Opinion
W.C. No. 4-441-053.
January 15, 2004.
FINAL ORDER
The pro se claimant seeks review of an order of summary judgment by Administrative Law Judge Klein (ALJ) which denied his petition to reopen a full and final settlement. We affirm.
In March 1999, the claimant suffered a compensable injury his back. Dr. Krauth recommended a laminectomy and microdiscectomy which was performed October 20, 1999. The respondents denied liability for Dr. Krauth's treatment. However, following a hearing on September 12, 2000, an ALJ entered an order dated November 30, 2000, which required the respondents to pay for Dr. Krauth's treatment including the surgery.
On July 6, 2001, the parties entered into a Stipulation for Full and Final Settlement (Settlement) in which the claimant gave up his right to all further workers' compensation benefits including medical benefits, in exchange for a lump sum payment of $85,000. The Settlement also states that the claimant waived the right to reopen the claim except on grounds of fraud or mutual mistake of material fact.
The Settlement was approved July 9, 2001. Apparently, some authorized medical expenses remained unpaid after the Settlement was approved.
In November 1992 the claimant petitioned to reopen the claim and alleged he was fraudulently induced to enter into the stipulation by the respondents representations that the respondent-insurer would pay all medical expenses incurred up to the date of the Settlement. Alternatively, the claimant alleged the parties were mutually mistaken about whether the Settlement required the respondents to pay all outstanding medical expenses. Both parties subsequently moved for summary judgment on the petition to reopen.
The ALJ found no ambiguity in the contract and determined the Settlement contained the entire agreement of the parties. The ALJ also determined the Settlement contained no language reflecting an agreement by the respondents to pay all outstanding medical expenses. Further, the ALJ determined the claimant failed to prove fraud or mutual mistake of material fact. In particular, the ALJ found that many of the alleged fraudulent actions by the respondents were known to the claimant before he entered into the Settlement. As to the allegedly fraudulent actions unknown to the claimant at the time of the Settlement, the ALJ found they were not intended to induce the claimant to settle. (Conclusions of Law 8). Consequently, the ALJ rejected the claimant's argument that he entered into the Settlement based on false representations by the respondents. The ALJ also found no "mutual" mistake concerning whether the respondents agreed to pay for all outstanding medical expenses. To the contrary, the ALJ determined that the claimant's mistaken belief that such expenses would be paid was unilateral. Therefore, the ALJ denied the petition to reopen.
On review the claimant asserts general allegations of error. See section 8-43-301(8), C.R.S. 2003. The claimant also renews his contention that the respondents and their agent made material misrepresentations which induced him to enter into the Settlement. In support the claimant contends the September 2000 hearing transcript contains evidence of the respondents "propensity to mislead." However, the claimant did not file a brief in support of the petition to review. Consequently, the effectiveness of our review is limited. Ortiz v. Industrial Commission, 734 P.2d 642 (Colo.App. 1986).
Initially, we note that the claimant's Designation of Record includes the "entire files of the Division of Administrative Hearings and the Division of Workers' Compensation file." The record transmitted to us on appeal apparently does not include the complete Division of Workers' Compensation file. Further, our review is limited to the evidentiary record before the ALJ, and there is no evidence in the record which tends to suggest the claimant requested the ALJ to consider the entire 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)(6), 7 Code Colo. Reg. 1101-3 at 22. Consequently, we have not obtained or considered the Division of Workers' Compensation file, but restricted our review to the record made at the hearing.
Under § 8-43-301(8), C.R.S. 2002, we are precluded from disturbing the ALJ's order unless the ALJ's findings of fact are insufficient to permit appellate review, the ALJ has not resolved conflicts in the evidence, the record does not support the ALJ's findings, the findings do not support the order, or the order is not supported by the applicable law. However, summary judgment is appropriate where the moving party is entitled to judgment as a matter of law and the claimant's factual assertions even if true, do not support the claim for relief. C.R.C.P. 56 ; Nova v. Industrial Claim Appeals Office, 754 P.2d 800 (Colo.App. 1988) (C.R.C.P. apply insofar as not inconsistent with the procedural or statutory provisions of the Workers' Compensation Act); Morphew v. Ridge Crane Service, Inc., 902 P.2d 848 (Colo.App. 1995).
