Opinion
W.C. Nos. 4-545-306 4-549-134
April 14, 2004
FINAL ORDER
The claimant, who is the surviving spouse of the decedent, seeks review of an order of Administrative Law Judge Stuber (ALJ) which dismissed and denied her claim for death benefits. We affirm.
The decedent was employed by the respondent for almost 34 years. In June 2002, the decedent alleged a work-related injury to his right knee. As a result of the injury, the decedent was temporarily disabled from performing his regular work and ceased receiving his regular wages, which was very disturbing to him. On June 21 the respondent's third-party administrator informed the decedent that the respondent would be filing a Notice of Contest to deny liability for medical and temporary disability benefits pending an investigation of the work-relatedness of the knee injury. The ALJ found the decedent was upset by this information and the potential delay in treatment.
On July 11 the respondent told the decedent to submit medical bills for surgery on the right knee to the decedent's group health insurance. The decedent then called the claimant and expressed concern about the contested workers' compensation claim as well as the scheduled surgery. Later that day the decedent received a copy of the respondent's Notice of Contest and became very upset. A short time later that evening the decedent took his own life.
Dr. Gamblin opined the decedent's death was a direct result of the knee injury. In support, Dr. Gamblin opined that the decedent's entire identity was his job and the decedent was disturbed by the Notice of Contest because he perceived the respondent to be questioning his truthfulness about the cause of the knee injury. Dr. Gamblin added that the decedent probably felt trapped because he could not get treatment from the respondent and could not return to work without treatment. Therefore, the decedent was worried he would be discharged from employment.
In reaching his conclusions, Dr. Gamblin conceded that the events of July 11 were instrumental in the decedent's suicide. (Tr. p. 118). Dr. Gamblin also stated that "managing" the workers' compensation claim was "instrumental in [the decedent's] belief that he would not be able to get appropriate treatment and return to work." (Tr. p. 125). However, Dr. Gamblin rejected the notion that "litigation stress" contributed to the decedent's suicide because the decedent was not represented by counsel and the decedent had been dealing directly with the respondent on the injury claim. (Tr. p. 124).
The ALJ found the right knee injury arose out of and in the course of employment and awarded temporary disability and medical benefits. However, the ALJ determined the decedent's suicidal death was not a natural consequence of the injury, and therefore denied the claim for death benefits. In support, the ALJ determined the suicide was not due to the injury itself and was not due to a severe mental disorder created by the injury. Rather, the ALJ found the suicide was "caused by intervening events, most specifically the denial of the workers' compensation claim." Under these circumstances, the ALJ found the decedent's mental condition was analogous to "litigation stress" discussed in Jarosinski v. Industrial Claim Appeals Office, 62 P.3d 1082 (Colo.App. 2002).
On appeal, the claimant contends there is no evidence to support the ALJ's finding that the decedent would not have committed suicide but for the respondent's decision to contest liability for the injury. Rather, the claimant argues the decedent's suicide was the result of a psychological reaction to physical limitations caused by the injury and the consequent economic loss caused by the physical limitations. The claimant also contends the ALJ erroneously analogized the decedent's condition to litigation stress. We are not persuaded by these arguments.
The respondents are liable for the natural consequences of an industrial injury. Vanadium Corp. of America v. Sargent, 134 Colo. 555, 307 P.2d 454 (Colo. 1957). As argued by the claimant, "neurotic mental disabilities" which develop as a result of a worker's psychological reaction to a traumatic industrial injury are compensable subject to the evidentiary requirements in 8-41-301(2)(a.5), C.R.S. 2003. See Arvas v. McNeil Coal Corp., 119 Colo. 289, 203 P.2d 906 (1949); Casa Bonita Restaurant v. Industrial Commission, 624 P.2d 1340 (Colo.App. 1981); Martinez v. Mac-Bestos, W.C. No. 4-291-444 (October 13, 2000). Thus, an injured worker may recover medical and disability benefits where the physical affects of an injury also cause a psychological injury. See National Lumber and Creosoting Co., 101 Colo. 535, 75 P.2d 144 (1937) (award for permanent total disability based in part on "fear and anxiety" caused by skull fracture upheld). However, the issue on appeal does not involve a claim for disability or medical benefits. Rather, the issue is the entitlement to death benefits.
Death benefits are payable where the death is proximately caused by an industrial injury. Section 8-42-115 C.R.S. 2003. As argued by the claimant, the injury does not have to be the immediate cause of the death, as long as the claimant proves the industrial injury was a proximate cause of the death. Johnson v. Industrial Commission, 366 P.2d 865 (Colo. 1961); Trudeau v. Umetco Minerals Corp., W.C. No. 4-537-010 (August 21, 2003). This standard requires the claimant to prove a direct causal relationship between the industrial injury and the death. See Seifried v. Industrial Commission, 736 P.2d 1262 (Colo.App. 1986); Trudeau v. Umetco Minerals Corp., supra.
