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ADVANCE SHEET HEADNOTE

May 18, 2020

2020 CO 41

No. 19SC298, Destination Maternity v. Burren—Workers’ Compensation—

Maximum Medical Improvement.

In this workers’ compensation case, the supreme court considers whether 

an Administrative Law Judge may place a claimant at maximum medical 

improvement (“MMI”) after concluding that an employer or an employer’s insurer 

has overcome the finding of a Division Independent Medical Examination doctor 

that a claimant hasn’t reached MMI. 

The supreme court holds that once an Administrative Law Judge concludes 

that an employer or an employer’s insurer has overcome a Division Independent 

Medical Examination doctor’s MMI opinion, the Administrative Law Judge may 

determine the claimant’s MMI status and permanent impairment rating as 

questions of fact. 

 
The Supreme Court of the State of Colorado

2 East 14th Avenue • Denver, Colorado 80203

2020 CO 41

Supreme Court Case No. 19SC298

Certiorari to the Colorado Court of Appeals

Court of Appeals Case No. 18CA565

Petitioners:

Destination Maternity and Liberty Mutual Insurance Company,

v.

Respondent:

Susan Burren.

Judgment Reversed

en banc

May 18, 2020

Attorneys for Petitioners:

Ruegsegger Simons & Stern, LLC

Michele Stark Carey

Denver, Colorado

Attorneys for Respondent:

Irwin Fraley, PLLC

Roger Fraley, Jr.

Centennial, Colorado 
2

Attorneys for Amicus Curiae Colorado Self Insurers Association:

Hall & Evans, L.L.C.

Douglas J. Kotarek

Matthew J. Hegarty

Denver, Colorado

JUSTICE HOOD delivered the Opinion of the Court.

JUSTICE MÁRQUEZ dissents.
3

¶1 “Maximum medical improvement” (“MMI”) is often a pivotal point in a 

workers’ compensation case. It marks when an injured employee stops receiving 

certain temporary statutory benefits and potentially starts receiving permanent 

disability benefits, the costs of which are borne by employers and their insurers. 

Because of the economic implications for all concerned, MMI can become a legal 

battleground. This case has been fought on that battleground for years now. 

¶2 Susan Burren was injured at work, and she received temporary workers’ 

compensation benefits after her employer admitted liability. Many months 

passed, with many efforts to treat her injuries, but none of her authorized treating 

physicians (“ATPs”) placed her at MMI. Her employer and her employer’s insurer 

sought a second opinion regarding Burren’s MMI status, and Burren subsequently 

underwent a Division Independent Medical Examination (“DIME”). The DIME 

doctor who examined Burren also declined to place her at MMI. The employer

and insurer then challenged the DIME doctor’s opinion under section 

8-42-107(8)(b)(III), C.R.S. (2019), of the Workers’ Compensation Act (“Act”). For 

the reasons discussed below, an administrative law judge (“ALJ”) concluded that 

the employer and insurer had overcome the DIME doctor’s finding. The ALJ then 

placed Burren at MMI with a finding of no permanent impairment, making Burren 

ineligible to receive permanent disability benefits. An administrative panel agreed 

with the ALJ. Burren appealed. 
4

¶3 A division of the court of appeals concluded that the ALJ had no authority 

to place Burren at MMI. Instead, Burren should have been allowed to resume 

treatment with her ATPs until either an ATP or a DIME doctor placed her at MMI. 

The employer and its insurer asked for our review. 

¶4 We reverse. We hold that once an ALJ concludes that an employer or an 

employer’s insurer has overcome a DIME doctor’s MMI opinion under section 

8-42-107(8)(b)(III), the ALJ may determine the claimant’s MMI status and 

permanent impairment rating as questions of fact. 

I. Facts and Procedural History

A. MMI, Permanent Impairment, and the DIME Process 

¶5 The Act provides both medical treatment and disability compensation for 

employees injured in the workplace. Harman-Bergstedt, Inc. v. Loofbourrow, 

2014 CO 5, ¶ 10, 320 P.3d 327, 329. In the parlance of workers’ compensation law, 

these employees are generally referred to as claimants. If an employer or the 

employer’s insurer (for ease of reference, we’ll just refer to them collectively as

“employer”) admits liability, it typically offers a claimant a list of ATPs, who are 

available to provide medical care to the claimant. Williams v. Kunau, 147 P.3d 33, 

36 (Colo. 2006). A claimant might also receive temporary lost-wage benefits. 

Harman-Bergstedt, ¶ 13, 320 P.3d at 330. 
5

¶6 A claimant receives such care and benefits until she reaches MMI, 

§ 8-42-105(3)(a), C.R.S. (2019), the “point in time when any medically determinable 

physical or mental impairment as a result of [workplace] injury has become stable 

and when no further treatment is reasonably expected to improve the condition,” 

§ 8-40-201(11.5), C.R.S. (2019). After reaching MMI, a claimant stops receiving 

temporary disability benefits, and if the injury resulted in permanent medical 

impairment, the claimant begins receiving permanent disability benefits. HarmanBergstedt, ¶ 13, 320 P.3d at 330. 

¶7 Generally, an ATP determines whether a claimant has reached MMI. 

§ 8-42-107(8)(b)(I) (“An authorized treating physician shall make a determination 

as to when the injured employee reaches maximum medical improvement.”). If 

an ATP places the claimant at MMI and “permanent medical impairment has 

resulted from the injury, the [ATP] shall determine a medical impairment rating 

as a percentage of the whole person.” Id. at -107(8)(c). A claimant’s medical

impairment rating dictates how much the claimant will receive in permanent 

disability benefits. Id. at -107(8)(d). 

¶8 But the Act also allows an employer to dispute the ATP’s conclusion. The 

employer may do so by requesting that the claimant undergo a DIME, but only 

when: 

• at least twenty-four months have passed since the date of injury;
6

• a party has requested in writing that an ATP determine whether the 

claimant has reached MMI;

• the ATP has not determined that the claimant has reached MMI; and

• a physician other than the ATP has determined that the claimant has 

reached MMI.

Id. at -107(8)(b)(II)(A)–(D). If the DIME doctor determines that a claimant has 

reached MMI, the doctor “shall also determine the injured worker’s permanent 

medical impairment rating.” Id. at -107(8)(b)(III).

¶9 Because an employer cannot request such an exam until twenty-four 

months after the injury, that exam is known as a “twenty-four-month DIME.” See 

Burren v. Indus. Claim Appeals Office, 2019 COA 37, ¶ 5, __ P.3d __. As the party 

requesting the twenty-four-month DIME, the employer must pay the full cost of 

the exam. § 8-42-107.2(5)(a), C.R.S. (2019). 

¶10 A twenty-four-month DIME doctor’s MMI determination typically controls. 

See City of Manassa v. Ruff, 235 P.3d 1051, 1059 (Colo. 2010) (Martinez, J., dissenting) 

(“The findings of a[] [D]IME physician are all but dispositive.”); Magnetic Eng’g, 

Inc. v. Indus. Claim Appeals Office, 5 P.3d 385, 387 (Colo. App. 2000) (noting that a

DIME doctor’s opinion “has presumptive effect”). However, section 

8-42-107(8)(b)(III) allows a party to overcome the DIME doctor’s “finding 

regarding [MMI] . . . by clear and convincing evidence.” Clear and convincing 

evidence is “stronger than a mere ‘preponderance’; it is evidence that is highly 
7

probable and free from serious or substantial doubt.” Metro Moving & Storage 

Co. v. Gussert, 914 P.2d 411, 414 (Colo. App. 1995). Thus, to carry that burden, an 

employer must produce evidence showing that it’s “highly probable” the DIME

doctor’s MMI determination was incorrect. Id. 

