W.C. No. 4-582-442.Industrial Claim Appeals Office.
November 9, 2004.
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Stuber (ALJ) which determined the claimant suffered a compensable injury diagnosed as an aortic dissection and required the respondents to provide workers’ compensation benefits. We affirm.
The claimant is a licensed chiropractor who suffered an enlarged ascending aorta. On March 6, 2002, the claimant was performing a procedure on a patient called an “anterior move,” where he had to lift the patient’s back off the adjusting table. (Tr. p. 20). The claimant testified that as he performed the move he felt an acute pain in his chest and arms which was diagnosed as an ascending aortic dissection.
Implicitly relying on the testimony of Dr. Vigoda, the ALJ found the claimant’s work activity on March 6, 2002, aggravated the claimant’s preexisting aortic dilation and caused the ascending aortic dissection. Therefore, the ALJ determined the claimant’s injury arose out of and in the course of his employment. Further, the ALJ rejected the respondents’ contention the claimant was not individually insured for workers’ compensation on March 6, 2002. Therefore, the ALJ held the respondents liable for the medical and temporary disability benefits awarded on account of the injury.
On review the respondents contend Dr. Vigoda’s testimony fails to support Finding of Fact 15 where the ALJ found:
“Dr. Vigoda admitted at hearing that lifting a patient would cause increased blood pressure in the aorta and that increased blood pressure could cause the dissection.”
The respondents argue that to the contrary, Dr. Vigoda attributed the claimant’s aorta dissection to a natural progression of the underlying deterioration and tearing of the lining of the aorta. Therefore, the respondents argue the record does not support the ALJ’s finding of a compensable injury. We disagree.
It is well-established that a compensable injury may be the result of an industrial aggravation of a pre-existing condition as long as the aggravation is the proximate cause of the disability or need for treatment. H H Warehouse v. Vicory, 805 P.2d 1167, 1169 (Colo.App. 1990); Subsequent Injury Fund v. State Compensation Insurance Authority, 768 P.2d 751 (Colo.App. 1988). The question of whether the claimant has proven a compensable aggravation is one of fact for resolution by the ALJ, and we must uphold the ALJ’s findings if supported by substantial evidence and plausible inferences drawn from the record. Section 8-43-301(8), C.R.S. 2004; City of Durango v. Dunagan, 939 P.2d 496
(Colo.App. 1997).
Dr. Vigoda stated that the claimant experienced a dissection or tear of the aorta. As argued by the respondents, Dr. Vigoda rejected the notion that the dissection was causally related to the claimant’s particular work activities on March 6, even if the claimant was performing an unusual procedure. (Tr. pp. 56, 57).
However, Dr. Vigoda admitted that if the claimant was doing a procedure similar to the “anterior move” described by the claimant, that the activity would cause an increase in pressure in the claimant’s aorta. (Tr. p. 59). Further, Dr. Vigoda stated that aortic dilatation is generally treated with Beta blockers and medication to reduce the patient’s blood pressure so the “heart muscle will have to pump less hard,” and “the force of the contractibility of the heart muscle” is reduced. (Tr. p. 51). Indeed, the claimant testified that he was taking medication to reduce his blood pressure.
Because the ALJ implicitly credited the claimant’s testimony that he was performing an unusual and physically demanding procedure immediately before the injury, the ALJ could, and did, reasonably infer that Dr. Vigoda’s testimony concerning the causal relationship between blood pressure in the heart and aortic dilatation also supported a causal connection between the claimant’s aorta dissection and the claimant’s work activities. Under these circumstances, Dr. Vigoda’s testimony supports the ALJ’s finding that the claimant suffered a compensable aggravation of his pre-existing condition.
Alternatively, the respondents contend the ALJ erred in finding the claimant was a covered employee under the claimant’s workers’ compensation policy in effect on March 6, 2002. Again, we disagree.
From 1991 to 2001 the claimant had workers’ compensation insurance with State Farm Fire Casualty (State Farm) as a sole proprietor. Under that policy the claimant elected to exclude himself from coverage. In January 2002, the claimant incorporated his business and became an employee of the corporation.
State Farm subsequently discovered the incorporation, but did not cancel the workers’ compensation policy. Instead, State Farm continued the policy and, in September 2002, sent the claimant a computer-generated letter of non-renewal and informed the claimant that a new corporate policy was required.
A witness for State Farm testified that in a corporate policy for workers’ compensation corporate officers are automatically covered unless the officer expressly elects to reject coverage. The ALJ found that on September 27, 2002, a State Farm agent sent claimant two insurance forms to complete. One form was the application for corporate coverage and the other form allowed the claimant to reject coverage as the corporation’s sole officer. The claimant never signed the forms.
Nevertheless, the ALJ found that in November 2002 a State Farm sales agent told the claimant’s wife that the claimant had been charged an additional premium for the November 2001 to November 2002 policy year because the business form had changed to a corporation and the claimant had not expressly elected to reject coverage. The agent also reported that the additional premium of $200 was charged based on a fixed corporate salary for the claimant’s clerical employee. (Tr. p. 83). The claimant paid the additional premium and State Farm accepted the payment. Under these circumstances, the ALJ determined the claimant was a covered employee under the workers’ compensation policy existing on March 6, 2002.
The respondents contend no separate corporate policy was ever issued and therefore argue the claimant was never covered for workers’ compensation as an employee of the corporation. Rather, the respondents contend the September 2002 non-renewal notice advised the claimant that the existing policy would remain in effect covering the sole proprietorship until November 2002. Because the claimant had excluded himself from coverage in the sole proprietorship policy, the respondents argue the policy in effect on March 6 did not include the claimant as a covered employee.
The doctrine of equitable estoppel may apply to preclude an insurer from denying coverage. State Compensation Insurance Fund v. Wangerin, 736 P.2d 1246 (Colo.App. 1986) (estoppel to deny coverage by acceptance of premium after knowledge of loss) ; Leland v. Travelers Indemnity Co., 712 P.2d 1060 (Colo.App. 1985). In order to obtain relief under an estoppel theory, the claimant is required to prove that: 1) the insurer knew the relevant facts; 2) the insurer intended that its conduct be acted on or must so act that the claimant had a right to believe that the insurer’s conduct was so intended; 3) the claimant was ignorant of the true facts; and 4) the claimant detrimentally relied on the insurer’s conduct. See Johnson v. Industrial Commission, 761 P.2d 1140 (Colo. 1988).
Although the evidence was highly conflicting, it is uncontested that State Farm charged the claimant an additional $200 premium for the November 2001 to November 2002 policy period, which was paid by the claimant and accepted by State Farm. Further, the testimony of the State Farm witness supports the ALJ’s finding that State Farm charged the extra premium partly to reflect a new corporate rate for the claimant’s clerical employee. (Tr. p. 83, 86). Thus, the record supports the ALJ’s implicit determination that State Farm was insuring the corporate entity, which automatically included the claimant, and the claimant paid a premium for corporate coverage. Further, these determinations support the application of equitable estoppel to preclude the insurer from denying coverage for the claimant’s injury.
IT IS THEREFORE ORDERED that the ALJ’s order dated March 9, 2004, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
_______________ Kathy E. Dean
_______________ Bill Whitacre
Bill Henrie, Colorado Springs, CO, Henrie Chiropractic, Inc., Colorado Springs, CO, Rhonda Norris, State Farm Fire Casualty, Littleton, CO, Cullen A. Wheelock, Esq., Colorado Springs, CO, (For Claimant).
Carol A. Finley, Esq., Colorado Springs, CO, (For Respondents).