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A PUBLICATION BY THE LAW FIRM OF Clifton, Mueller & Bovarnick, P.C. ATTORNEYS AT LAW |
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2006 |
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September & October |
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CLOSURE OF OLD CLAIMS WITH OPEN MAINTENANCE CARE
By Cheryl A. Martin |
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Do you have any files that remain open solely to provide medical maintenance care (Grover medical care) but the claimant has not obtained any medical care for a long period of time? Would you like to obtain closure of those claims? There are a couple of solutions available to close this type of claim. Medical benefits awarded after MMI by way of an order or Final Admission of Liability cannot be terminated by filing a Petition to Close and seeking an order based on claimant’s “failure to prosecute” his right to obtain medical care. Respondents are required to provide |
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It happens all the time. You receive information on what seems to be a legitimate time loss claim. You may have less than 20 days to decide whether to electronically file a notice of contest (NOC) or mail a general admission of liability (GAL). In that very limited time frame, with the limited information you have, you mail in the GAL and begin paying TTD. Then, after the GAL is filed, you begin to receive additional information about previous injuries all to the same body part or other information establishing the claim is not compensable! You want to withdraw the GAL. All is not lost. In the recent case of Fuller v. Marilyn Hickey Ministries, Inc., W.C. No. 4-588- |
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benefits that have been awarded and seek modification of the award by filing a Petition to Re-open the issue and then having the issue decided at hearing. Within six years after the date of injury C.R.S. § 8-43-303 permits the director or an administrative law judge to review and reopen any award on the ground of change in condition. If a claimant has been awarded maintenance care but has not accessed it for a substantial period of time, arguably his condition has changed so as not to warrant any further care. In order to obtain an order closing medical benefits, |
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Respondents would have to file an application for hearing and provide evidence at hearing that ongoing maintenance care is no longer reasonable and necessary. This argument may be supported by the mere prolonged absence of such care. In certain cases it may be necessary to obtain a follow up examination and/or an IME to provide medical evidence that claimant has no need for treatment. If the ALJ is persuaded no further care is necessary he would issue an order closing the issue of medical care. |
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675 (September 1, 2006), the Industrial Claim Appeals Office (ICAO) affirmed the ALJ’s order permitting respondents to withdraw their GAL. The ICAO held that Colorado law continues to provide that once liability is admitted, payments must be made according to admitted liability. If respondents improvidently admit liability, they may receive prospective relief from the admission after the matter is litigated before an ALJ. See also Mueller v. State of Colorado, 22nd Judicial District, W.C. No. 4-502-429 (September 26, 2006). In the event of an improvidently filed GAL, respondents’ recourse is to file an application for hearing on the issue of compensability. Even where respondents have filed a GAL, the burden remains on |
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Oops! I Shouldn’t Have Filed that General Admission… By Tiffany L. Scully |
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the claimant to prove a compensable injury. If respondents are successful, they will receive prospective relief from the date the order becomes final. If you have any doubts at all about the compensability of a claim, you should electronically file a notice of contest for further investigation. This will give you additional time to investigate the claim, gather medical records, interview the employer and employee, and make a more fully informed decision as to whether you should admit liability for the claim. Further, ALJ’s consistently impose exorbitant penalties for improperly terminating TTD. If you have any questions, do not hesitate to call CMB for legal advice. |
