Opinion
W.C. No. 4-451-413
February 21, 2001
FINAL ORDER
The respondent-insurer, Republic Indemnity Company (Republic) seeks review of an order of Administrative Law Judge Jones (ALJ) which required them to pay medical benefits. We affirm.
The pertinent facts are undisputed. The claimant suffered a work-related injury on January 17, 2000, when his fifth right finger was stuck by a used hypodermic needle. The claimant testified that as a result of the injury his finger became swollen, and painful. The respondent-employer referred the claimant to Concentra Medical Center (Concentra) where he received treatment which included vaccinations for Hepatitis, Tetanus and HIV. Republic denied liability for the vaccinations on grounds the vaccinations were "preventative" treatment and the claimant has not been diagnosed with a "disabling injury" or occupational disease.
The ALJ found the claimant has not been diagnosed with Hepatitis, Tetanus or HIV. However, the ALJ rejected the argument the claimant must be diagnosed with a blood borne disease before he is entitled to medical benefits. Relying on Wal-Mart Stores, Inc. v. Industrial Claim Appeals Office, ___ P.3d ___(Colo.App. No. 99CA0963, March 2, 2000), the ALJ also rejected Republic's argument that medical benefits may only be awarded for a "disabling" injury.
Based upon requirements of the United States Occupational Safety Health Administration (OSHA), the ALJ found that the standard protocol for a hypodermic puncture accident such as the one suffered by the claimant includes treatment for the actual puncture, prophylaxis, testing and monitoring. In particular, OSHA requires employers to provide workers injured by a needle stick with a post exposure medical evaluation, and follow up examinations. Therefore, the ALJ found the treatment provided by Concentra was reasonable and necessary to treat the claimant's industrial injury. Consequently, the ALJ ordered Republic to pay the disputed medical expenses.
On review Republic renews the arguments it made before the ALJ. We agree with the ALJ's reasoning and, therefore, we perceive no basis to disturb the award.
Initially, we note that Republic's designation of record includes the "Division of Workers' Compensation file." The record transmitted to us on appeal apparently does not include the complete Division of Workers' Compensation file. However, our review is limited to the evidentiary record before the ALJ, and there is no evidence in the record which tends to suggest Republic requested the ALJ consider the Division of Workers' Compensation file as part of the evidentiary record for the hearing. See City of Boulder v. Dinsmore, 902 P.2d 925 (Colo.App. 1995); Rules of Procedure, Part VIII(A)(7), 7 Code Colo. Reg. 1101-3 at 22. Consequently, we have not obtained or considered the Division of Workers' Compensation file. Instead, we have restricted our review to the record made at the hearing. See City of Boulder v. Dinsmore, 902 P.2d 925 (Colo.App. 1995).
Section 8-42-101(1)(a), C.R.S. 2000, provides that the employer is obliged to provide "such medical, surgical, dental, nursing, and hospital treatment . . . as may reasonably be needed" to cure and relieve from the effects of the injury." Contrary to Republic's contention neither the Workers' Compensation Act (Act), nor the case law, makes an arbitrary distinction between "active treatment" and diagnostic or preventative procedures. See Merriman v. Industrial Commission, 120 Colo. 400, 210 P.2d 448 (1949) (exploratory surgery compensable in order to ascertain the extent of the claimant's industrial injury). Furthermore, it is well established that compensable medical benefits include treatment designed to prevent a deterioration of the claimant's condition. See Grover v. Industrial Commission, 759 P.2d 705 (Colo. 1988). In fact, in Milco Construction v. Cowan, 860 P.2d 539 (Colo.App. 1992), the Court of Appeals stated the following:
We hold, therefore, that, if the evidence in a particular case establishes that, but for a particular course of treatment, a claimant's condition can reasonably be expected to deteriorate, so that he will suffer a greater disability than he has sustained thus far, such medical treatment, irrespective of its nature, must be looked upon as treatment designed to relieve the effects of the injury or to prevent deterioration of the claimant's present condition. (Emphasis added).
Accordingly, we have previously held that treatment to "monitor" a claimant's condition is compensable if it is designed to prevent a deterioration of the claimant's condition. See Atwood v. Western Slope Industries, W.C. No. 3-069-135 (November 28, 1994). This rational is even more compelling where the disputed treatment is designed to "prevent" a deterioration of the claimant's condition due to a potentially fatal infectious disease such as Hepatitis or HIV. We adhere to our previous conclusions.
