Town of Ignacio v. ICAO, 01CA2024 (November 7, 2002): Claimant sustained an admitted work injury to her hand in 1995, had surgeries, and was placed at maximum medical improvement (MMI) in 1996. Her symptoms later worsened and, in February 1998, her surgeon recommended additional treatment and reported that she was no longer at MMI. Claimant's surgeon then retired. Employer voluntarily reopened the claim. Employer referred claimant to another physician, who declined to give a surgical opinion, and instead referred claimant to a hand specialist. The specialist did not recommend a fusion or exploration of the basilar joint, the site of her prior surgeries, but indicated that claimant might consider an exploration if she could not live with her pain. The specialist also stated that claimant had reached MMI in October 1998. Following an evidentiary hearing on claimant's request for a change of physician, the administrative law judge (ALJ) concluded that there was "a conflict among treating physicians" regarding whether claimant had attained MMI after the worsening. The ALJ resolved the conflict by finding that claimant was not at MMI. The ALJ also ordered a change of physician.
Employer sought review of the ALJ's determination that claimant was not at MMI. The court of appeals set aside the order. The court noted that under C.R.S. §§ 8-42-107(8)(b)(I) & (II), if either party disputes an MMI finding by "an" authorized physician, a division-sponsored independent medical examination (DIME) may be requested. Absent a DIME, an ALJ lacks jurisdiction to resolve a dispute, or even a conflict of opinions between multiple authorized treating physicians, concerning an MMI determination.
The court of appeals concluded that the report of the hand specialist, who was "an" authorized treating physician, was ambiguous as to whether claimant had reached MMI because he provided a date of MMI but then stated that claimant might seek additional surgery. The case was remanded for a factual determination as to whether the specialist found claimant to be at MMI. If the specialist placed claimant at MMI, the only way to challenge that determination would be through the DIME process.