Opinion
W.C. No. 4-255-751
February 12, 1999.
FINAL ORDER
The claimant seeks review of a final order of Administrative Law Judge Friend (ALJ) which denied her claim for medical benefits associated with the treatment of her left upper extremity problems. The claimant argues that the doctrines of res judicata and collateral estoppel barred the respondents from challenging the "cause" of her need for treatment. The claimant further contends that the ALJ's findings concerning causation are not supported by the evidence. We affirm.
The claimant sustained an injury to her right upper extremity, shoulder, and neck when a box fell on her on March 8, 1995. The claimant filed a claim for benefits on August 28, 1995, and this claim was assigned W.C. No. 4-255-751. The claimant also filed a second claim for benefits on August 28, 1995. This claim alleged a bilateral repetitive motion disorder with a "date of disease" of March 31, 1995. The claim for this injury was assigned W.C. No. 4-263-411.
On June 10, 1996, the parties entered into a "Stipulation" concerning the two claims, and a prehearing administrative law judge (PALJ) approved the Stipulation on June 12. The Stipulation provided that "all claims" will be combined under W.C. No. 4-255-751 "bearing the date of injury/onset of March 8, 1995." The Stipulation further provided that the "bilateral repetitive motion disorder" claimed under W.C. No. 4-263- 411 "shall be included in" W.C. No. 4-255-751. The respondents subsequently filed two general admissions of liability for medical benefits and temporary total disability benefits under W.C. No. 4-255-751.
It is not now disputed that the claimant's compensable treatments prior to 1997 were aimed at curing the effects of the March 8 accidental injury to the right upper extremity. However, in 1997, the claimant sought treatment for pain and tingling in her left upper extremity.
At the hearing, claimant's counsel took the position that the parties' Stipulation constituted an agreement that the claimant's bilateral repetitive motion disorder, including the problems with her left upper extremity, was causally connected to an admitted 1995 occupational disease. However, the ALJ rejected this position, concluding that the Stipulation does not reflect any intent by the respondents retroactively to admit liability for the left upper extremity condition. Instead, the ALJ found the Stipulation was nothing more than an agreement by the parties that the claim for the occupational disease would constitute one of the "allegations" in W.C. No. 4-255-751. Consequently, the ALJ concluded that the respondents did not admit, nor were they estopped from denying, liability for treatment of the left upper extremity problems.
Further, the ALJ found that the claimant failed to prove that her left upper extremity problems were caused by her employment. In support, the ALJ credited the testimony of Dr. Leimbach that the claimant suffers from de Quervain's syndrome probably caused by "general activities of daily living." The ALJ also credited Dr. Parker who testified that the claimant's past problems with the left upper extremity "were resolved" and did not create any incapacity.
I.
On review, the claimant contends that the Stipulation and the respondents' subsequent admissions of liability preclude the respondents from denying liability for medical treatment of the left upper extremity problems. The claimant argues that the doctrines of res judicata and collateral estoppel render the Stipulation and admissions binding on the respondents with respect to the cause of the need for treatment in 1997. We disagree.
Initially, we reject the respondents' argument that the issues of res judicata and collateral estoppel were not timely raised by the claimant. Although the claimant's counsel did not use those specific terms at the time of the hearing, she did argue that the Stipulation and admissions had a preclusive effect on the issue of causation. (Tr. p. 4) Further, the ALJ's order refers to estoppel and reflects his understanding that the claimant was arguing the effects of the Stipulation and admissions. Consequently, we conclude that these issues are properly before us. Sneath v. Express Messenger Service, 931 P.2d 565 (Colo.App. 1996).
The claimant's reliance on the doctrine of res judicata is misplaced. It is true that res judicata may be applied in administrative proceedings. However, it must be demonstrated there was "identity of subject matter, identity of claim, and identity of parties to the action" between the first and second hearings. Mid-Continent Resources, Inc. v. Looby, 877 P.2d 1385 (Colo.App. 1994). Further, the first administrative proceeding must result in a final judgment on the merits, which means that the agency must have acted in a quasi-judicial capacity by properly resolving disputed issues of fact and by giving the parties a fair opportunity to litigate the issues. Id. at 1387-1388. The doctrine has no application where there has been a substantial change in facts or circumstances subsequent to the first proceeding. Whelden v. Board of County Commissioners, 782 P.2d 853 (Colo.App. 1989).