Moreover, the Act is intended to be interpreted to assure the "quick and efficient delivery of" of medical benefits to injured workers "at a reasonable cost to employers." Section 8-40-102(1), C.R.S. 2000. It would contravene the purpose of the Act to read § 8-42-101(1)(a) as precluding an injured worker from recovering medical benefits for preventative treatment. Therefore, we agree with the ALJ that preventative medical treatment is compensable if reasonable and necessary to cure or relieve the effects of the injury.
The question of whether treatment is reasonable and necessary is one of fact for resolution by the ALJ. Atencio v. Quality Care, Inc., 791 P.2d 7 (Colo.App. 1990). We must uphold the ALJ's determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2000.
Here, there is substantial evidence in the record to support the ALJ's determination that the disputed treatment is consistent with the standard medical protocol for the treatment of hypodermic punctures. ( See Republic Exhibit D). In fact, the respondent-employer's own policies offer a Hepatitis B vaccine to employees identified as having occupational exposure to blood and other potential infectious materials. (Memo January 3, 2000). Under these circumstances, the ALJ did not err in requiring Republic to pay the disputed treatment.
City of Littleton v. Schum, 38 Colo. App. 122, 553 P.2d 399 (Colo.App. 1976) is not authority to the contrary. The claimant in Schum was exposed to hepatitis in the normal course of his employment. Therefore, he requested medical benefits in the form of reimbursement for inoculations he obtained to avoid the risk of contracting hepatitis. It is true, the Schum court indicated that the Act does not provide compensation for "preventive measures." However, the court made that statement in the context of a finding that "there was no disease or injury and no disablement," and therefore, the claimant failed to prove he suffered any compensable injury which would warrant an award of medical benefits.
Here, the ALJ found the claimant suffered a traumatic accident on January 17 in the nature of a laceration injury. Furthermore, Republic admitted liability for treatment of the claimant's "needle stick/laceration." (Notice of Contest, February 1, 2000). Consequently, this claim involves a compensable "accidental injury" not an occupational disease. See Colorado Fuel Iron Corp. v. Industrial Commission, 154 Colo. 240, 392 P.2d 174 (1964). Thus, this claim is factually distinguishable from the circumstances presented in Schum.
Similarly, Republic's reliance on our conclusions in Bonazzo v. J. A. Jones Construction, W.C. No. 4-240-121 (September 24, 1998) and Griffith v. Rockwell International, W.C. No. 4-157-178 (July 27, 1994) is misplaced. Bonazzo and Griffith involve workers' compensation claims due to an occupational disease not an accidental injury.
Furthermore, the Wal-Mart Stores v. Industrial Claims Appeals Office, supra, the court noted that proof of a "disability" is not a prerequisite to the award of medical benefits in the case of an accidental injury. Id at 253. In reaching this result, the court noted that the need for medical treatment does not always coincide with the period when the worker is disabled." Consequently, the claimant was not required to prove that the needle stick injury was disabling to establish his entitlement to medical benefits.
Republic's remaining arguments have been considered and are unpersuasive.
IT IS THEREFORE ORDERED that the ALJ's order dated July 14, 2000, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ Kathy E. Dean
____________________________________ Robert M. Socolofsky
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, within twenty (20) days after the date this Order is mailed, pursuant to § 8-43-301(10) and § 8-43-307, C.R.S. 2000. The appealing party must serve a copy of the petition upon all other parties, including the Industrial Claim Appeals Office, which may be served by mail at 1515 Arapahoe, Tower 3, Suite 350, Denver, CO 80202.
Copies of this decision were mailed February 21, 2001 to the following parties:
Jesus Aranda, 12134 E. Ohio Ave., Aurora, CO 80012
B.J. Mandelstam, Integrated Cleaning Services, 7304 S. Alton Way, #K, Englewood, CO 80112
Helen Olson, Republic Indemnity of California, P. O. Box 15388, 5110 N. 40th St., #201, Phoenix, AZ 85060
Gregory B. Cairns, Esq., 1200 17th St., #1700, Denver, CO 80202 (For Respondent Employer)
J. Barton Maxwell, Esq., 600 17th St., #1600N, Denver, CO 80202 (For Respondent Insurer)
BY A. Hurtado