An intentional self-inflicted injury or suicide is considered an independent non-industrial intervening event which severs the causal connection between the injury and the death. Section 8-41-301(1)(c), C.R.S. 2003. A narrow exception exists where the industrial injury causes a deranged mental condition and the deranged mental condition is the proximate cause of the worker's suicidal death. See Jakco Painting Contractors v. Industrial Commission, 702 P.2d 755 (Colo.App. 1985); Dependable Cleaners v. Vasquez, 83 P.2d 583 (Colo.App. 1994).
Generally, the issue of whether the industrial injury caused such a "deranged mental condition" is one of fact for determination by the ALJ. Dependable Cleaners v. Vasquez, supra. Consequently, we must uphold the ALJ's determination if supported by substantial evidence. Section 8-43-301(8), C.R.S. 2003. In applying this standard, we must view the evidence in a light most favorable to the prevailing party, and defer to the ALJ's resolution of conflicts in the evidence, his credibility determinations, and the plausible inferences he drew from the evidence. Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995). Further, assessment of the weight and credibility of expert medical opinion on the issue of causation is a matter within the fact-finding authority of the ALJ. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990).
Here, the ALJ was not persuaded the industrial injury caused the claimant to develop a deranged mental disorder. The claimant's arguments notwithstanding, the ALJ's finding is a plausible inference from the record. In particular, there is evidence the decedent suffered a left knee injury in 2001 which was disabling and required surgical treatment. The respondent admitted liability for the injury, provided treatment and paid disability benefits. The claimant did not present evidence the decedent suffered any significant psychological disorder or depression as a result of that injury. Under these circumstances, the ALJ could, and did, reasonably infer that although the decedent "would not have committed suicide `but for' the [right] knee injury he also would not have committed suicide `but for' the claim denial by [the third party administrator]." ( See Conclusions of Law 4).
Moreover, there is substantial evidence that the primary source of the decedent's emotional distress was not the injury, but rather was the respondent's decision to contest liability for the right knee injury. Because the decedent's principal goal was to retain his employment, the Notice of Contest caused the decedent to fear the respondent would refuse to accommodate his condition if the respondent considered the knee injury to be unrelated to the employment.
Similarly, we perceive no error in the ALJ finding that the decedent's mental condition is akin to "litigation stress." The "quasi-course of employment" doctrine provides that an injury occurring during travel to or from authorized medical treatment is compensable because the employer is required to provide medical treatment for the industrial injury and the claimant is required to submit to the treatment. Excel v. Industrial Claim Appeals Office, 860 P.2d 1393 (Colo.App. 1993). However, in Jarosinski v. Industrial Claim Appeals Office, supra, the court held that if the element of a contractual obligation is missing, the resulting injuries are not compensable under the quasi-course of employment doctrine. Id. at 1085. Accordingly, in Jarosinski the court held that problems resulting from an injured worker's negative psychological reaction to the litigation process in a workers' compensation claim was not an activity that may fairly be characterized as a service or activity inherent to the employment contract. Id. at 1085. Thus, the court held that such activities do not bear the requisite causal connection between the injury and the employment to be compensable.
Indeed, the court in Jarosinski noted that if "litigation stress" injuries were compensable, respondents would be required to calculate, to the extent they are able, whether the benefits of successful litigation are likely to outweigh the potential costs if the injured worker experiences a psychological reaction to an adverse ruling. Under such circumstances, "respondents might forgo the presentation of valid defenses and drive up employers' costs of procuring workers' compensation insurance," which would be contrary to the statutory purposes of assuring the quick and efficient delivery of benefits at a reasonable cost to the employer. Id at 1085; § 8-40-102(1), C.R.S. 2003.
Here, the ALJ found that the decedent's mental condition immediately preceding his suicidal death was the product of the respondent's decision to exercise its right to contest liability for the right knee injury and thus, was the product of "litigation stress" regardless of the absence of a formal hearing. The finding is a plausible interpretation of the circumstances surrounding the decedent's suicidal death. See Ackerman v. Hilton's Mechanical Men, Inc., 914 P.2d 524 (Colo.App. 1996) (ALJ findings may be inferences from circumstantial evidence).
To the extent the claimant has made other arguments, they do not alter our conclusions. The ALJ's finding that the claimant failed to prove the decedent's suicide was the result of a deranged mental condition caused by the industrial injury is fatal to the claimant's entitlement to death benefits.
IT IS THEREFORE ORDERED that the ALJ's order dated October 20, 2003, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ Kathy E. Dean
______________________________ Bill WhitacreNOTICE
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. 2003. 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 order were mailed to the parties at the addresses shown below on April 14, 2004 by A. Hurtado
Sue Moore, 143 Ring Rd., Guffey, CO 80820
Mari Lombardi, Western Forge, 4607 Forge Rd., Colorado Springs, CO 80907
Carilyn Dakan, Crawford and Company, P. O. Box 6502, Englewood, CO 80155-6502
Steven U. Mullens, Esq., P. O. Box 2940, Colorado Springs, CO 80901-2940 (For Claimant)
Carol A. Finley, Esq. and T. Paul Krueger, II, Esq., 111 So. Tejon St., #700, Colorado Springs, CO 80903 (For Respondent)