Opinion
W.C. No. 4-814-217.
March 15, 2011.
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Krumreich (ALJ) dated October 19, 2010, that determined the claimant sustained a compensable injury and found certain medical care and referrals to be reasonable and necessary. We affirm.
The claimant testified that on December 23, 2009 as he was unloading a washing machine from a truck for his employer he felt an onset of lower back pain as he was pulling and lifting the machine with a hand-dolly. The claimant testified that on December 31, 2009 he was again loading and unloading trucks at the employer's warehouse and felt a "pop" and burning pain in his right knee.
On January 11, 2010 the claimant met with his supervisor regarding his workplace behavior and was terminated by the supervisor. The claimant, after being advised that he was terminated, told the Field Director for the employer that he had been injured and needed medical care. The Field Director directed the claimant to go to the Concentra Medical Center. The claimant was evaluated at Concentra on January 11, 2010 by Dr. Siemer. Dr. Siemer's assessment was lumbar and right knee strain. Dr. Siemer referred the claimant to Dr. Motz for consultation for the claimant's right knee condition. Dr. Motz' impression was probable meniscal tear and felt it would be reasonable to consider an arthroscopy for diagnostic as well as treatment purposes.
The ALJ found that the claimant sustained compensable injuries to his low back and right knee. The ALJ also found that the claimant had proven by a preponderance of the evidence that the treatment provided by Dr. Siemer, Dr. Motz and their referrals was reasonable and necessary to cure and relieve the claimant's injuries to his low back and right knee. The ALJ specifically found that the arthroscopic surgery recommended by Dr. Motz was reasonable and necessary to cure and relieve the claimant's right knee injury consisting of a torn medial meniscus. The respondents bring this appeal.
I.
The respondents first contend that applicable law and substantial evidence do not support the ALJ's finding that the claimant proved he suffered a compensable injury to his low back and right knee by a preponderance of the evidence. In our view the ALJ did not commit reversible error.
To prove a compensable injury, the claimant had the burden to prove by a preponderance of evidence that his condition arose out of and in the course of his employment. Section 8-41-301(1)(c), C.R.S.; Madden v. Mountain West Fabricators, 977 P.2d 861 (Colo. 1999); Faulkner v. Industrial Claim Appeals Office, 12 P.3d 844 (Colo. App. 2000). The question of whether the claimant met the burden of proof is one of fact for determination by the ALJ. Jefferson County Public Schools v. Dragoo, 765 P.2d 636 (Colo. App. 1988). Because the issue is factual in nature, we must uphold the ALJ's determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. This standard of review requires us to consider the evidence in a light most favorable to the prevailing party, and defer to the ALJ's credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo. App. 2003).
In determining that the claimant suffered a compensable injury the ALJ made detailed findings of fact, which include the following. The claimant, on December 23, 2009, was unloading a washing machine from a truck for his employer when he felt an onset of lower back pain. Tr. (8/4/2010) at 65-66. The claimant believed the pain would get better and continued working without seeking medical treatment. Tr. (8/4/2010) at 66. On December 31, 2009 the claimant was again loading and unloading trucks at the warehouse. Tr. (8/4/2010) at 67-68. The claimant felt a "pop" and burning pain in his right knee. Tr. (8/4/2010) at 67-68. The claimant did not initially seek medical care for his right knee because his supervisor requested that he continue working and that he run a route to Montana for another driver, Majestas, who was unable to run his route due to illness. Tr. (8/4/2010) at 68-70.
The respondents challenged the claimant's testimony, in part by denying that the supervisor had been notified of a back or knee injury. The respondents argued that after the alleged injures the claimant continued to perform his job duties until he was terminated for improper behavior.
However, the ALJ found the testimony of co-workers to be credible and persuasive on this issue. One of the co-workers, Mr. Luna, testified that he became aware that the claimant had been injured in early January 2010 when he contacted the claimant to have the claimant run his route while he was on vacation. Tr. (8/4/2010) at 29. The claimant told Mr. Luna that he would get someone else to cover the route because he had injured his knee. Tr. (8/4/2010) at 29. Mr. Luna believed the claimant had been injured lifting at work. Tr. (8/4/2010) at 30.
The ALJ also credited the testimony of another co-worker, Mr. Majestas. Mr. Majestas testified that he was running a route to Montana in the latter part of December 2009 and early January 2010 when he developed an ear infection and could not run his route. Tr. (8/4/2010) at 44-45. Mr. Majestas reported this to the claimant and asked the claimant to run the route for him. Tr. (8/4/2010) at 44-45. Claimant advised Mr. Majestas that he was injured and "begged" Mr. Majestas to run the route and asked him to call in daily to advise the claimant if he was able to run the route. Tr. (8/4/2010) at 45-46.
On January 11, 2010 the claimant met with his supervisor on a disciplinary issue and was terminated. The claimant talked to the Field Director for the employer and told him he had been injured and needed medical care. Tr. (8/4/2010) at 81-82. The Field Director sent the claimant to Concentra Medical Centers. Tr. (8/4/2010) at 81-82.