¶11 ALJs “have original jurisdiction to hear and decide all matters arising under 

[the Act].” § 8-43-201(1), C.R.S. (2019). Thus, an ALJ is the arbiter of disputes 

under section 8-42-107(8)(b)(III) and determines whether the appealing party has 

overcome the twenty-four-month DIME doctor’s MMI determination by clear and 

convincing evidence. Magnetic Eng’g, 5 P.3d at 387. 

B. Burren’s Claim

¶12 Burren suffered work-related injuries in September 2014 at her job as the 

manager of a retail clothing store owned by Destination Maternity, her employer. 

Burren testified that she injured herself after installing a steel and Plexiglas shelf 

above her head and moving a fourteen-foot ladder across an uneven floor. She

first reported pain in her right arm and shoulder but later complained of 

additional pain in her neck. She received treatment for those injuries from

multiple ATPs; however, none of her ATPs placed her at MMI. 

¶13 In June 2015, Destination Maternity and its insurer, Liberty Mutual 

Insurance Company (collectively, “Destination Maternity”), hired a third-party 

physician, Dr. Allison Fall, to examine Burren. Dr. Fall concluded that Burren had 
8

not suffered any work-related neck injury and predicted that she would reach 

MMI for her right arm and shoulder injuries “in three to six months.” Dr. Fall also 

noted that Burren’s subjective pain complaints did not “match the injury and the 

objective findings,” and she recommended that Burren “pursu[e] a psychological 

evaluation.” 

¶14 After that appointment, Burren continued to receive medical treatment from 

her ATPs. One of those physicians, Dr. Michael Horner, placed Burren at MMI for 

her neck injury on June 28, 2016. Dr. Fall re-examined Burren about one month 

later, at which point she placed Burren at MMI for her right arm and shoulder 

injuries as of August 9, 2016, with no permanent impairment. Destination 

Maternity then properly petitioned for a twenty-four-month DIME under section

8-42-107(8)(b)(II). 

¶15 The DIME doctor, Dr. Clarence Henke, examined Burren on December 27, 

2016, and he concluded that: (1) Burren suffered work-related injuries to her right 

arm, right shoulder, and neck; and (2) none of those injuries had reached MMI. 

Destination Maternity challenged Dr. Henke’s conclusions under section 

8-42-107(8)(b)(III).

¶16 After a hearing at which both Burren and Dr. Fall testified, the ALJ 

concluded that Destination Maternity produced enough evidence contradicting 
9

the DIME to prove that it’s “highly probable” that Dr. Henke was incorrect. 

Further, the ALJ noted that: 

• Dr. Henke’s examination and report were incomplete, as he proceeded 

“without having numerous relevant and necessary medical records, 

including Dr. Fall’s [second] report”; 

• Dr. Henke “failed to provide any details or analysis as to why [Burren] 

[wa]s not at MMI, or what needs to be done for [her] to reach MMI”; 

• although Dr. Henke recommended that Burren follow-up with one of her 

ATPs for further medical care, he “failed to state what body part [she] 

should follow up with,” and what type of future care she needed 

“despite nearly three years of treatment without any perceived benefit”; 

and

• Dr. Henke failed to provide an impairment rating, “a required step in the 

DIME process.” 

The ALJ also found that Burren’s testimony that no medical treatment provided 

her relief, her “ambivalence” about continued treatment, her “exaggerated” 

reports of pain and symptoms, and her refusal to undergo a psychological exam, 

“undermine[d] [Burren’s] credibility concerning the presence of an actual injury.” 

The ALJ concluded that Destination Maternity had overcome the DIME doctor’s 

conclusions by clear and convincing evidence, and the ALJ placed Burren at MMI 

for her workplace injuries as of June 28, 2016, with no permanent impairment.1 

1 It’s somewhat unclear whether the ALJ placed Burren at MMI as of June 28, 2016,

for all of her workplace-related injuries or only her cervical spine injury. In her 

initial order, the ALJ placed Burren at MMI but required Burren to attend a 
10

¶17 Burren appealed the ALJ’s decision to the Industrial Claim Appeals Office

(“ICAO”). She argued that because none of her ATPs, nor the DIME doctor, placed 

her at MMI for all of her workplace injuries, the ALJ lacked authority to do so.

2 

Burren further asserted that because neither the ATPs nor the DIME doctor placed 

her at MMI, those physicians couldn’t calculate her permanent impairment rating; 

therefore, the ALJ erred by interpreting that lack of rating as an indication that 

Burren suffered no permanent impairment from her injuries. 

psychological exam to “evaluate whether any further treatment is related to or 

reasonably necessary to cure and relieve [Burren] from the effects of her right 

upper extremity injuries.” Burren challenged that portion of the order as 

contradicting the ALJ’s finding that Burren reached MMI. The ALJ thereafter 

issued a supplemental order removing that requirement for further treatment and 

concluding that “[Burren] reached MMI as of June 28, 2016, and without 

permanent impairment,” but noting that “[a]s a result, [Burren] does not require 

any further treatment with regard to her cervical spine.” (Emphasis added.) The ALJ 

also retained language in the supplemental order that Dr. Fall credibly testified 

that Burren reached MMI without impairment for her right arm and shoulder 

injuries and that Burren’s cervical spine injury wasn’t workplace related. Thus, 

the scope of the ALJ’s MMI determination remains slightly ambiguous. 

2 Although Dr. Horner placed Burren at MMI for her neck injury on June 28, 2016, 

Burren contends that a claimant’s MMI date isn’t divisible—different injuries 

arising from the same workplace incident cannot be assigned different MMI dates. 

Burren points to Paint Connection Plus v. Indus. Claim Appeals Office, 240 P.3d 429, 

433 (Colo. App. 2010), which says as much. But this issue is not within the scope 

of the question on which we granted certiorari review; therefore, we do not 

address it. 
11

¶18 The ICAO panel concluded that, even if a claimant’s ATPs and a twentyfour-month DIME doctor agree the claimant isn’t at MMI, once an ALJ determines 

that an employer has overcome the DIME doctor’s opinion, the ALJ must

determine the claimant’s MMI status and permanent impairment rating as a 

question of fact. Burren v. Destination Maternity, W.C. No. 4-962-740-06, 2018 WL 

1403659, at *5 (Colo. I.C.A.O. Mar. 15, 2018). The panel noted that an appellate 

court will uphold an ALJ’s factual findings that are supported by substantial 

evidence in the record. Id. at *3. And the panel concluded that substantial 

evidence (“namely the opinions of Dr. Fall and Dr. Horner”) supported the ALJ’s 

finding that Burren reached MMI on June 28, 2016, with no permanent 

impairment.

