Opinion
W.C. No. 4-159-869
February 4, 1999.
FINAL ORDER
The respondents seek review of a final order of Administrative Law Judge Wheelock (ALJ) which requires them to pay medical expenses associated with the claimant's industrial injury. The respondents contend they were denied due process of law because they did not receive adequate notice the ALJ would make findings of fact concerning an alleged "psychological injury." The respondents also assert that the ALJ's findings of fact concerning causation are not supported by substantial evidence, and that the ALJ made several findings of fact which are not relevant to the issues. We affirm.
The claimant filed an application for hearing listing the issues as authorization for and the reasonableness and necessity of medical treatment. Subsequently, the issues were expanded to include suspension of benefits for the claimant's alleged refusal to cooperate with vocational rehabilitation. Following the hearing on July 16, 1997, the parties agreed that the ALJ should restrict her order to the issue of medical benefits and need not address the issues involving vocational rehabilitation.
The ALJ found the claimant was electrocuted in January 1993. Since the injury, the claimant has suffered numerous physical and mental symptoms including "weight gain, depression, panic/anxiety attacks, significant memory loss, cognitive difficulty, inability to sleep, chronic pain in her neck, head, arm, and left knee, burns on her feet and hands, a swollen right arm and difficulty with movement in that arm," and other problems.
At the hearing, the claimant sought an order requiring the respondents to pay for dental treatment, a health club membership, weight gain medication, medical expenses associated with treatment of a foot injury, and expenses incurred when the claimant was transported by helicopter to Memorial Hospital on December 25, 1996. The ALJ credited reports of the claimant's treating physicians that the claimant has experienced "blackouts" which are causally related to the industrial injury. The ALJ also credited evidence that the blackouts have caused the claimant to fall, damaging her teeth and foot. Thus, the ALJ ordered the respondents to pay for the disputed dental treatment, foot treatments, and medical expenses incurred after the fall of December 25, 1996.
The ALJ also found that the claimant's weight gain is causally connected to the psychological sequelae of the electrocution injury. Consequently, the ALJ ordered the respondents to pay for the weight gain medication and health club membership.
I.
On review, the respondents first contend they were denied due process of law because they did not receive adequate notice the ALJ would consider evidence of the claimant's "psychological injuries." The respondents argue that they should be allowed to present evidence disputing the existence of any causal relationship between the electrocution injury and the claimant's psychological condition. We find no error.
The respondents correctly state the due process of law requires that all parties be apprised of the evidence to be submitted and considered, and afforded a reasonable opportunity to confront adverse evidence and present evidence and argument in support of their position. Hendricks v. Industrial Claim Appeals Office, 809 P.2d 1076 (Colo.App. 1990). However, the respondents were given adequate notice of the legal and factual issues in this case.
Section 8-42-101(1)(a), C.R.S. 1998, requires the employer to furnish medical treatment "as may reasonably be needed at the time of the injury . . . and thereafter during the disability to cure and relieve the employee from the effects of the injury." To receive medical benefits under this statute, the claimant must meet the "threshold requirement" of establishing a "direct causal relationship between the on-the-job injury and the need for medical treatment." Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337, 1339 (Colo.App. 1997). The causation requirement may be satisfied where the claimant establishes that the need for medical treatment is a "natural and proximate result" of the industrial injury. Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (1970).
Here, the respondents do not deny that they understood the claimant was seeking compensation for a health club membership and weight gain medication. Further, the record reveals that the claimant submitted into evidence the medical reports of Dr. Gamblin in which the doctor opined that the electrocution injury caused depression, and that the depression caused weight gain requiring medication and exercise. The respondents did not object to the admission of Dr. Gamblin's medical reports or deny receiving them in a timely fashion. Consequently, the respondents received adequate notice the claimant intended to prove the existence of an injury-related psychological condition, and that the condition caused the need for the disputed medical treatment.
II.
Respondents next contend that the ALJ erred in finding that the medical report of Dr. Orent was "entirely unpersuasive." They argue that consideration of Dr. Orent's report was outside the scope of the issues to be decided by the ALJ. We disagree.
Dr. Orent's report contains numerous opinions concerning the cause or causes of the claimant's various conditions. As a rule, these opinions are unfavorable to the claimant and tend to refute her claim for medical benefits. Under these circumstance, it was for the ALJ to assess the weight and credibility of Dr. Orent's expert medical opinion. Rockwell International v. Turnbull, 802 P.2d 1182 Colo. App. 1990).
