Gallegos, supra. Thus, we must uphold the ALJ's resolution if supported by substantial evidence. Section 8-43-301(8), C.R.S. 2003. This standard of review requires us to view the evidence in a light most favorable to the prevailing party, and 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). In this regard, we note it is the ALJ's province to resolve conflicts between medical experts. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo.App. 2002).
The claimant's argument notwithstanding, the ALJ was not compelled to conclude the claimant was suffering from CRPS on the date of MMI based simply on the existence of medical records showing that in a few instances the claimant reported pain in the right arm, shoulder, and neck prior to MMI. As the respondents point out, Dr. Sparr testified there is a substantial difference between the type and severity of right upper extremity symptoms which were noted prior to MMI, and those which manifested as CRPS in the summer of 2002. (Tr. Pp. 119, 129, 131). Even Dr. Stieg, who opined that CRPS was present on the date of MMI, admitted the claimant's pain symptoms were poorly documented prior to MMI and that reasonable physicians might differ on the meaning of the records. (Stieg Depo. pp. 50-51, 60).
The claimant also asserts the ALJ found there were "no complaints of injury relating to the [claimant's] right arm or shoulder," and this finding is unsupported by the evidence. However, as the respondents contend, the ALJ found there were no significant symptoms involving the right upper extremity. Indeed, the ALJ expressly found there were "a few very minor complaints of right shoulder and arm pain during" the claimant's pre-MMI treatment. (Finding of Fact 8). The ALJ's finding constitutes a plausible interpretation of the evidence and we may not interfere with it on review.
The respondents have not argued, and we have not considered, whether the claimant's attempt to reopen based on the allegation that she was misdiagnosed at the time of MMI constitutes an impermissible attempt to circumvent the Division-sponsored independent medical examination process. See Cordova v. Industrial Claim Appeals Office, supra; Story v. Industrial Claim Appeals Office, 910 P.2d 80 (Colo.App. 1995). Because the issue has been resolved at the factual level based on the finding that there was no mistake, this order should not be considered indicative of what ruling we might reach if the issue were raised and squarely presented by the facts of some other case.
III.
Finally, the claimant contends the ALJ applied an incorrect standard of law in determining whether she proved a worsened condition caused by the industrial injury. The claimant notes the ALJ found that the CRPS developed in the claimant's right upper extremity, a portion of the body "that was not injured or impacted at all in her industrial accident." The claimant argues that this finding demonstrates the ALJ failed to recognize that the CRPS could be considered a compensable consequence of the industrial injury if it is a natural and proximate result of the injury. See Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (1970); Jarosinski v. Industrial Claim Appeals Office, 62 P.3d 1082 (Colo.App. 2002). We find no error.
In order to reopen based on a worsened condition, the claimant was required to show the worsened condition resulted from a change in the original compensable injury or a change of the claimant's physical or mental condition which can be causally connected to the original compensable injury. Jarosinski v. Industrial Claim Appeals Office, supra. Whether the claimant has proven causation is a question of fact for the ALJ. Owens v. Industrial Claim Appeals Office, 49 P.3d 1187 (Colo.App. 2002).
Here, the ALJ correctly recognized the claimant had the burden of proof on the issue of causation. Moreover, we do not understand the ALJ to have ruled out the possibility that the worsening of condition was caused by the injury simply because the symptoms appeared on the right side. Rather, we understand the ALJ to have recognized that trauma can cause CRPS, and that the documented trauma was to the claimant's left upper extremity. Further, as Dr. Stieg stated, even minor trauma can cause CRPS. Thus, considering the delay in onset of CRPS between the date of the industrial injury (April 2001) and the onset of CRPS (summer 2002), the ALJ could conclude the claimant failed to prove any relationship between the industrial injury and the CRPS.
IT IS THEREFORE ORDERED that the ALJ's order dated November 14, 2003, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ David Cain
______________________________ Bill WhitacreNOTICE
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, Colorado 80203, by filing a Petition to Review with the Court, within twenty (20) days after the date this Order was mailed, pursuant to § 8-43-301(10) and § 8-43-307, C.R.S. 2003. 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 order were mailed to the parties at the addresses shown below on May 5, 2004 by A. Hurtado.
Catrina Leibseit, 8 Bruce Ln., Pueblo, CO 81001
Parkview Medical Center, 400 W. 16th St., Pueblo, CO 81003
Patty Enloe, American Compensation Insurance Company, P. O. Box 390327, Minneapolis, MN 55439
Barkley D. Heuser, Esq., 625 N. Cascade, #300, Colorado Springs, CO 80903 (For Claimant)
Joseph R. Winston, Esq., 1009 S. Tejon St., Colorado Springs, CO 80903 (For Claimant)
Brad J. Miller, Esq., 5600 S. Quebec St, #130-D, Greenwood Village, CO 80111 (For Respondents)