W.C. No. 4-621-138.Industrial Claim Appeals Office.
June 29, 2005.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Harr (ALJ) which denied and dismissed the claim for workers’ compensation benefits. We affirm.
The claimant alleged injuries to her back and right hip on June 1, 2004, from an accident during her employment as a certified nursing assistant. The ALJ found an elderly patient pushed the claimant when he attempted to stand and accidentally caused the claimant to fall against a nightstand.
The claimant reported the incident to the employer on June 2, but the Assistant Director of Nursing, Dana Cutler (Cutler), observed no visible sign of bruising. Nevertheless, the employer referred the claimant to Dr. Dillon, who examined the claimant on June 3.
Dr. Dillon observed slight bruising on the claimant’s hip and slight tenderness in the right lumbosacral area over the lateral aspect of the claimant’s hip. However, Dr. Dillon opined the claimant’s range of motion was normal. Further, x-rays of the claimant’s pelvis and back were normal. Dr. Dillon diagnosed a contusion to the low back and right hip, to be treated with exercise, ice packs, and non-prescription pain medication. Dr. Dillon also released the claimant to return to her regular duties. In a follow-up appointment, Dr. Dillon released the claimant from further medical treatment without evidence of permanent impairment. The claimant sought further treatment from Dr. Dillon on June 23, but Dr. Dillon opined the claimant demonstrated exaggerated pain behaviors and again diagnosed a contusion injury.
Based on the medical evidence, the ALJ rejected the claimant’s contention that she suffered a compensable back injury. Instead, the ALJ found the industrial accident resulted in a non-disabling contusion injury to the right hip which did not require medical treatment. Therefore, the ALJ determined the claimant failed to prove a compensable injury and dismissed the claim.
On review, the claimant contends that her testimony proves she suffered injuries to her right hip and back on June 1. Further, the claimant argues the injuries are compensable because the employer referred her for medical treatment, which she accepted. We reject these arguments.
The ALJ correctly recognized that the Workers’ Compensation Act creates a distinction between the terms “accident” and “injury.” The term “accident” refers to an “unexpected, unusual, or undesigned occurrence.” Section 8-40-201(1), C.R.S. 2004. In contrast, an “injury” refers to the physical trauma caused by the accident. In other words, an “accident” is the cause and an “injury” is the result. City of Boulder v. Payne, 162 Colo. 345, 426 P.2d 194 (1967).
No benefits flow to the victim of an industrial accident unless the accident results in a compensable “injury.” A compensable injury is one which requires medical treatment or causes a disability. Furthermore, it is well established that it is the claimant’s initial burden to prove a compensable injury. City of Boulder v. Payne, supra; Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990).
The determination of whether the claimant proved an injury which required medical treatment is one of fact for the ALJ. F.R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985). We must uphold the ALJ’s determination if supported by substantial evidence. Section 8-43-301(8), C.R.S. 2004. Under this standard, we must defer to the ALJ’s credibility determinations, his resolution of conflicts in the evidence, and his assessment of the sufficiency and probative weight of the evidence. Arenas v. Industrial Claim Appeals Office, 8 P.3d 558
(Colo.App. 2000). Further, the ALJ findings may be based on reasonable inferences from circumstantial evidence. Ackerman v. Hilton’s Mechanical Men, Inc., 914 P.2d 524 (Colo.App. 1996).
Here, although the ALJ credited the claimant’s explanation of the industrial accident, the ALJ rejected the claimant’s testimony concerning the nature and severity of the injuries she sustained in the industrial accident. The claimant’s arguments notwithstanding, the ALJ’s finding is amply supported by the testimony of nurse Cutler and the medical records.
Finally, the fact the employer tendered the services of a physician is not dispositive of whether the injury is compensable. An employer has the right to designate the authorized provider for an alleged industrial injury by tendering the services of a physician of its selection in the first instance. Section 8-43-404(5)(a), C.R.S. 2004. However, the employer may tender the services of a physician while actively contesting liability for the claimant’s condition. See Yeck v. Industrial Claim Appeals Office, 996 P.2d 228 (Colo.App. 1999). Ultimately, the employer is only liable for medical treatment if it is reasonable and necessary as a result of an injury. Section 8-42-101(1)(a), C.R.S. 2004.
Here, Cutler testified that the employer always refers an employee who alleges a work-related injury to a physician for examination. (Tr. p. 39). Further, the ALJ found that although the claimant was evaluated by Dr. Dillon at the respondents’ request, the evaluation was not warranted by the claimant’s medical condition resulting from the industrial accident. The ALJ’s findings are a plausible interpretation of Dr. Dillon’s medical records and thus, must be upheld. Further, the ALJ’s findings support the conclusion the claimant failed to sustain her burden to prove a compensable injury.
IT IS THEREFORE ORDERED that the ALJ’s order dated January 25, 2005, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________ Kathy E. Dean
____________________ Dona Halsey
Edaena Graphman, Aurora, CO, Amberwood Court Care Center, Denver, CO, American Compensation Insurance Company, c/o Kurt Lawrence, RTW Colorado, Inc., Minneapolis, MN, Teresa A. Marra, Esq., Denver, CO, (For Claimant).
M. Kim McGarvie, Esq. and Douglas A. Thomas, Esq., Greenwood Village, CO, (For Respondents).