W.C. No. 4-330-198Industrial Claim Appeals Office.
October 13, 2000
ORDER
The respondents seek review of an order of Administrative Law Judge Erickson (ALJ) requiring Pinnacol Assurance (insurer) to reimburse Elliston Insurance Company (Elliston) for amounts paid to medical providers on the claimant’s behalf. We dismiss the petition to review without prejudice.
Elliston is a third-party administrator for automobile insurance companies. The claimant sustained injuries in an automobile accident allegedly arising out of and in the course of her employment. Initially, the insurer denied liability, and Elliston paid PIP benefits on behalf of the automobile insurers. After the insurer admitted liability and the workers’ compensation claim was settled, Elliston sought reimbursement from the insurer for medical expenses paid to the providers.
The matter went to a hearing before the ALJ on September 8, 1998. Despite lengthy factual representations by Elliston’s representative and counsel for the insurer, no evidence was taken. Further, there was no formal stipulation concerning the facts, including the amount of medical expenses paid or the reimbursement requested.
Section 8-43-301(2), C.R.S. 2000, provides that a party dissatisfied with an order “which requires any party to pay a penalty or benefits or denies a claimant any benefits or penalty” may file a petition to review. An order which does not meet the statutory standard for finality is interlocutory and not subject to our review. Director of the Division of Labor v. Smith, 725 P.2d 1161 (Colo.App. 1986). Moreover, an order which merely assigns liability without determining the amount of benefits or penalties to be paid is not final and reviewable. United Parcel Service, Inc. v. Industrial Claim Appeals Office, 988 P.2d 1146
(Colo.App. 1999). In light of these principles, we have frequently held that general awards of medical benefits are insufficient to satisfy the requirement of finality. Rosas v. DDC Interiors, Inc., W.C. No. 4-364-828 (August 18, 1999).
Here, the ALJ’s order contains no specific award determining the amount of reimbursement which the insurer owes to Elliston. Indeed, determination of this amount would be impossible since no evidence was ever taken on the issue, nor was any formal stipulation ever approved by the ALJ. Consequently, the order is interlocutory and not subject to our review. United Parcel Service, Inc. v. Industrial Claim Appeals Office, supra.
We note, for purposes of this order, that where issues of fact govern administrative determinations, a party should be afforded an evidentiary hearing to present evidence and argument in its own behalf and to confront adverse evidence. Hendricks v. Industrial Claim Appeals Office, 809 P.2d 1076 (Colo.App. 1990). Here, our review of the record suggests that such factual issues may well be present concerning whether or not Elliston waived its right to seek reimbursement. Consequently, on remand, due consideration should be given to the question of whether an evidentiary hearing is necessary to resolve the issues in this case.
IT IS THEREFORE ORDERED that the respondents’ petition to review the ALJ’s order dated October 4, 1999, is dismissed without prejudice.
INDUSTRIAL CLAIM APPEALS PANEL
___________________________________ David Cain
___________________________________ Kathy E. Dean
NOTICE
An action to modify or vacate the Order may be 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. (2000 Cum. Supp.).
Copies of this decision were mailed October 13, 2000 to the following parties:
Cindy Rodden, 3795 S. Santa Fe Dr., #3, Englewood, CO 80110
Cindy Rodden, Michael D. Ferber, Esq., 400 S. Colorado Blvd., #600, Denver, CO 80246
Family Auto Sales, Inc. dba Family Trucks and Vans, 2400 S. Broadway, Denver, CO 80210-5009
Michael D. Ferber, Esq., 400 S. Colorado Blvd., #600, Denver, CO 80246
Laurie A. Schoder, Esq., Pinnacol Assurance (CCIA) — Interagency Mail (For Respondents)
J. Mayer, G. E. Young Co., 10630 E. Bethany Dr., Building 6 Ste. B, Aurora, CO 80014-2602
Glen B. Goldman, Esq., 999 18th St., #3100, Denver, CO 80202
By: A. Pendroy