Opinion
W.C. No. 4-757-058.
October 15, 2008.
FINAL ORDER
The claimant seeks review of an order of the Director of the Division of Workers' Compensation (Director) dated June 20, 2008, that denied the claimant's request for an order requiring the insurer to pay temporary total disability (TTD) benefits without reduction for an alleged safety violation and denied the request for an award of penalties. We affirm.
The relevant facts are not in dispute. The claimant suffered an industrial injury on April 18, 2008. The insurer filed a general admission of liability in which it admitted for benefits, but reduced benefit payments by fifty percent for an alleged safety rule violation. The claimant filed a request with the Director asking for an order requiring the insurer to pay TTD benefits without reduction for the alleged safety violations and for penalties. The Director, citing Allison v. Industrial Claim Appeals Office 916 P.2d 623 (Colo.App. 1995), found that there was no statutory requirement to admit for the full amount of temporary benefits and the respondents were only obliged to continue to pay benefits pursuant to the admission. The Director noted that if the claimant disputed the safety rule violation, he must file an application for hearing. The Director determined that the respondents had not violated a provision of the Workers' Compensation Act (Act) or a rule of procedure and denied penalties.
On appeal, the claimant argues that decisions subsequent to Allison provide a more reasoned approach to the admission of temporary disability benefits. The claimant argues that by following Allison and allowing the insurer to file an admission with reduced benefits the ALJ erred by leaving him with only a post-deprivation remedy of applying for a hearing, which is inadequate as a matter of law. In our view, the cases cited by the claimant do not control the outcome of this matter. In essence, the claimant sought an order from the Director requiring the insurer to admit for TTD benefits without a reduction for alleged safety violations. We note that no one disputes that the claimant is entitled to a hearing on the issue of safety rule violation. Rather, the issue is whether the insurer is obligated under the Act to admit for and pay benefits to which it believes the claimant is not entitled. We are not convinced that such obligation exists. The Director's order does not prevent the claimant from proceeding to a full hearing to determine whether he is entitled to the relief that he sought summarily from the Director.
The claimant's reliance on Colorado Compensation. Ins. Auth. v. Industrial Claim Appeals Office, 18 P.3d 790 (Colo.App. 2000), is misplaced. In that case the court, citing Allison, significantly determined that "[a]n insurer has no legal duty to admit liability for temporary disability benefits." Colorado Compensation Ins. Auth, 18 P.3d at 791 (citing Allison v. Industrial Claim Appeals Office, supra). The court did go on to determine that once an insurer admits liability, it is bound by that admission and must pay accordingly. Here there is no dispute that the insurer is bound by its admission and has paid benefits pursuant to that admission. In Colorado Compensation Ins. Auth, the court determined that an admission for a closed period of TTD benefits did not conform to the specific statutory grounds for termination of TTD benefits under § 8-42-105(3) C.R.S. 2008. Therefore, the court found insurer's admission violated the specific statutory grounds regarding termination of TTD benefits. However, here the insurer's actions in filing an admission, as in Allison, did not violate a statute or rule. We see no principled distinction between Allison and the situation here.
We are further persuaded by the Panel's reasoning in Vaughn v. Monfort Inc., W.C. 4-102-119 (August 27, 1992). In Vaughn, the Panel was faced with a similar dispute concerning an admission of liability for, and payment of, a reduced amount of TTD benefits based on the respondents' assertion that the claimant's injury resulted from a willful violation of a safety rule. The Panel noted that the respondents had admitted for liability at a reduced amount of benefits and had made payment accordingly. Therefore, the Panel found there was no violation of an order, statute or rule and affirmed the ALJ's dismissal of the claimant's request for penalty claims. We see no reason to depart from the reasoning in Vaughn.
The claimant argues that the reduction of benefits in the admission filed here was not in compliance with W.C. Rule of Procedure 6, 7 Code Colo. Reg. 1101-3 at 21. We are not persuaded. As noted by the Director, Rule 6 deals with the modification, termination or suspension of TTD benefits and not the initial admission of TTD benefits at issue here. In contrast, Rule of Procedure 5, 7 Code Colo. Reg. 1101-3 at 12 deals with admissions of liability and revising admissions. The claimant has not argued, nor do we perceive, any violation of Rule 5 by the admission filed by the respondents. To the extent that the claimant asserts an unconstitutional deprivation of due process under the circumstances, he must present his arguments to the judiciary. Kinterknecht v. Industrial Commission, 175 Colo. 60, 485 P.2d 721 (1971); Celebrity Custom Builders v. Industrial Claim Appeals Office, 916 P.2d 539 (Colo.App. 1995). Accordingly, the claimant has failed to establish grounds which afford us a basis to grant appellate relief.
We further note that the provisions for filing admissions under the Act is part of the process to assure quick and efficient delivery of disability and medical benefits to injured workers at a reasonable cost to employers without the necessity of any litigation. Section 8-40-102 C.R.S. 2008. Following the reasoning in Allison an insurer may, with out litigation, admit and pay for benefits that are not in dispute and if necessary a hearing can resolve any disputed benefits.
As the court of appeals in Colorado Compensation Insurance Authority has instructed us, an insurer has no legal duty to admit liability for temporary disability benefits. See Collett v. Pacesetter Corporation W. C. No. 4-414-586 (October 19, 2000). Therefore, unless the admission is contrary to some provision of the Act or rules, such as in terminating admitted TTD benefits, the insurer is not obligated under the Act to admit for the full amount of TTD benefits that the claimant believes he is entitled to. Of course, the claimant is entitled to challenge the admission and litigate the issue of an alleged safety rule violation.
IT IS THEREFORE ORDERED that the ALJ's order issued June 20, 2008 is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ John D. Baird
____________________________________ Thomas Schrant
ERIC PERO, 2601 BELFORD AVE. #69, GRAND JUNCTION, CO, (Claimant)
PNCI CONSTRUCTION, INC., Attn: ANDREW BOSCH, GRAND JUNCTION, CO, (Employer)
PINNACOL ASSURANCE, Attn: HARVEY D FLEWELLING, ESQ., DENVER, CO, (Insurer)
HARRY E COFF, JR., PC, Attn: HARRY E COFF, JR., ESQ., GRAND JUNCTION, CO, (For Claimant)
RITSEMA LYON, PC, Attn: T. PAUL KRUEGGER, ESQ., DENVER, CO, (For Respondents)
PINNACOL ASSURANCE, Attn: ELIZABETH ONG/RENEE LEWIS, ESQ., DENVER, CO, (Other Party)