3 Id. at *4. 

¶19 A division of the court of appeals reversed the ICAO’s decision. Burren, 

¶ 1. The division concluded that an ALJ may only determine MMI as a question 

of fact when the ATP and the DIME doctor disagree regarding a claimant’s MMI 

status. Id. In the absence of such disagreement, “treatment should continue until 

3 The ICAO interpreted the ALJ’s supplemental order as placing Burren at MMI 

for all her workplace-related injuries on June 28, 2016. Burren didn’t challenge 

whether the record supports that finding by the ICAO. Nor did she ask this court 

to determine whether substantial evidence supports the ALJ’s finding that she 

reached MMI on June 28, 2016. Thus, neither of these issues is before the court 

today, and we decline to review whether the record supports a June 28, 2016, MMI 

date. 
12

either the DIME or the ATP places the claimant at MMI.” Id. at ¶ 19. The division 

thus concluded that once the DIME physician found Burren was not at MMI, she 

“should have been returned to the ATP for continued treatment.” Id. at ¶ 18. 

¶20 We granted Destination Maternity’s petition for certiorari review.4

II. Analysis

¶21 We begin with the standard of review, then examine (1) the authority of an 

ALJ under the plain language of the Act generally and under the plain language 

of section 8-42-107(8)(b)(III) specifically, (2) the ICAO’s interpretation of section 

8-42-107(8)(b)(III), and (3) the General Assembly’s evident intent in adding the 

twenty-four-month DIME provision. In doing so, we conclude that once an ALJ 

decides an employer has overcome a DIME doctor’s opinion, the ALJ may 

determine the claimant’s MMI status and permanent impairment rating as 

questions of fact. 

4 We granted certiorari to review the following issue:

Whether the court of appeals erred in holding that an administrative 

law judge cannot determine when an injured worker has reached 

maximum medical improvement when neither an authorized treating 

physician nor a division independent medical examiner has placed an 

injured worker at maximum medical improvement, despite the plain 

language of section 8-42-107(8)(b)(III), C.R.S. (2019), which permits 

the finding(s) of a division independent medical examiner to be 

overcome by clear and convincing evidence. 
13

A. Standard of Review

¶22 “We review the proper construction of statutes de novo.” Williams, 147 P.3d

at 36. When interpreting a statute, the reviewing court “must determine and put

into effect the intent of the legislature.” Davison v. Indus. Claim Appeals Office, 

84 P.3d 1023, 1029 (Colo. 2004). We “‘give considerable weight to an agency’s 

interpretation of its own enabling statute’; however, we set aside actions or 

interpretations that are clearly erroneous, arbitrary, or otherwise not in accordance 

with the law.” Id. (quoting Colo. Dep’t of Labor & Emp’t v. Esser, 30 P.3d 189, 193

(Colo. 2001)).

B. Whether an ALJ Can Determine MMI Status

¶23 Burren contends that in this context only ATPs and DIME doctors are 

statutorily authorized to place a claimant at MMI. Under Burren’s interpretation, 

even if an employer overcomes a DIME doctor’s opinion that a claimant isn’t at 

MMI, the ATP’s existing finding that a claimant hasn’t reached MMI remains fully 

intact. And ALJs are powerless to overrule an ATP and conclude otherwise. 

¶24 Destination Maternity asserts that once an ALJ concludes that an employer 

has overcome the DIME doctor’s finding that a claimant isn’t at MMI, the ALJ can 

determine the claimant’s MMI status as a question of fact. 

¶25 As always, in resolving such a dispute, we start with the language and 

structure of the statutory scheme in question. We begin by widening our lens and 
14

looking at the authority of ALJs under the Act generally before narrowing our 

focus to the language of section 8-42-107(8)(b)(III) specifically. 

1. ALJs’ Authority Under the Act

¶26 The Act empowers ALJs to “decide all matters arising under [the Act].” 

§ 8-43-201(1) (emphasis added). It also authorizes ALJs to make “evidentiary 

rulings” and issue “orders” as required “[i]n connection with hearings.”

§ 8-43-207(1)(c), (k), C.R.S. (2019); see § 8-40-201(15) (defining “order” to include 

“any decision . . . or other determination arrived at by [an ALJ]”). Whether a party 

has overcome a twenty-four-month DIME doctor’s opinion regarding a claimant’s 

MMI status is therefore a question of fact for the ALJ as the “sole arbiter of 

conflicting medical evidence.” Davison, 84 P.3d at 1031; Magnetic Eng’g, 5 P.3d at 

387.

¶27 Before an ALJ concludes that an employer has overcome the DIME doctor’s 

opinion, conflicting evidence regarding whether a claimant has reached MMI must 

exist. After all, the clear-and-convincing-evidence standard requires an employer 

to prove that it’s highly probable the DIME doctor’s MMI opinion is incorrect. 

Metro Moving, 914 P.2d at 414. “[I]f a factual issue arises as to the attainment of 

MMI, then the ALJ must resolve that issue.” Monfort Transp. v. Indus. Claim Appeals 

Office, 942 P.2d 1358, 1360 (Colo. App. 1997). And a resolution of those conflicting 

opinions requires the ALJ to determine which physician is correct: the DIME 
15

doctor who didn’t place the claimant at MMI or the third-party physician who did. 

See Postlewait v. Midwest Barricade, 905 P.2d 21, 24 (Colo. App. 1995) (noting that an

ALJ is not bound to credit any one physician’s opinion regarding MMI when 

weighing the sufficiency of medical evidence under section 8-42-107(8)(b)(III)). 

Therefore, it’s within the ALJ’s power as the arbiter of evidentiary disputes in 

DIME dispute hearings to determine whether an injured employee has reached 

MMI.5 

¶28 Contrary to the division’s opinion below, an ALJ’s statutory power to render 

evidentiary decisions does not disappear merely because the ATP and the DIME 

doctor agree that a claimant hasn’t reached MMI. The court of appeals concluded 

that when “there is no conflict between the ATP’s and DIME physician’s opinions 

. . . there [i]s no conflict [in medical opinions] for the ALJ to resolve.” Burren, ¶ 15. 

But the statute expressly injects the opinions of third-party physicians into the 

twenty-four-month DIME process: Before an employer may request a twenty-four5 We note that subsection (8)(b)(III) doesn’t only address situations where a DIME 

doctor has placed an employee at MMI. The statute provides parties an 

opportunity to challenge a DIME doctor’s “finding regarding [MMI].” 

§ 8-42-107(8)(b)(III) (emphasis added). “Regarding” simply means “with respect 

to : concerning.” Merriam-Webster Dictionary, https://www.merriamwebster.com/dictionary/regarding; [https://perma.cc/2UJ9-EDNZ]. Thus, 

subsection (8)(b)(III) applies whether the DIME doctor found the employee at 

MMI or not at MMI.
16

month DIME, a third-party physician must have placed the claimant at MMI. 

§ 8-42-107(8)(b)(II)(D). And if the employer presents the opinion of a third-party 

physician when it invokes the twenty-four-month DIME process, nothing in the 

statute prevents the ALJ from considering that opinion. Mosley v. Indus. Claim 

Appeals Office, 78 P.3d 1150, 1153 (Colo. App. 2003) (noting that an ALJ is “free to 

consider the other medical evidence” concerning a claimant’s MMI status). 

