Opinion
W.C. No. 4-400-162
May 8, 2000
FINAL ORDER
Cambridge Integrated Services Group (the insurer) seeks review of an order of the Director of Workers' Compensation (Director) which required the payment of temporary disability benefits from November 11, 1998 to July 28, 1999. We affirm.
The claimant suffered a work-related injury on November 6, 1998. The insurer filed a Final Admission of Liability dated August 14, 1999, which admitted liability for temporary disability benefits from November 7, 1998 to January 3, 1999, February 15, 1999 to March 28, 1999, and April 19, 1999 to May 16, 1999. Attached to the Admission was a medical report showing the claimant was released to return to regular employment and placed at maximum medical improvement on July 28, 1999.
The Director requested the insurer file an amended admission with documentation supporting the unilateral termination of temporary disability benefits on January 3, 1999, March 28, 1999, and May 16, 1999. However, no amended admission was filed. Under these circumstances, the Director determined that the insurer had failed to provide adequate documentation for the termination of temporary disability benefits as required by the Rules of Procedure, Part IX(C)(1)(a)-(f), 7 Code Colo. Reg. 1101-3 at 34. Consequently, the Director ordered the insurer to pay temporary disability benefits at the admitted rate for the entire period between November 11, 1998 and July 28, 1999, plus interest on all unpaid benefits. The Director also ordered the insurer to show good cause within twenty days of the date of they order, why penalties should not be imposed for the insurer's failure to comply with the applicable rules and statutes for the termination of temporary disability benefits. In the alternative the insurer was afforded twenty days to request a prehearing conference or evidentiary hearing on the issue of penalties. The insurer timely appealed the Director's order, and on February 26, 2000, the insurer filed a response to the Director's good cause order.
The insurer contends that an admission of liability does not automatically entitle the claimant to temporary disability benefits. The insurer also contends the Director has no authority to award benefits without holding an evidentiary hearing. Therefore, the insurer argues the Director abused her discretion and violated due process guarantees by awarding "disputed benefits" without holding an evidentiary hearing. We disagree.
The insurer asserts that the Director's order was an abuse of discretion because the insurer never received the Director's requests for the filing of an amended admission of liability, and the claimant never requested a hearing on the issue of temporary disability benefits. However, the insurer's argument fails to recognize the pertinent issue.
The insurer had no legal duty to admit liability for temporary disability benefits. See Allison v. Industrial Claim Appeals Office, 916 P.2d 623 (Colo.App. 1995). Rather, it was the claimant's burden to prove her entitlement to temporary disability benefits. Lymburn v. Symbios Logic, 952 P.2d 831 (Colo.App. 1997). However, the insurer's admission of liability for temporary disability benefits, is an implicit concession that the claimant is entitled to temporary benefits.
Sections 8-43-203(1)(a), (2)(d), C.R.S. 1999, provide that the insurer must pay benefits "according to admitted liability." Furthermore, § 8-42-105(3), C.R.S. 1999, provides that once the claimant has established an entitlement to temporary disability benefits, benefits "shall continue" until the occurrence of one of the events listed in subsections (a) through (d). Accordingly, once the claimant established that the industrial injury caused a compensable wage loss, the burden shifted to the employer to establish grounds for the termination of benefits. See Atlantic Pacific Insurance Co. v. Barnes, 666 P.2d 163 (Colo.App. 1983) (party seeking to change status quo bears burden of proof). It follows that insofar as the insurer "disputed" the claimant's entitlement to temporary disability benefits for the entire period between January 3, 1999 and July 28, 1999, it was the insurer's duty to request a hearing or establish grounds under the Rules of Procedure for the unilateral termination of benefits. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997); Monfort Transportation v. Industrial Claim Appeals Office, 942 P.2d 1358 (Colo.App. 1997).
Under § 8-47-107 C.R.S. 1999, the Director may adopt reasonable rules and regulations to govern proceedings relative to the Workers' Compensation Act. Within her authority, the Director adopted Rule IX(C)(1), which provides that an insurer may terminate temporary disability benefits without a hearing by filing an admission of liability form with a medical report, written report, certified letter or other documentation which establishes one of the grounds listed in § 8-42-105(3) for the termination of temporary disability benefits.