On January 11, 2010 saw Dr. Siemer at Concentra. Exhibit 5 at 24. Dr. Siemer obtained a history that the claimant had injured his back and right knee when he was moving appliances. Exhibit 5 at 26. Dr. Siemer prescribed medication, physical therapy for lumbar and right knee strain and placed the claimant on work restrictions. Exhibit 5 at 29. Dr. Siemer assessed the claimant as having lumbar and knee strain. Exhibit 5 at 28.
Dr. Siemer referred the claimant to Dr. Motz for consultation for the claimant's right knee condition. Dr. Motz saw the claimant on February 5, 2010. Exhibit 6 at 39. Dr. Motz' impression was probable meniscal tear of the right knee. Exhibit 6 at 39. Dr. Motz felt it would be reasonable to consider an arthroscopy for diagnostic as well as treatment purposes. Exhibit 6 at 40.
The ALJ determined that the claimant's testimony regarding being injured was supported by the credible and persuasive testimony of Lee Luna and Ted Majestas. As noted above we must defer to the ALJ's credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record. We find no extreme circumstances that would justify our interference with the ALJ's credibility determinations. Further the ALJ's determination is supported by substantial evidence in the medical record, in particular the records of Dr. Motz and Dr. Siemer. We are therefore not persuaded to interfere with the ALJ's determination of compensability.
II.
The respondents next contend that applicable law and substantial evidence do not support the ALJ's finding that the treatment provided by Dr. Siemer and Dr. Motz and their referrals were reasonable and necessary to relieve the claimant from the effects of his low back and right knee injuries. We disagree.
Section 8-42-101(1)(a), C.R.S., requires an employer to furnish reasonable and necessary medical treatment "to cure and relieve the employee from the effects of the injury." See Owens v. Industrial Claim Appeals Office, 49 P.3d 1187, 1188 (Colo. App. 2002). The claimant has the burden of proving entitlement to specific medical benefits. See § 8-43-201(1), C.R.S. 2010; Lutz v. Industrial Claim Appeals Office, 24 P.3d 29, 31 (Colo. App. 2000).
The causation question inherent in this determination is, like all causation questions, one of fact. See Cabela v. Indutrial Claim Appeals Office, 198 P.3d 1277, 1280 (Colo. App. 2008). Furthermore, whether medical treatment is reasonable or necessary is also a question of fact for the ALJ, and the ALJ's determination of this issue must be upheld if supported by substantial evidence. Kroupa v. Industrial Claim Appeals Office, 53 P.3d 1192, 1197 (Colo. App. 2002).
Here, the respondents do not dispute that Dr. Siemer, Dr. Motz and their referrals are authorized treating physicians. Rather, the respondents contend that the claimant did not suffer a compensable injury because there was no causal relationship between the industrial injury and the medical treatment for which he seeks benefits. We have above affirmed the ALJ's determination the claimant sustained compensable injuries to his low back and right knee. Because there is record support for the causal connection between the industrial accidents and the treatment provided by Dr. Siemer and Dr. Motz, it follows that the respondents are liable to pay for any treatment for those conditions. Owens v. Industrial Claim Appeals Office, supra. Therefore, we decline to interfere with the ALJ's determination.
III.
The respondents finally contend that applicable law and substantial evidence do not support the ALJ's finding that the claimant's need for arthroscopic surgery for his right knee is reasonable and necessary. The respondents direct our attention to the testimony of Dr. Primack who testified that the claimant's knee condition would only be work related if the claimant had been providing an accurate history of the incident happening at work. The respondents then cite evidence in the record suggesting that the claimant's testimony might be viewed as inconsistent. However, the respondents' arguments essentially constitute an invitation to reweigh the evidence on review on causation and compensability. As noted above, in our view there was substantial evidence in the medical record and testimony from lay witnesses to support the ALJ's determinations on causation. We have no authority to substitute our judgment for that of the ALJ concerning the sufficiency and probative weight of the evidence and we decline the respondents' invitation to do so. Arenas v. Industrial Claim Appeals Office, 8 P.3d. 558 (Colo. App. 2000); Rockwell International v. Turnbull, 802 P.2d 1182 (Colo. App. 1990). In our view the ALJ relied on substantial evidence in the record and found that the claimant was entitled to arthroscopic surgery for his right knee. Therefore we affirm this award.
IT IS THEREFORE ORDERED that the ALJ's order dated October 19, 2010 is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ John D. Baird
______________________________ Thomas Schrant
DAVID B. CALDWELL, 15186 E JEFFERSON PLACE, AURORA, CO, (Claimant).
RENT-A-CENTER, INC., ENGLEWOOD, CO, (Employer).
FIDELITY GUARANTY, Attn: JOHN MESSNER, C/O: SPECIALTY RISK SERVICES, DENVER, CO, (Insurer).
LAW OFFICES OF DARRELL S. ELLIOTT, Attn: ROBERT F. JAMES, ESQ., DENVER, CO, (For Claimant).
THOMAS, POLLART MILLER, LLC, Attn: BRAD J. MILLER, ESQ., GREENWOOD VILLAGE, CO, (For Respondents).