¶29 Accordingly, if an employer overcomes a twenty-four-month DIME

doctor’s MMI opinion, an ALJ may determine an employee’s MMI status as a 

question of fact. 

2. The ICAO’s Interpretation of Section 8-42-107(8)(b)(III)

¶30 The ICAO has interpreted section 8-42-107(8)(b)(III) to allow ALJs to 

determine an employee’s MMI status as a question of fact after an employer 

overcomes the twenty-four-month DIME doctor’s MMI determination, even if both 

the DIME doctor and the employee’s ATPs agree that the employee hasn’t reached 

MMI. McFadden v. Sun Health Care, W.C. No. 4-710-119, 2011 WL 737114 (Colo. 

I.C.A.O. Feb. 25, 2011). 

¶31 In McFadden, the employer and the insurer requested a DIME after none of 

the ATPs placed the employee at MMI. Id. at *1. The DIME doctor agreed with 

the ATPs and found that the employee wasn’t at MMI; however, the employer and 

insurer challenged the DIME doctor’s opinion under subsection (8)(b)(III), 
17

presenting evidence by a third-party physician that the claimant had reached 

MMI. Id. at *1–2. The ALJ concluded that the employer and insurer had overcome 

the DIME doctor’s findings by clear and convincing evidence and placed the 

claimant at MMI, crediting the employer’s third-party physician’s testimony. Id.

¶32 The ICAO upheld the ALJ’s decision. Id. at *3. Like the panel that reviewed 

Burren’s claim, the McFadden panel approved: (1) the ALJ’s reliance on a thirdparty physician’s testimony regarding the employee’s MMI status, id. at *2; and 

(2) the ALJ’s decision to place the claimant at MMI even though neither the DIME 

doctor nor the ATP had placed the employee at MMI, id. at *2–3. Thus, McFadden

supports allowing an ALJ to place a claimant at MMI as part of the DIME dispute 

process, even if a third-party physician is the only doctor who found the employee

at MMI. 

¶33 Because the ICAO administers the Act, this court defers to its reasonable 

statutory interpretations. Pinnacol Assurance v. Hoff, 2016 CO 53, ¶ 26, 375 P.3d 

1214, 1220. And since the McFadden panel’s interpretation of section 8-42-107(8)(b) 

reasonably aligns with the plain language and structure of the Act, we defer to it 

today.6 

6 Burren asserts that McFadden doesn’t represent the ICAO’s interpretation of 

section 8-42-107(8)(b), because the employee only challenged whether the ALJ’s 

decision was supported by substantial evidence, not the ALJ’s interpretation of 
18

3. The Legislature’s Intent in Adding the Twenty-Four-Month DIME 

Provisions

¶34 Finally, by adding the twenty-four-month DIME provisions in section 

8-42-107(8)(b)(II) and (III), the legislature contemplated the need for ALJs to 

resolve an employee’s MMI status at a “hearing” in cases such as Burren’s. The 

division’s holding would impede that legislative goal. 

¶35 Originally, the Act allowed only ATPs to place an employee at MMI. See 

Ch. 112, sec. 1, § 8-42-107(8)(b), 1996 Colo. Sess. Laws 456, 456–57. If an ATP 

refused to do so, the Act did not provide employers the opportunity to obtain a 

second opinion from a neutral, division-sponsored physician. But in 1996 the 

General Assembly added the twenty-four-month DIME provisions in section 

8-42-107(8)(b). See 1996 Colo. Sess. Laws at 457. The legislature also amended 

section 8-42-107(8)(b)(III) to allow employers to overcome a DIME doctor’s 

opinion by clear and convincing evidence, thus indicating that section 

8-42-107(8)(b) should function to ensure that employers and insurers receive an 

section 8-42-107(8)(b). True, the employee in McFadden simply argued that the ALJ 

erred in finding that the employer overcame the DIME doctor’s opinion by clear 

and convincing evidence. 2011 WL 737114, at *2. But if the McFadden panel hadn’t

construed section 8-42-107(8)(b) to permit an ALJ to credit, over the contrary 

opinions of an ATP and a DIME doctor, a third-party physician’s testimony that 

an employee has reached MMI, it wouldn’t have upheld the ALJ’s order. 
19

accurate second opinion. See 1996 Colo. Sess. Laws at 457. The division’s holding

severely limits the remedial power of these provisions. 

¶36 The division relied on this court’s decision in Williamsto hold that a claimant

must return to the ATP for continued treatment if the ATP and DIME doctor agree 

that the claimant isn’t at MMI. Burren, ¶¶ 17–18. But in Williams, the employer 

did not challenge the DIME doctor’s MMI opinion. 147 P.3d at 34–35. Thus, the 

DIME doctor’s determination that the claimant hadn’t reached MMI retained its 

presumptive effect. Magnetic Eng’g, 5 P.3d at 387. Here, Destination Maternity not 

only challenged but overcame the DIME doctor’s opinion by clear and convincing 

evidence. Therefore, Williams is inapposite. 

¶37 The division recognized that its “interpretation of the statute effectively 

precludes an employer’s ability to challenge a twenty-four-month DIME when the 

DIME agrees with the ATP that a claimant is not at MMI.” Burren, ¶ 19. The 

division justified its holding by noting that “prior to the addition of section 

8-42-107(8)(b)(II) in 1996, employers were at the mercy of ATPs and had no 

recourse to challenge perpetual care; treatment simply continued until an ATP 

placed the claimant at MMI.” Id.

¶38 While the division’s observation is correct, its holding fails to give full effect 

to the statutory amendments. First, the division’s approach returns the claimant 

to the ATP for continued treatment, even though the legislature added the twenty-
20

four-month DIME provision to prevent unending care by an ATP when conflicting

medical evidence indicates the claimant has reached MMI and two years have 

passed since the date of injury. See 1996 Colo. Sess. Laws at 457. And, just as the 

division noted, it would essentially prevent employers from challenging a DIME

doctor’s determination that a claimant isn’t at MMI if the ATP also found the 

claimant isn’t at MMI. Yet courts should avoid statutory constructions that would 

render certain provisions “without practical effect.” Howard v. People, 2020 CO 15, 

¶ 13, 458 P.3d 893, 897 (quoting Roberts v. Bruce, 2018 CO 58, ¶ 9, 420 P.3d 284, 286). 

Therefore, we avoid such a construction here.

¶39 The division also proposed an alternate solution for employers in this 

situation—“reinvok[e] the twenty-four-month DIME process at an appropriate 

time in the future.” Burren, ¶ 19. This suggestion might allow employers to obtain 

a more accurate second opinion regarding an injured employee’s MMI status, as it 

would permit the appointment of a new DIME doctor. But nothing in subsection 

(8)(b)(III) indicates that an employer should be forced to reinvoke the twenty-fourmonth DIME process if it has already overcome the original DIME doctor’s MMI 

determination. Had the legislature intended the twenty-four-month DIME 

process to function in that manner, it could’ve said so. It did not, and “[w]e do not

add words to the statute.” People v. Diaz, 2015 CO 28, ¶ 12, 347 P.3d 621, 624

(quoting Turbyne v. People, 151 P.3d 563, 567 (Colo. 2007)). Moreover, the division’s 
21

suggestion could have the effect of placing employers on a kind of MMI hamster 

wheel, where they might repeatedly reinvoke the twenty-four-month DIME 

process without resolution. The language and structure of the statute don’t 

support a construction that yields that potential outcome.

