W.C. No. 4-588-675.Industrial Claim Appeals Office.
September 1, 2006.
FINAL ORDER
The claimant seeks review of an order dated March 25, 2006 of Administrative Law Judge Friend (ALJ) that determined her claim is not compensable and terminated the respondents’ liability for additional benefits. We affirm.
The ALJ’s findings are summarized as follows. The claimant suffered from extensive medical problems that were not related to her work. She fell on her way to work while walking to an elevator in an underground parking garage owned by her employer. Various co-employees in the area near the time of her fall did not indicate that anything had impeded the claimant’s progress toward the elevator. The claimant’s fall was either unexplained or idiopathic without being subject to any special hazard. The ALJ determined that the claimant failed to sustain her burden to establish a compensable injury and ruled that the respondent insurer was not liable for additional benefits.
On appeal, the claimant asserts that substantial evidence exists to support her claim. She also asserts that the ALJ erred in allowing the respondents to withdraw their prior admissions of liability. We perceive no error in the ALJ’s decision.
In support of her contentions, the claimant argues that she proved a compensable injury by virtue of the fact that she fell on the employer’s premises. We are not persuaded. To recover workers’ compensation benefits, the claimant must prove she suffered a compensable injury. A compensable injury is one which arises out of and in the course of employment. Section 8-41-301(1)(b)-(c), C.R.S. 2005.
There appears to be no dispute that the claimant’s injury occurred “in the course of” the employment because it occurred within the time, place, and activity limitations associated with the claimant’s job. The “arising out of” test is one of causation. It requires that the injury have its origin in an employee’s work-related functions, and be sufficiently related thereto so as to be considered part of the employee’s service to the employer. There is no presumption that an injury which occurs in the course of a worker’s employment arises out of the employment. Furthermore, contrary to the claimant’s assertion, the fact that an employee is injured on her employer’s premises does not establish a compensable injury. Finn v. Industrial Commission, 165 Colo. 106, 437 P.2d 542 (1968); see also, Industrial Commission v. London Lancashire Indemnity Co., 135 Colo. 372, 311 P.2d 705 (1957) (mere fact that the decedent fell to his death on the employer’s premises did not give rise to presumption that the fall arose out of and in course of employment). Rather, it is the claimant’s burden to prove by a preponderance of the evidence that there is a direct causal relationship between the employment and the injuries. Section 8-43-201, C.R.S. 2005; Ramsdell v. Horn, 781 P.2d 150
(Colo.App. 1989).
The determination of whether there is a sufficient “nexus” or causal relationship between the claimant’s employment and the injury is one of fact which the ALJ must determine based on the totality of the circumstances. In Re Question Submitted by the United States Court of Appeals, 759 P.2d 17 (Colo. 1988) Moorhead Machinery Boiler Co. v. Del Valle, 934 P.2d 861
(Colo.App. 1996). Thus, we must uphold the ALJ’s determination of this issue if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2005; Lori’s Family Dining, Inc. v. Industrial Claim Appeals Office, 907 P.2d 715 (Colo.App. 1995). This standard of review requires us to defer to the ALJ’s credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record Cordova v. Industrial Claim Appeals Office, 55 P.3d 186
(Colo.App. 2002).
Here, the ALJ found that the claimant’s fall was either “entirely unexplained” or “idiopathic, without a special hazard.” Findings of Fact, Conclusions of Law, and Order (Order) at 5, ¶ 17. Contrary to the claimant’s argument, these findings are supported by the record and by reasonable inferences from it. The ALJ credited the testimony of individuals in the vicinity of the area where the claimant fell. A vice president of the respondent employer testified that near the time of the fall the claimant advised him she had not tripped on anything. Order at 4, ¶ 11. The ALJ also found the claimant advised two other employees that she “tripped over her own feet.” Order at 4, ¶ 12. He further found that employees searched the area of the accident and failed to detect any potential hazards that may have contributed to the claimant’s fall. Order at 4-5, ¶¶ 9, 13, 15. In addition, medical reports indicated that the claimant was unaware how she fell. Order at 3, ¶¶ 5-6. The ALJ also credited various medical reports indicating that the claimant had advised various physicians that she had simply fallen or tripped. Order at 5, ¶ 16. These findings have record support. See, e.g., Tr. at 90-91; Exhibit I at 34; Exhibit L at 46; Exhibit S at 140; Exhibit Y at 214; Exhibit GG at 281-82; Zirger Depo. at 11-20.