Here, neither the Stipulation nor the respondents' general admissions of liability constitute a final judgment on the merits concerning the cause of the claimant's need for treatment in 1997. In workers' compensation cases an admission of liability for medical benefits does not amount to an admission that the respondents must automatically pay all subsequent claims for medical expenses. Rather, the claimant remains responsible for establishing the "threshold requirement" that the need for particular treatment is causally connected to the admitted injury, and the respondents remain free to dispute the cause of the need for treatment regardless of the admission. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997).
The claimant's assertions notwithstanding, the Stipulation contains no provision stating that the respondents agreed to become liable for all subsequent medical treatment associated with the claimant's left upper extremity problems. As the ALJ found, the Stipulation merely provides that the two separate claims for benefits would be combined under one claim number. We may not contradict the plain terms of the Stipulation by inventing provisions which are not found in the agreement. Cary v. Chevron U.S.A.., Inc., 867 P.2d 117 (Colo.App. 1993) (interpretation of settlement agreement is question of law where terms are unambiguous). We recognize that in her brief the claimant asserts there is evidence, in the form of notes written by a PALJ, that she agreed to drop her claim for penalties in exchange for the respondents' agreement to pay medical expenses for the bilateral upper extremity condition. However, even if such extrinsic evidence were admissible to clarify the terms of the Stipulation, the notes were not offered into evidence at the hearing and may not now be considered on appeal. City of Boulder v. Dinsmore, 902 P.2d 925 (Colo.App. 1995); Rule of Procedure VIII (I) (6), 7 Code Colo. Reg. 1101-3 at 27 (only records filed and identified at hearing will be considered as evidence).
Because the Stipulation does not contain any provision resolving the respondents' liability for medical expenses, it is not a final judgment for purposes of applying res judicata. Similarly, the respondents' general admissions of liability do not amount to a final adjudication on the merits of their liability for the 1997 medical expenses. To the contrary, the respondents remained free to dispute the cause of the need for the medical treatments. Snyder v. Industrial Claim Appeals Office, supra.
Similarly, the doctrine of collateral estoppel has no application to this case. Collateral estoppel requires, among other things, that an issue actually litigated and finally decided in a prior proceeding be identical to the issue to be decided in the subsequent proceeding. M M Management Co. v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA0370, December 10, 1998). Here, as we have pointed out, neither the Stipulation nor the admissions of liability finally determined the cause of the claimant's need for medical treatment in 1997. In fact, such a determination would have been impossible at the time of the Stipulation and the admissions.
II.
The claimant's second contention is that the ALJ erred in finding that she failed to prove a causal relationship between the need for treatment and the alleged occupational disease. In support of this contention the claimant cites evidence that she reported left upper extremity problems throughout her career with the respondent-employer, and also relies on her own testimony. We perceive no error.
The question of whether the claimant proved a causal relationship between the alleged occupational disease and her need for treatment in 1997 was one of fact for determination by the ALJ. City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). Because the issue is factual in nature, we must uphold the ALJ's order if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 1998. In applying this standard we must 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). It is the unique province of the ALJ to assess the weight and credibility of expert medical testimony on the issue of causation. Rockwell International v. Turnbull, 802 P.2d 1185 (Colo.App. 1990).
Here, the expert testimony cited by the ALJ supports his conclusion that the claimant failed to prove the requisite causal connection. Particularly persuasive is Dr. Parker's testimony that the claimant's prior left upper extremity problems appeared to resolve before 1997. Although the record contains conflicting evidence which might support a different result, we decline the claimant's invitation to substitute our judgment for that of the ALJ concerning the credibility of the expert witnesses or the inferences to be drawn from the record.
IT IS THEREFORE ORDERED that the ALJ's order dated September 23, 1998, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
_______________________________ David Cain
_______________________________ Bill Whitacre
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. 1998.
Copies of this decision were mailed February 12, 1999 to the following parties:
Louise Perez, 11257 Larson Lane, Northglenn, CO 80233
Barbara Melton, Storage Technology Corporation, 2270 South 88th Street, Louisville, CO 80028-4317
Kathy Redmond, St. Paul Fire Marine Insurance Co., PO Box 441565, Aurora, CO 80044-1565
Michelle Holland, Esq., 1120 Lincoln Street, Suite 906, Denver, CO 80203 (For Claimant)
Michael J. Barbo, Esq., 12250 East Iliff Ave., Ste. 308, Aurora, CO 80014-1253 (For Respondents)
BY: _______________