C. Whether an ALJ Can Determine Permanent Impairment 

¶40 Burren also argues that we shouldn’t allow an ALJ to place an employee at 

MMI on these facts because of the effect on a claimant’s permanent impairment 

rating. More pointedly, Burren contends that only an ATP or a DIME doctor can 

determine a claimant’s permanent impairment rating, and those physicians cannot 

provide that rating until placing the claimant at MMI. Thus, allowing an ALJ to 

place a claimant at MMI in such cases and then determine a claimant’s permanent 

impairment would deprive claimants of their statutory right to an ATP- or DIME

doctor-approved rating and force injured employees to undertake the financially 

burdensome task of presenting their own evidence regarding permanent 

impairment. 

¶41 We disagree. First, the Act doesn’t specify that only ATPs and twenty-fourmonth DIME doctors may determine a claimant’s permanent impairment rating. 

ATPs and DIME doctors may calculate a claimant’s impairment rating. See 

§ 8-42-107(8)(b)(III), (c). But so too may any other level-II-accredited physician. 
22

§ 8-42-101(3.6)(b), C.R.S. (2019); § 8-42-107(8)(c).7 And a level-II-accredited 

physician may participate in a workers’ compensation case without serving as one 

of the employee’s ATPs or as a DIME doctor. For example, Dr. Fall (the third-party 

physician hired by Destination Maternity to examine Burren) is a level-IIaccredited physician and thus qualified to determine Burren’s impairment rating. 

Yet Dr. Fall served as neither an ATP nor a twenty-four-month DIME doctor in 

this case. So, we reject Burren’s contention that we should not allow an ALJ to 

place a claimant at MMI and then address the employee’s impairment rating in 

cases like this one. 

¶42 We also reject Burren’s assertion that allowing an ALJ to determine a

claimant’s impairment rating under these circumstances forces an injured

employee to undertake the financially burdensome task of producing evidence of 

impairment from a third-party physician. Both the Act and the procedures of the 

Division of Workers’ Compensation (the “DWC”) include safeguards that prevent 

such an outcome. Notably, the statute doesn’t require that an ATP or a twentyfour-month DIME doctor first place an employee at MMI before calculating the 

7 The accreditation system functions to “provide physicians with an 

understanding of the administrative, legal, and medical roles and . . . is accessible 

to every licensed physician, with consideration of specialty and geographic 

diversity.” § 8-42-101(3.6)(e).
23

employee’s permanent impairment rating. True, if an ATP or DIME doctor 

determines that a claimant has reached MMI, then that physician must determine 

the claimant’s impairment rating. § 8-42-107(8)(b)(III), (c). But nothing in the 

statute prevents an ATP or DIME doctor from providing a provisional rating for 

the ALJ to consider at a DIME dispute hearing.8

¶43 In fact, the DWC specifically directs twenty-four-month DIME doctors to 

address impairment if requested by the parties, even if the DIME doctor determines 

the claimant hasn’t reached MMI. Colo. Dep’t of Labor & Emp’t, Div. of Workers’ 

Compensation Desk Aid #11—Impairment Rating Tips: DIME Panel Physician 

Notes, 14 (“Remember that a DIME is a legal/medical proceeding and you are 

being asked to provide specific information. If the party requesting the DIME has 

8 Burren cites court of appeals caselaw that she contends requires an ATP or DIME 

doctor to first place the employee at MMI before rating the claimant’s permanent 

impairment. See Dziewior v. Mich. Gen. Corp., 672 P.2d 1026, 1030 (Colo. App. 1983) 

(noting that “permanent disability generally cannot be determined until the 

authorized physicians treating a claimant for work-related injuries advise that 

they can do nothing further for the claimant”); accord MGM Supply Co. v. Indus. 

Claim Appeals Office, 62 P.3d 1001, 1005 (Colo. App. 2002). However, the court of 

appeals decided Dziewior before the General Assembly amended section 

8-42-107(8)(b) to include the twenty-four-month DIME dispute provisions, and 

nothing in the Act prevents a DIME doctor from providing a provisional 

impairment rating. Accordingly, we decline to interpret section 8-42-107(8)(b) to 

prevent DIME doctors from providing provisional ratings. 
24

asked that impairment be addressed, and if you find the patient not at MMI for that workrelated injury, you should nevertheless provide a rating for that injury.”). 

¶44 Here, the DWC directed Dr. Henke, the twenty-four-month DIME doctor 

who examined Burren, to address permanent impairment. Thus, Dr. Henke 

should have provided Burren with a provisional impairment rating that she could

have introduced at the DIME dispute hearing. Although Dr. Henke failed to 

provide the rating as requested by Destination Maternity, the DWC again offered 

both parties the opportunity to solicit a provisional rating from Dr. Henke. In the 

Division’s letter to Burren notifying her that Dr. Henke did not place her at MMI, 

the Division stated: “If the physician did not provide a rating, and either or both 

parties desire that a rating (for informational purposes) be provided, please 

convey your request to the [Independent Medical Examination] Unit and we will 

forward it to the physician.” 

¶45 Thus, neither the Act nor the DWC’s procedural rules prevented Burren 

from obtaining a DIME doctor-approved provisional rating, free of charge to her. 

Burren simply elected not to do so. 

¶46 We therefore decline to deprive ALJs of their authority to place an employee 

at MMI because of the effect on an employee’s permanent impairment rating. 

Once an ALJ determines an employee has reached MMI, the employee’s 
25

permanent impairment rating becomes a question of fact that the ALJ can resolve 

after considering any conflicting medical evidence regarding impairment.

9 

III. Conclusion

¶47 We reverse the judgment of the court of appeals and remand this case to the 

court of appeals for further proceedings consistent with this opinion. 

JUSTICE MÁRQUEZ dissents.

9 Burren also argues that she never received notice that the ALJ would address her 

permanent impairment rating at the DIME dispute hearing, and this deficiency 

deprived the ALJ of jurisdiction to address impairment. However, Burren didn’t 

raise this argument in her petition to review the ALJ’s order or in her appeal to the 

ICAO. Accordingly, Burren waived her right to challenge the ALJ’s order on this 

ground. See Bermel v. BlueRadios, Inc., 2019 CO 31, ¶ 18 n.4, 440 P.3d 1150, 1154 n.4 

(declining to address an argument because the party “failed to raise this argument 

before the lower courts,” so the “issue [was] not properly presented for our 

consideration”).
1

JUSTICE MÁRQUEZ, dissenting.

¶48 Where an employer-selected authorized treating physician (“ATP”) and a 

Division Independent Medical Examination (“DIME”) physician reach opposite 

conclusions about whether a claimant has reached maximum medical 

improvement (“MMI”) for a work-related injury, I agree that an administrative 

law judge (“ALJ”) may resolve the conflict as a factual matter by crediting one 

physician’s determination over the other. But where both the ATP and DIME 

physician conclude that a claimant has not reached MMI, I disagree that the 

Workers’ Compensation Act authorizes the ALJ to conclude otherwise based on 

the opinion of an employer-retained third-party physician. 

