W.C. No. 4-134-501Industrial Claim Appeals Office.
March 28, 1996
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Martinez (ALJ) dated September 30, 1995, as corrected on October 20, 1995. We modify the ALJ’s order and as modified, affirm.
The pertinent facts are undisputed. The claimant suffered an injury on April 24, 1992, but did not seek medical treatment until May 5, 1992. The respondent filed a General Admission of Liability on May 14, 1992, which admitted liability for medical benefits and temporary total disability benefits from “5/5/92 to undet.”
Apparently the claimant returned to work for the respondent in June 1992, but the respondent did not file an amended admission. The claimant was subsequently off work between June 9, 1993 to August 1, 1993.
In January 1993 the respondent obtained medical evidence which indicated that the claimant’s disability and need for medical treatment after May 5, 1992, was not causally related to the April 24 injury. As a result the respondent stopped paying medical and temporary disability benefits. However, the respondent did not attempt to withdraw its admission of liability.
Following a hearing on the claimant’s request for further medical and temporary disability benefits, the ALJ determined that the claimant failed to sustain his burden to prove that his temporary disability and need for medical treatment was causally connected to the April 24 injury. Therefore, in a Summary Order dated September 13, 1995, the ALJ denied and dismissed the claimant’s request for temporary total disability benefits during the period June 9, 1993 to August 1, 1993. The ALJ also denied the request for medical benefits beyond the medical expenses which had already been paid pursuant to the respondent’s General Admission of Liability. Specific Findings of Fact were entered on September 30, 1995 and corrected on October 20, 1995.
The claimant contends that the respondent was bound by its May 14 General Admission of Liability. Accordingly, the claimant argues that the ALJ erred in failing to grant the claims for medical and temporary disability benefits. We agree with the claimant insofar as the ALJ failed to hold the respondent liable for temporary total disability benefits.
I.
Once an admission of liability is filed for temporary disability benefits, the Workers’ Compensation Act does not allow the respondent to unilaterally terminate those benefits except as provided by the Rules of Procedure, Part IX, Code Colo. Reg. 1101-3 at 34 (1995). See Kraus v. Artcraft Sign Co., 710 P.2d 480 (Colo. 1985); Collins v. Industrial Commission, 676 P.2d 1270 (Colo.App. 1984). Furthermore, unless admitted benefits are unilaterally terminated in accordance with the Rules of Procedure, “payments shall continue according to admitted liability,” until the duty to pay is terminated pursuant to an order by the ALJ. Section 8-43-203(2), C.R.S. (1995 Cum. Supp.); cf. Standard Metals Corp. v. Gallegos, 781 P.2d 142 (Colo.App. 1989) (employer failure to follow proper procedure to establish SIF liability is not entitled to have compensation assessed against the SIF). In that event the respondent is limited to “prospective” relief from its admission, except where the admission was induced by the claimant’s fraudulent misrepresentations. Lewis v. Scientific Supply Co., 897 P.2d 905 (Colo.App. 1995); Vargo v. Industrial Commission, 626 P.2d 1164 (Colo.App. 1981).
The respondent admits that it did not terminate the claimant’s temporary disability benefits in accordance with the Rules of Procedure. (Tr. pp. 4, 10, 17). In fact, the respondent took no action to withdraw its admission of liability. Furthermore, there is no allegation or finding that the admission was induced by fraud.
Under these circumstance, the respondent was obligated to continue the payment of temporary disability benefits in accordance with its admission until the date of the ALJ’s Summary Order which resolved the dispute concerning the respondent’s liability for further benefits. See HLJ Management Group v. Kim, 804 P.2d 250 (Colo.App. 1990). Consequently, the respondent is liable for temporary disability payments which became due prior to the date of the ALJ’s Summary Order. HLJ Management Group v. Kim, supra.
Here, the claimant only sought temporary total disability benefits for the period June 9, 1993 to August 1, 1993, and the respondent admits that the claimant was temporarily and totally disabled during this period. (Tr. p. 26). Because these disability benefits became due prior to the entry of the ALJ’s Summary Order, the ALJ erred in denying the claim for temporary total disability benefits. We therefore reverse the ALJ’s order concerning the claim for temporary total disability benefits.
In reaching our conclusion we recognize that these facts may support a different result under Collins v. Industrial Commission, supra. However insofar as Collins and HLJ are inconsistent, we note that HLJ was decided more recently. Therefore, we are persuaded that HLJ represents the current state of the law concerning the interpretation of § 8-43-203(2).
II.
However, an admission of liability for medical benefits is not an admission that all medical treatment thereafter received by the claimant is compensable. Saurini v. Ice Cream Wagon, Inc., W.C. No. 3-896-179, July 21, 1995; Metz v. Cornerstone Care Center, W.C. No. 4-151-534, March 7, 1994. Consequently, the respondent’s May 14 General Admission of Liability for medical benefits did not obligate the respondent to pay for all medical treatment the claimant received between April 24, 1992 and the date of the hearing before the ALJ. Rather, the respondent remained free to dispute the reasonableness and necessity of any particular treatment, and the burden was on the claimant prove that the treatment was necessitated by the industrial injury. See Williams v. Industrial Commission, 723 P.2d 749
(Colo.App. 1986).
Here, the ALJ was not persuaded that the treatment the claimant obtained after May 5, 1992 was necessitated by the April 24 injury, and that determination is supported by substantial evidence in the medical records which the ALJ found persuasive. Therefore, the ALJ did not err in failing to order the respondent to pay medical expenses beyond the expenses paid pursuant to its May 14 admission of liability.
IT IS THEREFORE ORDERED that the ALJ’s order dated September 30, 1995 is modified to require the payment of temporary total disability benefits for the period June 9, 1993 to August 1, 1993, and as modified, the ALJ’s order is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
NOTICE
This Order is final unless an action to modify or vacate this Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, CO 80203, by filing a petition for 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 this Order is mailed, pursuant to section 8-43-301(10) and 307, C.R.S. (1995 Cum. Supp.).
Copies of this decision were mailed March 28, 1996 to the following parties:
Gregory A. Snyder, 7776 S. Dover Street, Littleton, CO 80123
City of Aurora, Attn: Robert Medina, Risk Manager, 1470 S. Havana, Aurora, CO 80012
GAB Business Services, Inc., Attn: Michelle Burgan, 789 Sherman St., Ste. 100, Denver, CO 80203
Ann McEntire, Esq., 1430 Larimer Square, Sussex Building, Ste. 400, Denver, CO 80202
(For the Respondent)
Joseph M. Goldhammer, Esq., 1563 Gaylord St., Denver, CO 80206
(For the Claimant)
BY: _____