The ALJ also found that, even if the claimant’s fall was caused by an idiopathic condition, there was no special hazard contributing to her injury. The “special hazard” requirement applies only where the precipitating cause of an injury is a preexisting non-industrial condition which the claimant brings to the workplace. In such cases, the “special hazard” requirement provides the requisite causal connection between the injury and the employment. National Health Laboratories v. Industrial Claim Appeals Office, 844 P.2d 1259 (Colo.App. 1992); Ramsdell v. Horn, 781 P.2d 150 (Colo.App. 1989). However the ALJ found it was, at best, uncertain that the claimant’s fall was idiopathic. The ALJ also found there was no special hazard involved with the claimant’s fall.
The claimant asserts that the ALJ erred in not relying on or failing to mention in his Order a variety of evidence that would tend to support her claim. It is well-settled that the existence of evidence which, if credited, might support a determination contrary to that reached by the ALJ does not afford us grounds to grant appellate relief. Colorado Fuel and Iron Corp. v. Industrial Commission, 152 Colo. 25, 380 P.2d. 28 (1963). The ALJ is presumed to have considered the entire record and is not required to cite or discuss every piece of evidence before crediting evidence to the contrary. Crandall v. Watson-Wilson Transportation System, Inc., 171 Colo. 329, 467 P.2d 48 (1970). Rather, evidence not cited is implicitly rejected as unpersuasive. Magnetic Engineering, Inc. v. Industrial Claim Appeals Office, 5 P.3d 385 (Colo.App. 2000).
The findings of fact are sufficient to permit appellate review, and they are supported by substantial evidence in the record and by reasonable inferences from the record. Further, the ALJ’s findings support the pertinent conclusions of law and the order denying the claim. Under these circumstances, we decline to disturb the ALJ’s order that the claimant failed to carry her burden to prove a compensable injury.
The claimant also argues that the ALJ erred in allowing the respondents to withdraw their admissions of liability and, in support of her position, cites the case of Sunny Acres Villa, Inc. v. Cooper, 25 P.3d 44 (Colo. 2001) (doctrine of collateral estoppel not applied to issue of causation in context of permanent total disability adjudication). We read the ALJ’s order to determine that the claimant’s right to benefits ceased because she failed to establish that her injury was compensable, thereby ending any liability of the respondents for future benefits. In any event, we conclude that the ALJ properly determined that the respondents have no further liability in this matter.
Once liability is admitted, payments must be made according to admitted liability. Section 8-43-203(2)(d), C.R.S. 2005; HLJ Management Group, Inc. v. Kim, 804 P.2d 250 (Colo.App. 1990). If respondents improvidently admit liability, they may receive only prospective relief from the admission after the matter is litigated before an ALJ. See Rocky Mountain Cardiology v. Industrial Claim Appeals Office, 94 P.3d 1182 (Colo.App. 2004). Thus, the statute accords a degree of finality to admissions of liability in cases where there is no legitimate controversy, but still affords respondents an opportunity for a hearing and prospective relief if they subsequently discover facts indicating that the admission was incorrect. HLJ Management Group, Inc., 804 P.2d at 252-253.
When an insurer seeks to withdraw an admission of liability, it does not have the burden of showing why the admission was improvident, and the burden remains on the claimant to show a compensable injury. Pacesetter Corp. v. Collett, 33 P.3d 1230
(Colo.App. 2001). Therefore, in the present proceeding the ALJ properly placed the burden of proof on the claimant to prove that she sustained a compensable injury. Having found that the claimant did not carry the burden of establishing a compensable injury, the ALJ correctly determined that the respondents were not liable for further benefits.
The claimant also argues that the ALJ’s determination as to causation should be controlled by the findings of an independent medical examination sponsored by the Division of Workers’ Compensation (DIME). However, the courts have declined to extend the DIME provisions to initial compensability determinations Cordova v. Industrial Claim Appeals Office, 55 P.3d 186
(Colo.App. 2002) (DIME physician’s opinion concerning whether or not condition worsened so as to justify reopening not entitled to “special weight” under DIME procedure); Westerkamp v. Target Stores, W.C. No. 4-408-369 (December 26, 2001). Rather, the claimant bears the initial burden to prove by a preponderance of the evidence that she sustained an injury arising out of and in the course of his employment. Whether the claimant met this burden of proof is a question of fact for the ALJ. Faulkner v. Industrial Claim Appeals Office, 12 P.3d 844 (Colo.App. 2000). Here, the ALJ determined that the claimant failed to sustain her burden of proof.
We have considered the claimant’s remaining arguments and they do not persuade us to reach a different result.
IT IS THEREFORE ORDERED that the ALJ’s order dated March 25, 2006, is affirmed
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ John D. Baird
____________________________________ Thomas Schrant
Christine Fuller, Castle Rock, CO, Attn: Betty Bryant, Marilyn Hickey Ministries, Denver, CO, Attn: Harvey Frewelling, Pinnacol Assurance, Denver, CO, Kevin C. Smith, Esq., Denver, CO, (For Claimant).
Thomas M. Stern, Esq., Denver, CO, (For Respondent).