¶49 In construing the Act to reach a contrary result, the majority upsets the 

careful balance between employee and employer rights struck by the legislature 

and effectively gives employers yet a third bite at the apple to establish that a 

claimant has reached MMI. The majority also gives deference to a nonbinding

Industrial Claim Appeals Office (“ICAO”) ruling that contains no statutory 

analysis whatsoever. Even more troubling, the record here simply does not 

support an MMI date of June 28, 2016, for all of the claimant’s workplace injuries. 

No doctor—not even the employer-hired third-party physician—opined that the 

claimant had reached MMI for her arm and shoulder injuries as of that date. 
2

¶50 I would affirm the court of appeals and hold that the Act does not authorize 

an ALJ to find MMI where neither an ATP nor a DIME physician has placed the 

claimant at MMI. Like the court of appeals, I conclude that nothing prevents an 

employer from reinvoking the twenty-four-month DIME process, and thus, 

employers still have avenues to challenge a claimant’s ongoing treatment. But 

unlike the majority, I would not read into the Act a remedy that the legislature did 

not provide for the relatively rare situation presented here. Because I disagree 

with the majority’s construction of the Act, and because the record does not 

support the June 28, 2016 MMI date in any event, I respectfully dissent.

I. Facts and Procedural History

¶51 Susan Burren sustained work-related injuries to her neck, arm, and shoulder 

in September 2014. Burren received treatment from several ATPs, none of whom 

placed her at MMI. Destination Maternity retained a third-party physician, Dr. 

Allison Fall, to examine Burren. On June 24, 2015, Dr. Fall opined that Burren was 

not at MMI, but she anticipated that Burren would reach MMI “in three to six 

months.” 

¶52 On June 28, 2016, one of Burren’s ATPs, Dr. Homer, placed Burren at MMI 

for her cervical spine injury only, but no ATP placed Burren at MMI for her other 

injuries; consequently, no ATP assigned her an overall MMI status or a permanent 

impairment rating.
3

¶53 Dr. Fall examined Burren a second time on August 9, 2016. At that time, Dr. 

Fall opined that Burren had reached MMI with no permanent impairment. 

¶54 Several weeks after receiving Dr. Fall’s opinion, Destination Maternity 

requested a twenty-four-month DIME under section 8-42-107(8)(b)(II), C.R.S. 

(2019), because no ATP had placed Burren at MMI for all of her injuries for over 

two years. The DIME physician, Dr. Clarence Henke, agreed with Burren’s ATPs 

that Burren had not reached MMI.

¶55 Unsatisfied, Destination Maternity requested a hearing to overcome the 

DIME physician’s finding. At that hearing, Dr. Fall criticized the DIME report and 

testified that Burren had not suffered a work-related injury to her cervical spine. 

Dr. Fall did not modify the findings in her June 2015 or August 2016 reports 

regarding MMI. 

¶56 Following the hearing, the ALJ concluded that Destination Maternity had 

overcome the DIME’s findings by clear and convincing evidence. Notably, in its 

November 22, 2017 supplemental order, the ALJ incorrectly stated that Dr. Fall 

opined that Burren was at MMI as of June 24, 2015: “On June 24, 2015, Allison Fall, 

M.D., performed a second Respondents sponsored [examination]. Dr. Fall 

reported that [Burren] was at MMI without impairment, and that there was no 

work-related injury to [Burren]’s cervical spine.” In fact, Dr. Fall’s reports reflect 

that she did not conclude that Burren was at MMI until August 9, 2016. 
4

¶57 In the conclusions of law portion of the order, the ALJ noted that “[t]he 

determination of MMI must be made by an authorized treating physician. 

§ 8-42-107(8)(b)(I),” and concluded “that [the ATP] placed [Burren]’s cervical spine 

injury at MMI on June 28, 2016, with no impairment.” (Emphasis added.) 

¶58 The ALJ ultimately concluded that Destination Maternity had overcome the 

DIME report by clear and convincing evidence. Regarding MMI, the ALJ 

concluded that “[Burren] reached MMI as of June 28, 2016, and without permanent 

impairment. As a result, [Burren] does not require any further treatment with 

regard to her cervical spine.”1 (Emphasis added.)

¶59 Burren petitioned for ICAO review, contending that the ALJ erred in finding 

her at MMI and assigning her a permanent impairment rating when no ATP or 

DIME had found that she had reached MMI or assigned her an overall permanent 

impairment rating. Burren also argued that the ALJ erred by finding she was at 

MMI for only one of her three injuries, noting that the court of appeals has long 

1 The ALJ’s reference to Burren’s cervical spine injury was not accidental. In its 

initial order issued July 27, 2017, the ALJ expressly concluded that further 

evaluation was necessary “to evaluate whether any further treatment is related to 

or reasonably necessary to cure and relieve [Burren] from the effects of her right 

upper extremity injuries.” Although this language regarding potential further 

treatment of Burren’s shoulder and arm does not appear in the November 2017 

supplemental order, the ALJ’s finding of MMI refers only to Burren’s cervical 

spine both in the original order and the supplemental order.
5

held that the Workers’ Compensation Act contains no provision for “partial” MMI. 

See Paint Connection Plus v. Indus. Claim Appeals Office, 240 P.3d 429, 433 (Colo. 

App. 2010). 

¶60 The ICAO panel affirmed the ALJ’s order. In so doing, it agreed with Burren 

that “MMI is not divisible and cannot be parceled out among the various 

components of a multi-faceted industrial injury,” but concluded “that is not what 

the ALJ did here.” Burren v. Destination Maternity, W.C. No. 4-962-740-06, 2018 WL 

1403659, at *4 (Colo. I.C.A.O. Mar. 15, 2018). Instead, the panel reasoned, the ALJ 

had found Burren was at MMI as of June 28, 2016, for all of her work-related 

injuries based on the opinions of Dr. Fall and the ATP:

The ALJ essentially adopted the opinions of . . . Dr. Fall and [the ATP],

that the claimant reached MMI for all of her industrial injuries as of 

June 28, 2016 . . . . [S]ince the ALJ’s finding regarding the [June 28, 

2016] MMI date is supported by substantial evidence, namely the 

opinions of Dr. Fall and [the ATP], we have no basis to set aside the 

ALJ’s supplemental order on this ground. . . .

Again, relying upon the opinions of Dr. Fall, the ALJ here found that 

the claimant was at MMI for all her industrial injuries on June 28, 

2016, with no impairment. 

Id. at *4–5. 

¶61 The ICAO panel reached this conclusion, even though

• the ATP placed Burren at MMI as of June 28, 2016, for her cervical 

spine injury only;

• the ALJ’s order finds MMI only with respect to Burren’s cervical spine 

injury, not all her injuries;
6

• no doctor opined that Burren reached MMI as of June 28, 2016, for her 

shoulder and arm injuries; and 

• Dr. Fall did not place Burren at MMI for her injuries until August 9, 

2016.

¶62 Burren appealed, and the court of appeals set aside the panel’s order, 

concluding that section 8-42-107(8)(b)(II) of the Act does not permit an ALJ to 

determine MMI when neither an ATP nor a DIME physician has placed the injured 

worker at MMI. Burren v. Indus. Claim Appeals Office, 2019 COA 37, ¶¶ 1, 20, 

__ P.3d __. Having concluded that the panel misinterpreted section 

8-42-107(8)(b)(II), the court of appeals did not address whether substantial 

evidence supported the ALJ’s findings of fact. Id. at ¶ 20.

