W.C. No. 4-781-144.Industrial Claim Appeals Office.
May 11, 2010.
FINAL ORDER
The claimant seeks review of an order on remand of Administrative Law Judge Friend (ALJ) dated January 12, 2010 that determined that the non-insured employer is liable for medical benefits, for temporary total disability benefits, and for penalties for failure to insure. We modify the ALJ’s order to reflect that payments of medical bills should be pursuant to the fee schedule and otherwise we affirm.
This matter was previously before us. In an order dated June 9, 2009, the ALJ found that the claimant was injured while performing services in connection with six horses owned by the employer. The ALJ concluded that the claimant’s labor was casual and that she was therefore excluded from the definition of employee under the Workers’ Compensation Act. The ALJ therefore denied the claim for compensation. In an Order of Remand dated November 19, 2009, we concluded that the ALJ erred in determining that the claimant’s labor was casual. Therefore, we reversed the ALJ’s order and remanded for a determination of the compensation, benefits, and penalties, if any, for which the respondent was liable.
Apparently without conducting any further hearings, the ALJ on remand entered the order under review here. The ALJ found that on July 25, 2008, the claimant was injured when a horse fell on her leg, fracturing it. She underwent surgery and was hospitalized for several days until being released with restrictions precluding her from performing her job. She continued to be treated by her surgeon, Dr. Peterson, who prescribed physical therapy, medications, and home health care. On March 2, 2009 Dr. Peterson released the claimant to any activity she could tolerate, and the ALJ found that
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at that time she could return to work. The ALJ also found that the employer was uninsured at the time of the accident. The ALJ found that the claimant had paid a small amount for her medical treatment, that her health carrier had paid the bulk of the expenses, and that a portion of the billed amounts were outstanding.
Based upon his factual findings, the ALJ concluded that the employer was liable for medical benefits, for temporary total disability benefits, and for penalties for failure to insure. The ALJ ordered the employer to reimburse the claimant’s health carrier and the claimant for payments they had made and to pay the outstanding amounts.
The employer appealed the ALJ’s order. However, no brief in support of the petition to review has been filed, nor does the petition itself specify error in any terms but the most general. Therefore, the effectiveness of our review is limited Ortiz v. Industrial Commission, 734 P.2d 642 (Colo. App. 1986).
Under § 8-43-301(8), C.R.S. we are precluded from disturbing the ALJ’s order unless the findings of fact are insufficient to permit appellate review, the ALJ has not resolved conflicts in the evidence, the record does not support the findings, the order is not supported by the findings, or the order is not supported by applicable law. Whether the claimant sustained her burden of proof to show entitlement to compensation and beneftis is a factual question for resolution by the ALJ. City of Durango v. Dunagan, 939 P.2d 496 (Colo. App. 1997). The ALJ’s factual determinations must be upheld if supported by substantial evidence and plausible inferences drawn from the record. We have no authority to substitute our judgment for that of the ALJ concerning the credibility of witnesses and we may not reweigh the evidence on appeal. Delta Drywall v. Industrial Claim Appeals Office, 868 P.2d 1155 (Colo. App. 1993).
Here, we have reviewed the record and the ALJ’s factual findings are supported by substantial evidence. Moreover, the ALJ’s awards of benefits, and compensation and his imposition of penalties are supported by the factual findings and by the applicable law. Therefore, we perceive no basis on which to set aside the order.
However, we note that the ALJ ordered the employer to reimburse the claimant’s health insurer for amounts that it paid and to pay the outstanding medical bills. Section 8-42-101(3)(a)(I), C.R.S. provides that it is unenforceable as a debt for any person or entity to “bill, or charge any party for services, rendered in connection with injuries coming within the purview of this article or an applicable fee schedule, which are or may be in excess of said fee schedule. . . .” Therefore, in our view, the employer may only be ordered to pay the health insurer and the outstanding medical bills the amounts that could be billed pursuant to the medical fee schedule.
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IT IS THEREFORE ORDERED that the ALJ’s order dated August 21, 2009, is modified to reflect that payments of the medical bills and reimbursement to the health carrier shall be pursuant to the fee schedule and the order as modified is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
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John D. Baird
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CURT KRIKSCIUN
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KAMI JEAN MARTIN, PENROSE, CO, (Claimant).
LISA HYAMS, PENROSE, CO, (Employer).
WINSTON LAW FIRM, PC, Attn: JOSEPH R WINSTON, ESQ., COLORADO SPRINGS, CO, (For Claimant).
JOAN A GOLDSMITH, LLC, Attn: JOAN A GOLDSMITH, ESQ., COLORADO SPRINGS, CO, (For Respondents).
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