W.C. No. 4-431-099.Industrial Claim Appeals Office.
March 12, 2010.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Friend (ALJ) dated September 18, 2009 that denied the claimant’s request for certain medical care. We affirm.
The record indicates that the claimant sought an order authorizing him to receive pain management treatment by Dr. Castro. Tr. at 3. The ALJ credited the opinions of Dr. Madsen, who testified at the hearing, and determined that the claimant failed to show such treatment was reasonably necessary to cure and relieve the claimant from the effects of his injury.
The claimant reviews the medical evidence in the record, including the various testimony and reports of Dr. Madsen, in support of his contention that “substantial and overwhelming evidence in the record” indicates that the requested treatment is required under the circumstances. We find no reversible error and, therefore, uphold the ALJ’s decision.
The respondent is liable for medical treatment that is reasonably necessary to cure and relieve the effects of the industrial injury. Section 8-42-101(1)(a), C.R.S. 2009; Colorado Compensation Insurance Authority v. Nofio, 886 P.2d 714 (Colo. 1994). The question of whether medical treatment is reasonable and necessary is one of fact for determination by the ALJ. Kroupa v. Industrial Claim Appeals Office, 53 P.3d 1192 (Colo. App. 2002) Wal-Mart Stores, Inc. v. Industrial Claims Office, 989 P.2d 251 (Colo. App. 1999). The claimant bears the burden of proof to establish the right to specific medical benefits. HLJ Management Group, Inc. v. Kim, 804 P.2d 250 (Colo. App. 1990).
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We must uphold the ALJ’s factual determinations if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2009. Substantial evidence is that quantum of probative evidence which a rational fact finder would accept as adequate to support a conclusion without regard to the existence of conflicting evidenc . Metro Moving Storage Co. v. Gussert, 914 P.2d 411, 415 (Colo. App. 1995).
The claimant asserts that the treatment he sought must be necessary because the “substantial and overwhelming evidence in the record” shows that his 2004 surgery was reasonable and necessary. Therefore, according to the claimant, any treatment related to the surgery is compensable. We conclude otherwise. The respondent was free to challenge the reasonableness, necessity, and relatedness of the requested treatment notwithstanding its position regarding the previous surgical care. See Kroupa v. Industrial Claim Appeals Office, supra (upholding employer’s refusal to pay for third arthroscopic procedure after having paid for multiple surgical procedures).
At the hearing Dr. Madsen opined that the claimant’s current pathology was not primarily related to his fall at work. He explained that imaging studies of the claimant showed extensive degenerative change that typically take years to accumulate. He further opined that the claimant’s pathology was not caused by the claimant’s original work injury. Tr. at 21-22. The ALJ credited Dr. Madsen’s opinion that the claimant’s earlier surgery was related to normal degenerative change, rather than the claimant’s work-related injury. The ALJ’s dispositive findings are supported by the record. The claimant’s reference to other evidence which, if credited, might permit a contrary result affords no basis for relief on appeal. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo. App. 2002).
IT IS THEREFORE ORDERED that the ALJ’s order dated September 18, 2009 is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ John D. Baird
____________________________________ Thomas Schrant
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DAVID DOUCET, ENGLEWOOD, CO, (Claimant)
CITY AND COUNTY OF DENVER, Attn: PATRICIA LORMAN, DENVER, CO, (Employer)
FOGEL, KEATING, WAGNER, POLIDORI, AND SHAFNER, Attn: NICK D. FOGEL, ESQ., DENVER, CO, (For Claimant)
DENVER CITY ATTORNEYS OFFICE, Attn: OLIVIA L HUDSON SMITH, ESQ., DENVER, CO, (For Respondents)
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