Where the insurer is unable to proceed without a hearing, Rule IX(D) requires the insurer to file a Petition to Suspend and continue paying benefits until the Petition is adjudicated. Furthermore, Rule IX(H)(2) at 36.01, states that if the Director concludes that the insurer has not met the requirements of Rule IX, she may order the insurer to continue the payment of temporary disability benefits until the requirements of the rule are satisfied or until a hearing is held on a Petition to Suspend.
Accordingly, in Childers v. Noah's Ark Whitewater Rafting, W.C. No. 4-392-209 (April 7, 1999), we rejected an argument that the Director lacks authority to order an insurer to reinstate temporary disability benefits where the Director determines that the insurer has not complied with Rule IX. See also Kesinger v. J.C. Trucking Inc., W.C. No. 4-424-931 (February 2, 2000); Withrow v. Delivery LLC, 4-404-884 (August 13, 1999); Valdez v. Estate of S.G. Deacon, W.C. No. 4-398-418 (June 8, 1999). The insurer's arguments do not persuade us to depart from our conclusions in Childers. Therefore, we conclude that, it was within the Director's authority to order the payment of additional temporary disability benefits pending the insurer's compliance with Rule IX or further order.
Furthermore, we perceive no due process violation. We do not dispute that where an administrative adjudication turns on issues of fact, due process requires that parties be given adequate notice of the pending adjudication in order to present evidence and argument in support of their positions. Hendricks v. Industrial Claim Appeals Office, 809 P.2d 1076 (Colo.App. 1990). However, an evidentiary hearing is not required where there is no disputed issue of material fact and the issue is a matter of law. C.R.C.P. 56(e) ; Service Supply Co. v. Vallejos, 169 Colo. 14, 452 P.2d 387 (1969); Morphew v. Ridge Crane Service, Inc., 902 P.2d 848 (Colo.App. 1995).
Here, the insurer alleges that it paid temporary disability benefits for all periods of time the claimant suffered a wage loss due to the industrial injury. The insurer also contends that it had proper grounds for the unilateral termination of benefits. However, the insurer does not allege that it complied with Rule IX(C)(1) by filing any documentation to support the unilateral termination of temporary disability benefits on January 3, 1999, March 28, 1999 and May 16, 1999. Neither does the record contain any evidence of such documentation. Therefore, there is no dispute of material fact concerning the relevant issue, and the record compels the conclusion that the insurer's unilateral termination of temporary disability benefits on March 28, 1999 and May 16, 1999, did not comply with Rule IX. Consequently, Director did not err in failing to hold an evidentiary hearing prior to ordering the insurer to reinstate temporary disability benefits.
The insurer's factual assertions concerning its lack of notice of the Director's request for an amended admission, and its reasoning for the unilateral termination of temporary disability benefits may be relevant to the issue of penalties. However, the Director's order does not assess any penalties. Neither does the order purport to preclude the insurer from requesting an evidentiary hearing on that issue. Under these circumstances, the insurer's due process rights were not implicated.
To the extent the insurer has additional arguments, they are not persuasive.
IT IS THEREFORE ORDERED that the Director's order dated January 24, 2000, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ David Cain
____________________________________ Kathy E. Dean
NOTICE
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. 1999. 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 decision were mailed May 8, 2000 to the following parties:
Elizabeth Shepherd, 2725 Canossa Dr., Broomfield, CO 80020
Costco Wholesale, 6400 W. 92nd Ave., Westminster, CO 80030
Joe Tracy, Supervisor, Cambridge Integrated Services Group, Inc., P. O. Box 52106, Phoenix, AZ 85072
Roger Fraley, Jr., Esq., 517 E. 16th Ave., Denver, CO 80203 (For Claimant)
Kathleen Mowry North, Esq., 999 18th St., #1600, Denver, CO 80202 (For Respondents)
BY: A. Pendroy