W.C. No. 4-677-755.Industrial Claim Appeals Office.
January 9, 2007.
ORDER
The claimant seeks review of an order of Administrative Law Judge Walsh (ALJ) dated August 2, 2006, determining that the respondents are only liable for medical treatment provided by authorized treating physicians. We dismiss the petition to review without prejudice.
A hearing was held on the issues of compensability and whether the respondents lost their right to specify an authorized treating physician. Following the hearing the ALJ made the implicit determination that the claimant had sustained a compensable industrial accident. He entered a general award requiring the provision of reasonable and necessary medical benefits. The ALJ found that, based on a conversation with a representative from the employer’s human resources department, the claimant was informed of the medical facility authorized to treat her condition and the respondents’ right to choose the authorized treating physician was preserved. The ALJ concluded that the respondents were only liable for medical treatment provided by authorized treating physicians.
The claimant filed a petition to review arguing that the ALJ’s order “fails to address with specificity the identity of authorized treating physicians or the responsibility of payment of medical expenses.” The rest of the petition to review contains only general allegations of error, derived from § 8-43-301(8), C.R.S. 2006. The claimant did not file a brief in support of her petition to review. Therefore, the effectiveness of our review is limited. See Ortiz v. Industrial Commission, 734 P.2d 642 (Colo.App. 1986). Further, the record contains no transcripts of the hearing before the ALJ. As a general matter, we must uphold the ALJ’s factual findings if supported by substantial evidence in the record. Section 8-43-301(8). Where, as here, the appealing party fails to procure transcripts of the relevant hearings we must presume the pertinent findings of fact are supported by substantial evidence. Nova v. Industrial Claim Appeals Office, 754 P.2d 800
(Colo.App. 1988).
The respondents have argued that the order is not final and, therefore, not presently reviewable. Under § 8-43-301(2), C.R.S. 2006, a party dissatisfied with an order “which requires any party to pay a penalty or benefits or denies a claimant a benefit or penalty,” may file a petition to review. Orders which do not require the payment of benefits or penalties, or deny the claimant benefits or penalties are interlocutory and not subject to review. Natkin Co. v. Eubanks, 775 P.2d 88 (Colo.App. 1989). Furthermore, orders which determine liability for benefits, without determining the amount of benefits, do not award or deny benefits as contemplated by this statute, and consequently, are not subject to review. Oxford Chemicals, Inc. v. Richardson, 782 P.2d 843 (Colo.App. 1989) (order may be partially final and reviewable and partially interlocutory); CF I Steel Corp. v. Industrial Commission, 731 P.2d 144 (Colo.App. 1986).
We have previously held that orders which determine compensability and contain only a general award of medical benefits are interlocutory unless the record reveals that specific medical benefits were at issue See, e.g., Gonzales v. Public Service Co. of Colorado, W.C. No. 4-131-978 (May 14, 1996); Tilton v. ABC Turf Care, W.C. No. 3-105-542
(August 18, 1994). Here, although the ALJ determined that the claimant had sustained a compensable injury, the ALJ only orders the respondents to pay for medical care as was reasonably needed to cure and relieve the claimant from the effects of her work-related injury and noted that the respondents were only liable for treatment provided by authorized treating physicians.
We note that one of the issues as framed by the order was if the injury was compensable, whether the respondents lost their right to specify an authorized treating physician. The findings of fact contain reference to Dr. Miller, a chiropractor the claimant saw shortly after her accident, and whose services she apparently sought on her own. The ALJ specifically found that statements made by a representative of the employer’s human resources department regarding a medical facility authorized to treat the claimant condition preserved the respondents’ right to choose the authorized treating physician. However, the order merely notes that the respondents are only liable for all medical treatment provided by authorized treating physicians and makes no determination as to what medical care providers are authorized. Moreover, the ALJ did not address the issue of what specific medical care providers were not authorized. Without a transcript we are unable to determine that anything beyond whether the respondents lost their right to specify an authorized treating physician was at issue. Consequently, in the absence of a transcript, the record is insufficient to support the claimant’s contention that the ALJ erroneously failed to address with specificity the identity of authorized treating physicians or the responsibility of payment of medical expenses.
“Authorization” refers to the physician’s legal authority to treat, and is distinct from whether treatment is “reasonable and necessary” within the meaning of § 8-42-101(1)(a), C.R.S. 2006. Mason Jar Restaurant v. Industrial Claim Appeals Office, 862 P.2d 1026 (Colo.App. 1993). A finding that treatment is “authorized” is not itself a “medical benefit.” One Hour Cleaners v. Industrial Claim Appeals Office, 914 P.2d 501 (Colo.App. 1995). Accordingly, we have previously held that an order which determines a physician’s “authorization,” but does not award or deny payment for that physician’s treatment, is not a final order for purposes of appellate review. See Matthews v. United Parcel Service, W.C. No. 4-325-652 (December 15, 1997); Fernandez v. City and County of Denver, W.C. No. 4-122-784 (February 7, 1996); Churchill v. Goodyear Tire and Rubber Co., W. C. No. (April 17, 1995). Orders which determine the identity of the authorized provider are not final and reviewable unless the reasonableness of the provider’s medical treatment is resolved. Rosas v. DDC Interiors, Inc., W.C. No. 4-364-828 (August 18, 1999); Tilton v. ABC Turf Care, W.C. No. 3-105-542 (August 18, 1994). The rationale for these decisions is that the respondents maintain the right to contest the reasonableness and necessity for particular medical benefits. E.g. Rosas v. DDC Interiors, Inc., W.C. No. 4-364-828 (August 18, 1999); Tilton v. ABC Turf Care, W.C. No. 3-105-542
(August 18, 1994). Mockmore v. Joslins W. C. No. 4-343-875 (July 5, 2002). We adhere to our prior conclusions.
IT IS THEREFORE ORDERED that the petition to review the ALJ’s order dated August 2, 2006, is dismissed without prejudice.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ John D. Baird
______________________________
Thomas Schrant
Kristin A. Hodgman, 5374 Allison Street # 302, Arvada, CO, Ruegsegger, Simons, Smith Stern, LLC, David L. Smith, Esq., 1625 Broadway, Suite 2300, Denver, CO, (For Respondents)
Tony’s Meat, Inc., Lynnea Louison, 12001 E. Caley Ave., Unit A, Centennial, CO, Pinnacol Assurance, Harvey D. Flewelling, Esq., 7501 East Lowry Blvd., Denver, CO.