II. Analysis 

¶63 Understood in context, section 8-42-107(8)(b)(III) allows a claimant to seek to

overcome a twenty-four-month DIME doctor’s “finding regarding maximum 

medical improvement and permanent medical impairment” by clear and 

convincing evidence. As such, the provision provides the injured worker with a 

response to the employer’s second bite at the MMI apple (the twenty-four-month 

DIME process) when an employer-selected ATP has failed to find that the injured 

worker has reached MMI but the DIME concludes that she has. But section 

8-42-107(8)(b)(III) does not provide employers with yet a third bite at the MMI 

apple by authorizing the ALJ to make a finding that the claimant has reached MMI 
7

based on the opinion of an employer-hired third-party physician where both the 

ATP and the DIME physician have concluded otherwise. 

¶64 Thus, I disagree with the majority’s interpretation of the Act. But I also 

believe the record before us does not support the June 28, 2016 MMI date upheld 

by the majority in any event. 

A. Section 8-42-107(8) and Determination of MMI

¶65 The declared purpose of the Workers’ Compensation Act is to “assure the 

quick and efficient delivery of disability and medical benefits to injured workers 

at a reasonable cost to employers, without the necessity of any litigation.” 

§ 8-40-102(1), C.R.S. (2019). “The Act is remedial and beneficent in purpose and 

should be liberally construed to accomplish its humanitarian purpose of assisting 

injured workers and their families.” Williams v. Kunau, 147 P.3d 33, 38 (Colo. 2006). 

¶66 As the majority correctly observes, maj. op. ¶¶ 5–6, a claimant under the Act 

receives both medical treatment and temporary disability benefits until the worker 

reaches MMI, § 8-42-105(3)(a), C.R.S. (2019), or the “point in time when any 

medically determinable physical or mental impairment as a result of injury has 

become stable and when no further treatment is reasonably expected to improve 

the condition,” § 8-40-201(11.5), C.R.S. (2019). After reaching MMI, the claimant 

stops receiving temporary disability benefits and can begin receiving permanent 
8

disability benefits if the injury resulted in permanent medical impairment. Maj. 

op. ¶ 6; Harman-Bergstedt, Inc. v. Loofbourrow, 2014 CO 5, ¶ 13, 320 P.3d 327, 330.

¶67 Section 8-42-107(8)(b) of the Act establishes the procedure for determining 

MMI; subsection (8)(b)(I) provides that an “authorized treating physician shall”

determine when the injured worker reaches MMI. 

¶68 Because the employer or the employer’s insurer selects the ATPs who treat 

an employee’s workplace injuries,

2 see Kunau, 147 P.3d at 36, ATPs have been 

viewed as potentially favoring the employer’s position. In fact, when the 

legislature first created the DIME process in 1991, Ch. 219, sec. 15, § 8-42-107(8)(b), 

1991 Colo. Sess. Laws 1291, 1309, it was intended to provide claimants an 

independent check on this potential for ATPs to be biased in favor of employers,

see Whiteside v. Smith, 67 P.3d 1240, 1246 (Colo. 2003) (“[T]he General Assembly 

created the DIME system within the statutory scheme because of the potential for 

treating physicians to be biased in favor of the employer and the insurer.”). 

¶69 For many years, employers had no opportunity to challenge the ATP’s 

finding that a claimant had not reached MMI. See Aren Design, Inc. v. Becerra, 

897 P.2d 902, 904 (Colo. App. 1995). But in 1996, the legislature amended the Act 

2 Employers provide the employee with a list of ATPs from which the employee 

must choose unless an exception is met. See generally § 8-43-404, C.R.S. (2019).
9

to give employers a second bite at the MMI apple by providing an opportunity to 

request a DIME where an ATP has determined that the claimant has not reached

MMI. See Ch. 112, sec. 1, § 8-42-107(8)(b), 1996 Colo. Sess. Laws 456, 456–57. Thus, 

section 8-42-107(8)(b)(II) now provides that if “either party” disputes the ATP’s 

determination of “whether the injured worker has or has not reached [MMI],” a 

DIME doctor may be selected in accordance with section 8-42-107.2, C.R.S. (2019). 

(Emphasis added.) But importantly, the employer or insurer may request a DIME 

only if four conditions are met: (1) at least twenty-four months have passed since 

the date of injury; 3 (2) a party has requested an MMI determination from the ATP; 

(3) the ATP “has not determined that the employee has reached [MMI]”; and (4) a 

third-party physician other than the ATP has determined that the claimant 

reached MMI. § 8-42-107(8)(b)(II) (emphasis added). 

¶70 Notably, under this scheme, the employer-retained third-party physician’s 

examination serves only as a necessary threshold requirement to trigger the DIME 

process. It does not supplant that process.

¶71 Under section 8-42-107(8)(c), if the ATP has determined that a claimant has 

reached MMI and determines that the injury has resulted in permanent medical 

3 In 2013, the time an employer must wait to request a DIME was extended from 

eighteen to twenty-four months. Ch. 301, sec. 6, § 8-42-107(8)(b), 2013 Colo. Sess. 

Laws 1593, 1595. 
10

impairment, “the authorized treating physician shall determine a medical 

impairment rating.” Alternatively, under section 8-42-107(8)(b)(III), if instead the 

DIME physician “finds that the injured worker has reached [MMI]” through the 

DIME process under subsection (8)(b)(II), the DIME physician “shall also 

determine the [claimant’s] permanent medical impairment rating.” 

§ 8-42-107(8)(b)(III) (emphasis added). 

¶72 Subsection (8)(b)(III) goes on to state, “The finding regarding maximum medical 

improvement and permanent medical impairment of an independent medical examiner 

in a dispute arising under subparagraph (II) of this paragraph (b) may be 

overcome only by clear and convincing evidence.” Id. (emphasis added). 

¶73 Viewed in the context of section -107(8) as a whole, this quoted language 

from subsection (8)(b)(III) allows a claimant to seek to overcome a DIME 

physician’s finding of MMI and permanent medical impairment by clear and 

convincing evidence. As described above, subsection (8)(b) is careful to set forth 

when an ATP or a DIME physician determines that a claimant “has or has not” 

reached MMI. On its face, subsection (8)(b)(III) addresses only the situation where 

a DIME physician “finds that the injured worker has reached [MMI].” (Emphasis 

added.) Thus, it is the DIME physician’s “finding regarding [MMI] and 

permanent medical impairment” that may be “overcome” by clear and convincing 

evidence. 
11

B. The Act Does Not Authorize the ALJ to Find MMI Based 

Solely on the Opinion of an Employer-Hired Third-Party 

Physician

¶74 I believe the majority errs by interpreting section 8-42-107(8)(b)(III) to hand

employers yet a third bite at the MMI apple by construing that provision to allow 

an ALJ to find that a claimant has reached MMI when both the ATP and the DIME 

physician have concluded otherwise. Certainly nothing in section 

8-42-107(8)(b)(III) authorizes the ALJ to make such a finding based solely on the 

opinion of an employer-hired third-party physician. Rather than generally 

“inject[ing]” the third-party physician’s opinion into the DIME process, maj. op. 

