Opinion
W.C. No. 3-979-492
December 23, 1996
FINAL ORDER
The claimant filed a Petition to Review a final order of Administrative Law Judge Rumler (ALJ), which denied and dismissed his Petition to Reopen the claim for workers' compensation benefits. We affirm.
The claim was closed in 1992 pursuant to a full and final "Settlement Agreement," which was approved by the Division of Workers' Compensation [formerly Division of Labor] in accordance with § 8-43-204 C.R.S. (1996 Cum. Supp.). The Settlement provides that in exchange for the respondents' payment of $12,512 above and beyond all workers' compensation benefits previously paid in connection with the claimant's 1989 industrial injury, the claimant waived the right to reopen the claim except on the "ground of fraud or mutual mistake of material fact."
The claimant filed a Petition to Reopen in 1996. Although the Petition to Reopen alleges "mistake," at hearing the claimant asserted that the claim should be reopened on the ground of "fraud." However, the claimant admitted that he was not alleging fraud in the workers' compensation claim. (Tr. p. 14). To the contrary, the claimant stated that he was satisfied with the respondents' payment of benefits, and did not seek any additional benefits. (Tr. pp. 3, 5). Instead, the claimant requested that the ALJ reopen the claim to order an investigation by the Denver District Attorney or the Attorney General's Office of alleged wrongful acts by the respondents which resulted in the claimant's separation from his employment at Colorado Interstate Gas. He also asserted various delays and evidentiary errors during a 1990 hearing which resulted in a determination that the 1989 injury was compensable. (Tr. pp. 24, 31, 38).
Under these circumstances, the ALJ determined that the claimant's allegations, even if accepted as true, do not state a claim of "fraud" for purposes of reopening the claim. Therefore, the ALJ denied and dismissed the Petition to Reopen.
On appeal the claimant restates the arguments he made before the ALJ, and based upon these arguments, contends that the ALJ erred in failing to reopen the claim. We disagree.
The statutory language currently codified in § 8-43-303(1), C.R.S. (1996 Cum. Supp.) provides that a claim which has been closed by virtue of a settlement under § 8-43-205 may be reopened on the grounds of fraud or mutual mistake of fact. To reopen the claim on grounds of "fraud," the claimant must prove that the respondents made false representations which the claimant relied upon to settle the claim. See 3 A. Larson, Workmens' Compensation Law, § 81.51(b), at 15-1131, 15-1132, 15-1133 (1996); see also American Fence Co. v. Industrial Commission, 123 Ariz. 45, 597 P.2d 198 (Ct.App. 1979) (claimant's misunderstanding of effect of waiver signed on advice of counsel was a matter between the claimant and counsel, and was not due to any fraud by the insurance carrier). Furthermore, the determination of whether the claimant has established the existence of such fraud is factual in nature. Therefore, we must uphold the ALJ's determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. (1996 Cum. Supp.).
Here, there is substantial evidence in the record to support the ALJ's findings of fact, and they support the conclusion that the claimant failed to sustain his burden to prove that the settlement should be reopened on grounds of "fraud." Therefore, the ALJ did not err in denying the Petition to Reopen. Furthermore, we agree with the ALJ that she did not have authority to grant the other relief requested by the claimant, including his request for an investigation concerning the circumstances surrounding his separation from employment. See § 8-43-207(1), C.R.S. (1996 Cum. Supp.) (ALJ empowered to adjudicate issues arising under Workers' Compensation Act).
IT IS THEREFORE ORDERED that the ALJ's order dated April 4, 1996, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ Kathy E. Dean
____________________________________ 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, 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. (1996 Cum. Supp.).
Copies of this decision were mailed December 23, 1996 to the following parties:
Stanley A. Howe, 10705 E. Exposition Ave., Apt. 305, Aurora, CO 80012
Mike Williams, Colorado Interstate Gas Co., P.O. Box 1087, Colorado Springs, CO 80944
John Bearss, CIGNA, P.O. Box 2941, Greenwood Village, CO 80150-0141
Lynn P. Lyon, Esq., 999 18th St., Ste. 3100, Denver, CO 80202 (For the Respondents)
BY: _______________________