Bolton v. Industrial Claim Appeals Office

Citations

• 2019 COA 47

Syllabus

Workers' Compensation—Maintenance Medical Benefits—Intervening Cause. Claimant sustained admitted work-related injuries when she fell backward to the ground. Physicians diagnosed a concussion as well as cervical and lumbar strains. Within a few months claimant developed clinical depression related to the work injury. Employer admitted the compensability of the depression treatment. In October 2015, a physician who performed a division-sponsored independent medical examination placed claimant at maximum medical improvement. Pursuant to a settlement agreement that was approved by an administrative law judge (ALJ), employer paid claimant a lump sum for her permanent partial disability award. In addition, employer agreed to continue paying for maintenance care through authorized providers that was reasonable, necessary, and related to the compensable injury. The primary care that claimant was receiving was psychological. Several months later, employer retained a psychiatrist to examine claimant, and he and several other health care providers concluded claimant had returned to baseline and required no further maintenance care related to the work injury. Employer petitioned to terminate claimant's maintenance medical benefits. An ALJ agreed that claimant had returned to baseline and that any further treatment was related to claimant's pre-injury condition, not to her work-related injury. A panel of the Industrial Claim Appeals Office (the Panel) affirmed. On appeal, claimant argued that because her claim had closed, employer could only modify her maintenance medical benefits by first seeking to reopen the claim. Future maintenance medical benefits are by their nature not yet awarded, so those benefits remain open and are not closed by an otherwise closed final admission of liability. Here, claimant was entitled to receive future ongoing maintenance medical benefits for her depression. The issue was not closed, and reopening was not required to assess the continuation of t