Failure to show fall from chair caused injuries undermines physician's opinion

In Colorado, a worker must first show that her impairment was caused by a work-related injury. An authorized treating physician's opinion alone does not establish a right to benefits.

Case name: Eller v. Industrial Claim Appeals Office of the State of Colorado and Boulder Valley School District, No. 08CA2274 (Colo. Ct. App. 09/03/09).

Ruling: The Colorado Court of Appeals upheld the finding that a school district employee failed to show her injuries were caused by falling out of a chair at work.

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What it means: In Colorado, a worker must first show that her impairment was caused by a work-related injury. An authorized treating physician's opinion alone does not establish a right to benefits. If causation has not been proven, the authorized treating physician's findings and determination are inconsequential for purposes of compensation.

Summary: A school district employee alleged she injured her head and neck when a chair she was sitting in toppled over. Her employer provided medical treatment but did not admit liability. After her authorized treating physician placed her at maximum medical improvement and gave her a permanent impairment rating, the district filed a notice of contest.

An independent medical examiner concluded the employee's impairment was not causally related to the chair incident. The employee argued the employer failed to request the IME in a timely fashion, and therefore the findings of her authorized treating physician were binding.

The court disagreed, noting that the employee had not established causation. The employee had failed to immediately report the accident and failed to show it was more probable than not she suffered her injury at work. An administrative law judge determined her testimony was contradictory and unreliable and her account of the injury improbable and unsupported by evidence. The court said that where the threshold issue of causation has not been established, the authorized treating physician's opinion is not binding. It upheld the denial and dismissal of her claims.

The court explained that the authorized treating physician's findings were inconsequential for purposes of determining compensability. Contrary to the employee's argument, Colorado law does not grant the authorized treating physician any decisional authority to determine causation as it pertains to compensability.

The court rejected the employee's argument that she was subjected to "surprise" by the employer's hearing testimony concerning how she was injured. The court noted she did not object to her supervisor's testimony concerning her statements made to him after the alleged accident, his description of the fall, or the use of a chair as demonstrative evidence during the hearing. The court noted the ALJ expressly credited the testimony of several of the district's witnesses, including the IME physician who opined the employee's impairment was not causally related to the effects of the chair incident.

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October 5, 2009

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