III.
The respondents next contend that nine of the findings of fact are irrelevant because they do not pertain to the issues before the ALJ. We find no error.
Findings of Fact 4, 5, 6, 7, 8, 10, 11, 12, and 14 are all relevant to proving that the claimant's various medical problems are attributable to falls or psychological problems caused by the electrocution injury. Although some of the findings touch on factual matters which may be relevant to other unresolved legal issues, there is no basis for setting aside the ALJ's order.
To the contrary, the ALJ reserved for future determination all issues not specifically addressed in her order. Consequently, the ALJ's findings of fact can have no binding effect on future orders, except to the extent of issues actually litigated, necessarily adjudicated, and finally resolved. M M Management Co. v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA0370, December 10, 1998). It is premature to determine whether any of the ALJ's findings will affect future litigation, and we decline to speculate on this issue by altering the ALJ's findings.
IV.
The respondents next contend that the award of benefits for dental treatment, weight gain treatment, and medical expenses incurred on December 25, 1996, is not supported by substantial evidence. Essentially, the respondents argue the claimant failed to present any evidence of a causal relationship between the electrocution injury and the need for these treatments. We disagree.
The question of whether the claimant proved a causal relationship between the industrial injury and the need for subsequent medical treatment is one of fact for determination by the ALJ. City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). Consequently, we are obliged to uphold the ALJ's order if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 1998. In applying this standard, we must defer to the ALJ's resolution of conflicts in the evidence, her credibility determinations, and the plausible inferences she drew from the evidence. Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995).
Here, as we already concluded, the record contains substantial evidence that the electrocution injury caused the claimant to experience depression, which in turn resulted in weight gain requiring treatment.
Moreover, there is substantial evidence that the electrocution injury naturally and proximately caused the claimant to fall, damaging her teeth and foot, and requiring her to seek medical attention, including the treatment she obtained on December 25, 1996. As the claimant points out, there is no evidence that she experienced any falls prior to the 1993 industrial injury. However, the claimant's testimony, the testimony of nurse Bridgmon, and the medical records of the claimant's treating physicians demonstrate that the claimant has experienced numerous falls since the injury. The reports of Dr. Gamblin permit the inference that the claimant's psychological condition causes her to faint, and that her medications aggravate this problem. Thus, there is ample evidence from which the ALJ could find a causal relationship between the industrial injury and the need for the disputed treatments. Cf. Savio House v. Dennis, 665 P.2d 141 (Colo.App. 1983) (finding of causation upheld on circumstantial evidence despite the lack of any medical testimony favorable to the claimant).
V.
The claimant argues that the respondents' appeal is frivolous and that she is entitled to an award of attorney fees under § 8-43-301(14), C.R.S. 1998. We deny the claim for attorney fees.
Resort to an appellate forum cannot be the basis of sanctions if there is a reasonable basis for the appeal. BCW Enterprises, Ltd., v. Industrial Claim Appeals Office, 964 P.2d 533 (Colo.App. 1997). Here, because the medical treatment for which the claimant sought compensation was temporally and factually remote from the electrocution injury, we are not persuaded that the respondents' appeal lacks any merit.
IT IS THEREFORE ORDERED that the ALJ's order dated January 21, 1998, is affirmed.
IT IS FURTHER ORDERED that the claimant's request for attorney fees is denied.
INDUSTRIAL CLAIM APPEALS PANEL
_______________________________ David Cain
_______________________________ Dona Halsey
NOTICE
This Order is final unless an action to modify or vacate the 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, 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 the Order was mailed, pursuant to §§ 8-43-301(10) and 307, C.R.S. 1998.
Copies of this decision were mailed February 4, 1999 to the following parties:
Ingrid Norton, Manitou Road, #183, PO Box 32, Peyton, CO 80831
Eric Valuckas, NHA, Cheyenne Mountain Nursing Home, 835 Tenderfoot Hill Raod, Colorado Springs, CO 80906
Denise Groves, Support Services, Inc., PO Box 22438, Denver, CO 80222
William Richardson, Esq., 400 Sussex Building, 1430 Larimer Square, Denver, CO 80202 (For Respondents)
Karen Lambart Spencer, Esq., 403 South Tejon, Colorado Springs, CO 80903 (For Claimant)
BY: ________________