W.C. No. 4-310-241Industrial Claim Appeals Office.
June 23, 1999.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Gandy (ALJ) which denied his claim for medical benefits. The claimant contends the ALJ’s order is contrary to the evidence. We affirm.
The claimant sustained a groin injury in 1996. Ultimately, the injury was diagnosed as bilateral hernias and the claimant underwent surgery by Dr. Tyburczy in September 1996. The claimant’s treating physician, Dr. Shih, placed the claimant at maximum medical improvement (MMI) on October 17, 1996, and released him to return to work without restrictions.
Thereafter, the claimant continued to complain of groin pain and periodically returned to Dr. Tyburczy for diagnosis and treatment. Dr. Tyburczy prescribed various medications, performed injections, and eventually referred the claimant for a pain clinic evaluation on March 4, 1998. Dr. Tyburczy stated that he would “consider performing a laparoscopy” but expressed doubts concerning the probability of relieving the claimant’s pain.
The claimant underwent a pain clinic evaluation by Dr. Fernon. Dr. Fernon referred the claimant for x-rays, and ultimately issued a report on May 13, 1998. Dr. Fernon opined the claimant was at MMI and that no type of therapy “is going to bring this to a complete resolution.”
In November 1997, the claimant underwent an independent medical examination by Dr. Hughes. Dr. Hughes opined that the claimant is suffering from the “residuals of left inguinal regional contusion with persistent post-traumatic epididymitis.” Dr. Hughes recommended the use of anti-inflammatory drugs for one to two years, together with medical monitoring at six-month intervals. In December 1997 the respondents admitted liability for ongoing medical benefits consistent with Dr. Hughes’ recommendations, but denied liability for any other treatments.
The claimant sought an order requiring the respondents to pay for the post-MMI treatments provided by Dr. Tyburczy, Dr. Fernon, and to pay the cost of the x-rays requested by Dr. Fernon. The claimant also requested the respondents be ordered to pay for the laparoscopy suggested by Dr. Tyburczy. However, the ALJ credited the opinions of Dr. Hughes, and found that the post-MMI treatments recommended and/or provided by Dr. Tyburczy and Dr. Fernon were not reasonable or necessary to relieve the claimant’s condition, nor necessary to prevent deterioration. Consequently, the ALJ denied the relief requested by the claimant.
On review, the claimant contends the evidence establishes his right to receive the treatments denied by the ALJ. The claimant argues that, under Grover v. Industrial Commission, 759 P.2d 705
(Colo. 1988), he is entitled to receive post-MMI medical treatment reasonably necessary to relieve his condition and prevent future deterioration. The claimant argues that the treatments provided by Dr. Tyburczy and Dr. Fernon constitute a specific course of treatment designed to relieve his symptoms and prevent deterioration. We find no error.
As a general matter, we do not dispute the claimant’s legal argument that he is entitled to receive ongoing medical treatment after MMI which is designed to relieve him from the effects of the injury or prevent further deterioration. Stollmeyer v. Industrial Claim Appeals Office, 916 P.2d 609 (Colo.App. 1995). There is no requirement that the claimant produce evidence of a “particular course of anticipated treatment” so long as substantial evidence shows that any future treatment will be reasonably necessary Stollmeyer v. Industrial Claim Appeals Office, supra.
However, as Grover itself recognizes, even if ongoing treatment is awarded, the respondents remain free to contest the reasonableness and necessity for particular treatments. The question of whether particular treatments are reasonable and necessary is one of fact for determination by the ALJ. Suetrack USA v. Industrial Claim Appeals Office, 902 P.2d 854 (Colo.App. 1995).
Because the issue is factual in nature, we must uphold the ALJ’s order if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 1998. In this regard, we note that the weight and credibility of expert medical testimony is a matter within the ALJ’s province as fact-finder. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990).
Here, the ALJ resolved conflicts in the expert medical evidence and determined that the treatments recommended and provided by Dr. Tyburczy and Dr. Fernon are not reasonable and necessary to the extent they exceed the recommendations of Dr. Hughes. Thus, there is substantial evidence to support the ALJ’s order, and we may not substitute our judgment for his concerning the weight and credibility of the evidence.
Insofar as claimant makes other arguments, we find them to be without merit.
IT IS THEREFORE ORDERED that the ALJ’s order dated October 14, 1998, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
________________________________ David Cain
________________________________ Dona Halsey
NOTICE
This Order is final unless an action to modify or vacate the Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, Colorado 80203, by filing a petition to review with the court, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date the Order was mailed, pursuant to §§ 8-43-301(10) and 307, C.R.S. 1998.
Copies of this decision were mailed JUNE 23, 1999 to the following parties:
Jose M. Rizo, 3701 Yosemite Dr., Greeley, CO 80634
Gina Griego, Monfort, Inc., P. O. Box G, Greeley, CO 80632
Regina M. Walsh Adams, Esq., 1011 37th Avenue Ct., #201, Greeley, CO 80634 (For Claimant)
Andrew R. Bantham, Esq., 2629 Redwing Rd., #330, Fort Collins, CO 80526 (For Respondents)
BY: JLS