Opinion
W.C. No. 4-322-880
January 28, 2000
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Wheelock (ALJ) which requires them to provide 20 hours of "essential housekeeping services each week" as a form of medical benefit. The respondents argue the award is not proper because other members of the claimant's family will benefit from the housekeeping services, and because the evidence does not demonstrate that the services will cure or relieve the effects of the injury. We affirm.
The ALJ found the claimant suffers from "diffuse fibromyalgia" and related depression. The claimant's treating physician prescribed 20 hours each week of essential housekeeping services to treat the claimant's condition. The ALJ credited the treating physician's testimony that the effects of the injury preclude the claimant from performing ordinary household chores including "vacuuming, laundry, washing dishes, sweeping, mopping floors, and some grocery shopping." The ALJ further credited the physician's testimony that the claimant's inability to perform these chores has led to family stress which, in turn, compounds the claimant's work-related depression.
Under these circumstances, the ALJ concluded the claimant's condition "is cyclic and that the prescribed method for breaking that destructive and disabling cycle is the provision of the housekeeping services." Thus, relying on Bellone v. Industrial Claim Appeals Office, 940 P.2d 1116 (Colo.App. 1997), the ALJ held the prescribed housekeeping services are "medical in nature and incidental to an overall home healthcare program."
Relying principally on Hillen v. Tool King, 851 P.2d 289 (Colo.App. 1993), the respondents contend there is an insufficient "nexus" between the claimant's medical condition and the housekeeping services prescribed by the treating physician. In fact, the respondents argue the ALJ ordered the provision of housekeeping services which benefit other members of the claimant's family and, therefore, are not "medical" in nature. Because we conclude the evidence supports the ALJ's order, we find no error.
As the ALJ observed, there has been some inconsistency in appellate rulings concerning the compensability of housekeeping services as a form of medical benefit under § 8-42-101(1)(a), C.R.S. 1999. However, as a general matter, the courts have held the reasonableness and necessity for such services is a question of fact to be determined by the ALJ based on the particular circumstances of the case. Atencio v. Quality Care, Inc., 791 P.2d 7 (Colo.App. 1990); Bellone v. Industrial Claim Appeals Office, supra. The courts deny such services only where the record demonstrates the services are not "medical" because they have no direct bearing on the claimant's symptoms or condition, or where the services are not incidental to the provision of professional home healthcare services. See Hillen v. Tool King, supra.
To the extent the issue is factual, we must uphold the ALJ's order if supported by substantial evidence in record. Section 8-43-301(8), C.R.S. 1999. This standard of review requires us to defer to the ALJ's resolution of conflicts in the evidence, her credibility determinations, and the plausible inferences she drew from the evidence. Metro Moving and Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995).
The respondents' arguments notwithstanding, the record supports the ALJ's determination that the housekeeping services prescribed by the treating physician are "medical" in nature. First, the evidence establishes the claimant is restricted from performing many ordinary activities of daily living including cleaning and shopping, which directly affect her personal welfare. Moreover, the claimant's inability to perform these activities, and the resulting family strife, aggravates the injury-related depression thereby worsening the claimant's overall condition. Therefore, the treating physician testified the prescription of housekeeping services constitutes "a legitimate part of the claimant's treatment." (Tr. p. 20).
In view of this testimony, we agree with the ALJ that the evidence supports a determination that the provision of housekeeping services will confer a direct "medical benefit" on the claimant by treating the injury-related depression. As was true of the child care in the Bellone case, the provision of housekeeping services relieves the claimant of the stresses which perpetuate and prevent recovery from the work-related depression. In fact, the Bellone case specifically sanctioned the provision of child care as a form of treatment for fatigue and depression.
We are unpersuaded by the respondents' argument that because the prescribed housekeeping services may provide collateral benefits to other members of the claimant's family that the services are not compensable. In Edward Kraemer Sons, Inc. v. Downey, 852 P.2d 1286 (Colo.App. 1992), the court upheld an order requiring compensation of the claimant's spouse where the spouse was providing nursing care services. The court stated that the mere fact the "spouse may be able to perform household tasks when not actually rendering a specific service to the claimant does not alter the essential nature of the nursing services being provided by the spouse." Here, the ALJ has determined that the provision of essential housekeeping services will have the beneficial effect of treating the claimant's injury-related depression. Therefore, the fact that the services may incidentally benefit other family members does not render the services noncompensable. In fact, successful treatment of an injured worker may frequently produce collateral benefits to other members of the claimant's family.
Insofar as the respondents make other arguments we find them to be without merit.
IT IS THEREFORE ORDERED that the ALJ's order dated March 25, 1999, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
___________________________________ David Cain
___________________________________ Robert M. Socolofsky
NOTICE
This Order is final unless an action to modify or vacate the Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, Colorado 80203, by filing a petition to review with the court, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date the Order was mailed, pursuant to §§ 8-43-301(10) and 307, C.R.S. 1999.
Copies of this decision were mailed January 28, 2000 to the following parties:
Glenna J. Riccillo, 24744 Birdsong Dr., Pueblo, CO 81006
Parkview Episcopal Medical Center, 400 W. 16th St., Pueblo, CO 81003-2745
Indemnity Insurance Company of North America, P.O. Box 2941, Greenwood Village, CO 80150-0141
CIGNA Companies, P.O. Box 2941, Greenwood Village, CO 80150
Steven U. Mullens, Esq., 1401 Court St., Pueblo, CO 81003 (For Claimant)
Mark Overturf, Esq., 625 E. 16th Ave., #100, Denver, CO 80203 (For Respondents)
BY: A. Pendroy