A settlement agreement is in the nature of a written contract which must be interpreted in accordance with the general rules which apply to the construction of contracts. Cary v. Chevron U.S.A., Inc., 867 P.2d 117 (Colo.App. 1993); Resolution Trust Corp., v. Avon Center Holdings, 832 P.2d 1073 (Colo.App. 1992). The general rules of contract interpretation provide that where the contract terms are clear and unambiguous the contract must be enforced as written. Cary v. Chevron U.S.A., Inc., supra. In determining whether the Settlement is ambiguous "the instrument's language must be examined and construed in harmony with the plain and generally accepted meaning of the words used, and reference must be made to all the agreement's provisions." Fibreglas Fabricators, Inc. v. Kylberg, 799 P.2d at 374. Evidence the parties ascribe different meanings to a contract term does not compel the conclusion the contract is ambiguous. Dorman v. Petrol Aspen Inc., 914 P.2d 909 (Colo. 1996).
We have reviewed the record and the ALJ's findings of fact. The ALJ's findings are sufficient to permit appellate review, and ALJ's order reflects his consideration and application of the applicable law. We also agree with the ALJ that the Settlement is unambiguous and the plain and clear meaning of the Settlement fails to establish any agreement that the respondent-insurer will pay all outstanding medical expenses. In particular, part 21 of the Settlement states that it "contains the entire agreement between the parties." Part 3 of the Settlement states that the parties disagree on the amount of "medical benefits to which the Claimant may be entitled." Further, part 6 states the Settlement is "intended to resolve all claims."
We also note that part 21 of the Settlement states that the claimant has "carefully reviewed and discussed the terms of this Stipulation with his attorney." It follows we reject the claimant's contention the ALJ committed reversible error in failing to give greater weight to the affidavit of his former attorney that reflects his belief the Settlement obligated the respondents to pay all outstanding medical expenses. See Cheyenne Mountain School Dist. #12 v. Thompson, 861 P.2d 711 (Colo. 1993) (parol evidence is only admissible if the agreement is so ambiguous that the parties' intent is unclear).
To reopen the claim on grounds of "fraud," the claimant must prove that the respondents made false representations which the claimant relied upon to settle the claim. Section 8-43-303(1), C.R.S. 2003; Trimble v. City and County of Denver, 697 P.2d 716 (Colo. 1985). In particular, the claimant must prove: (1) a false representation of material fact or a concealment of a material fact which should in good conscience be disclosed; (2) knowledge on the part of the party making the representation that it is false, or indifference to that issue; (3) ignorance of the true facts by the person to whom the representations are made; (4) the party making the representation or concealing a fact does so with the intent to induce action on the part of the other party, and (5) the party to whom the representation or concealment is directed is damaged. Morrison v. Goodspeed, 100 Colo. 470, 60 P.2d 458 (1937); Beeson v. Albertson's Inc., W.C. No. 3-968-056 (April 30, 1996).
To prove a "mutual mistake of material fact" the claimant must prove the existence of a "mistake" pertaining to a past or present fact. For a fact to be "material," it must relate to a "basic assumption" on which the agreement was made. Maryland Casualty v. Buckeye Gas Products Co., 797 P.2d 11 (Colo. 1990); Gleason v, Guzman, 623 P.2d 378.
We agree with the ALJ's determination that the pleadings and affidavits fail to establish the elements of fraud or the existence of a mistake of fact concerning the respondents' willingness to pay all outstanding medical expenses that was mutually shared by the respondents. Therefore, the ALJ did not err in finding the claimant failed to prove grounds to reopen the Settlement.
Finally the claimant contends the respondents' payment of additional medical bills after the Settlement compels a finding the Settlement required the respondents' payment of all outstanding expenses. Because the Settlement does not contain any language requiring the respondents to pay additional medical expenses, the respondents' gratuitous payment of such expenses does not establish grounds to set aside the agreement.
IT IS THEREFORE ORDERED that the ALJ's order dated May 16, 2003, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ David Cain
______________________________ Kathy E. DeanNOTICE
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 January 15, 2004 by A. Hurtado.
Kelle C. Hickam, 3885 Quay St., Wheat Ridge, CO 80033
LeBoeuf, Lamb, Leiby Macrea, 633 17th St., #2800, Denver, CO 80202-3663
Ursula Lowe, Royal Indemnity Company, 9800 S. Meridian Blvd., Englewood, CO 80155
James Buck, Esq., 1777 S. Harrison St., #1110, Denver, CO 80210 (For Respondents)