¶ 28, the statute plainly limits the third-party physician’s evaluation of the 

claimant to functioning as a necessary threshold requirement to trigger the DIME 

process,4 § 8-42-107(8)(b)(II)(D). As noted above, it in no way substitutes for the 

DIME itself. The majority’s interpretation, however, improperly elevates the 

third-party physician’s MMI finding and equates it with the statutory role of the 

ATP or DIME physician’s conclusion. 

¶75 The majority reasons that its interpretation avoids rendering provisions of 

the statute without practical effect. Maj. op. ¶ 38. But the provision allows an 

4 The DIME then has that third-party physician’s report available to her when she 

makes her MMI determination.
12

employee to challenge a DIME physician’s determination that a claimant has 

reached MMI. Thus, the provision continues to have important, practical 

application where the ATP and DIME physician do not agree. And as the court of 

appeals observed, even when the ATP and DIME physician agree a claimant has 

not reached MMI, nothing precludes the employer from reinvoking the DIME 

process. However, I am unwilling to read into the statute a remedy that the 

legislature did not provide for the relatively rare situation where both an 

employer-selected ATP and a DIME physician agree that a claimant has not 

reached MMI. 

¶76 Finally, to the extent the majority relies on the nonbinding ICAO opinion in 

McFadden v. Sun Health Care, W.C. No. 4-710-119, 2011 WL 737114 (Colo. I.C.A.O. 

Feb. 25, 2011), to support its interpretation of the Act, its deference to that opinion 

is troubling. Maj. op. ¶¶ 30–33. Although we may defer to an agency’s reasonable 

interpretation of its own statute, Kunau, 147 P.3d at 38, the panel ruling in 

McFadden engaged in no statutory “interpretation” justifying this court’s 

deference. Cf. Univ. of Tex. Sw. Med. Ctr. v. Nassar, 570 U.S. 338, 360 (2013) (“The 

weight of deference afforded to agency interpretations . . . depends upon ‘the 

thoroughness evident in its consideration, the validity of its reasoning, its 

consistency with earlier and later pronouncements, and all those factors which 

give it power to persuade.’” (quoting Skidmore v. Swift & Co., 323 U.S. 134, 140 
13

(1944))). Thus, I disagree that McFadden supports the majority’s reading of the 

statute.

C. The Record Does Not Support the June 2016 MMI Date

¶77 Although I disagree with the majority’s statutory interpretation, I also note 

that the June 28, 2016 MMI date is simply not supported by the record. As set out 

above, the ICAO panel concluded that the ALJ had found Burren was at MMI as 

of June 28, 2016, for all of her work-related injuries based on the opinions of Dr. 

Fall and the ATP, even though the ATP placed Burren at MMI as of June 28, 2016,

for her cervical spine injury only; the ALJ’s order finds MMI only with respect to 

Burren’s cervical spine injury, not all her injuries; no doctor opined that Burren 

reached MMI as of June 28, 2016, for her shoulder and arm injuries; and Dr. Fall 

did not place Burren at MMI for her injuries until August 9, 2016. 

¶78 The majority sidesteps this issue by reasoning that these factual questions

are not within the scope of our certiorari review. Maj. op. ¶¶ 16–17 nn.1–2. I 

disagree. The question in this case is whether the ALJ has the authority to find a 

claimant at MMI where no ATP or DIME physician found the claimant at MMI. 

But here, the ALJ’s order found the claimant at MMI as of June 2016 only for her 

cervical spine injury, based on the ATP’s conclusion that Burren had reached MMI 

as of June 2016 only for the cervical spine injury. In my view, the ICAO panel 

erroneously construed the ALJ’s order to mean more than it said and arrived at an 
14

MMI date that is simply unsupported by the record or the ALJ’s findings and 

order.

5

III. Permanent Impairment Rating

¶79 Because I conclude that the ALJ could not find Burren had reached MMI 

based on a third-party physician’s opinion, I need not reach the issue of the 

permanent impairment rating. § 8-42-107(8)(c). Nonetheless, I briefly lay out my 

concerns with the majority’s permanent impairment rating analysis.

¶80 First, the majority relies on sections 8-42-107(8)(c) and 8-42-101(3.6)(b), 

C.R.S. (2019), to reason that because Dr. Fall was a level-II physician, she was 

authorized to find a permanent impairment rating for Burren. Maj. op. ¶ 41. 

However, that Dr. Fall was qualified to make such a finding does not mean she 

was acting in the proper capacity to make such a finding in this case, and, as the 

majority notes, “Dr. Fall served as neither an ATP nor a twenty-four-month DIME 

doctor in this case.” Id. Instead, much like with the MMI finding, the statute 

authorizes an ATP or DIME physician to determine a permanent impairment 

rating. § 8-42-107(8)(c) (“When the injured employee’s date of maximum medical 

5 Although Burren did not challenge whether the record supported the ALJ’s MMI 

finding in her briefing to this court, she had no reason to petition for certiorari 

review on that issue because she was the prevailing party at the court of appeals 

and, because the division agreed with her statutory interpretation, it did not reach 

whether substantial evidence supported the ALJ’s findings of fact. Burren, ¶ 20.
15

improvement has been determined . . . the authorized treating physician shall 

determine a medical impairment rating as a percentage of the whole person 

. . . .”); -107(8)(b)(III) (“[I]f the independent medical examiner selected pursuant to 

subparagraph (II) of this paragraph (b) finds that the injured worker has reached 

maximum medical improvement, the independent medical examiner shall also 

determine the injured worker's permanent medical impairment rating.”).

¶81 Second, the majority appears to blame Burren for the shortcomings in the 

DIME physician’s report. The DIME physician did fail to issue a provisional 

permanent impairment rating. But such a rating is merely recommended; it is not 

required by statute. Colo. Dep’t of Labor & Emp’t, Div. of Workers’ Compensation 

Desk Aid #11—Impairment Rating Tips: DIME Panel Physician Notes, 14 (“If the 

party requesting the DIME has asked that impairment be addressed, and if you 

find the patient not at MMI for that work-related injury, you should nevertheless 

provide a rating for that injury.” (original emphases omitted, emphasis added)). 

The majority implies that Burren should be faulted because she failed to request 

that the DIME provide such a rating. Maj. op. ¶¶ 44–45. Yet Destination Maternity 

requested the DIME and wanted a finding on permanent impairment; thus, I see 

no reason to hold Burren responsible for the DIME doctor’s failure to issue a 
16

provisional rating.6 I worry the majority’s opinion today disadvantages claimants 

who fail to seek their own expert to testify at any hearing where the employer 

challenges the ATP and DIME physician’s opinions that the claimant has not 

reached MMI. Imposing such a disadvantage on claimants who fail to seek their 

own experts undermines the purpose of the statute to avoid litigation. See 

§ 8-40-102(1).

IV. Conclusion

¶82 Because I disagree with the majority’s statutory interpretation, and because

the MMI date is unsupported by the record in this case, I respectfully dissent.

6 Burren also argues she lacked adequate notice that permanent impairment would 

be decided at the hearing. Maj. op. ¶ 46 n.9. This too may explain why Burren 

might not have followed up with the DIME about a provisional permanent 

impairment rating.