CO Code § 8-42-101 (2021)
2021 Colorado Code|Title 8 - Labor and Industry|Article 42 - Benefits|§ 8-42-101. Employer Must Furnish Medical Aid - Approval of Plan - Fee Schedule - Contracting for Treatment - No Recovery From Employee - Medical Treatment Guidelines - Accreditation of Physicians and Other Medical Providers - Rules - Definition - Repeal

      Every employer, regardless of the employer's method of insurance, shall furnish medical, surgical, dental, nursing, and hospital treatment; medical, hospital, and surgical supplies; crutches; apparatus; and guardian ad litem or conservator services as may reasonably be needed at the time of the injury or occupational disease and thereafter during the disability to cure and relieve the employee from the effects of the injury. (a) (I)Every employer, regardless of the employer's method of insurance, shall furnish medical, surgical, dental, nursing, and hospital treatment; medical, hospital, and surgical supplies; crutches; apparatus; and guardian ad litem or conservator services as may reasonably be needed at the time of the injury or occupational disease and thereafter during the disability to cure and relieve the employee from the effects of the injury.    An employer or an employer's insurer that is required to furnish guardian ad litem or conservator services pursuant to this subsection (1)(a) shall pay an amount set in a fee schedule established by the director by rule. The director shall include in the fee schedule:   Reasonable attorney fees and costs to appoint a guardian ad litem or conservator through the appropriate probate court for an employee who is legally incapacitated as the result of a work-related injury or occupational disease; and    Reasonable fees and costs of a guardian ad litem or conservator appointed for an employee for services that are reasonably necessary as a result of the work-related injury or occupational disease.          In all cases where the injury results in the loss of a member or part of the employee's body, loss of teeth, loss of vision or hearing, or damage to an existing prosthetic device, the employer shall furnish within the limits of the medical benefits provided in paragraph (a) of this subsection (1) artificial members, glasses, hearing aids, braces, and other external prosthetic devices, including dentures, which are reasonably required to replace or improve the function of each member or part of the body or prosthetic device so affected or to improve the employee's vision or hearing. The employee may petition the division for a replacement of any artificial member, glasses, hearing aid, brace, or other external prosthetic device, including dentures, upon grounds that the employee has undergone an anatomical change since the previous device was furnished or for other good cause shown, that the anatomical change or good cause is directly related to and caused by the injury, and that the replacement is necessary to improve the function of each member or part of the body so affected or to relieve pain and discomfort. Implants or devices necessary to regulate the operation of, or to replace, with implantable devices, internal organs or structures of the body may be replaced when the authorized treating physician deems it necessary. Every employer subject to the terms and provisions of articles 40 to 47 of this title must insure against liability for the medical, surgical, and hospital expenses provided for in this article, unless permission is given by the director to such employer to operate under a medical plan, as set forth in subsection (2) of this section.    In any case in which a firefighter, emergency medical services provider, or peace officer, as described in section 16-2.5-101, C.R.S., is exposed during the course and within the scope of employment to a known or possible source of hepatitis C, the employer, or if insured, the insurer, shall, at their expense, provide for baseline testing within the period of time specified in section 8-41-208 (1)(a) to determine whether the employee was free of hepatitis C at the time of the on-the-job exposure. The employer, or if insured, the insurer, shall pay for all reasonable and necessary medical procedures and treatment for exposure to hepatitis C during the period of time set forth in section 8-41-208 (1)(d).       Every such plan, which is agreed to between the employer and employee, for the furnishing of medical, surgical, and hospital treatment, whether or not the employee is to pay any part of the expense of such treatment, before being put into effect, shall receive the approval of the director. The director has full power to formulate the terms and conditions under which any such plan may operate and the essentials thereof, and at any time the director may order modifications or changes in any such plan or withdraw prior approval thereof. No plan shall be approved by the director which relieves the employer from the burden of assuming and paying for any part of the medical, surgical, and hospital services and supplies required.        The director shall establish a schedule fixing the fees for which all surgical, hospital, dental, nursing, vocational rehabilitation, and medical services, whether related to treatment or not, pertaining to injured employees under this section shall be compensated. It is unlawful, void, and unenforceable as a debt for any physician, chiropractor, hospital, person, expert witness, reviewer, evaluator, or institution to contract with, bill, or charge any party for services, rendered in connection with injuries coming within the purview of this article or an applicable fee schedule, which are or may be in excess of said fee schedule unless such charges are approved by the director. Fee schedules shall be reviewed on or before July 1 of each year by the director, and appropriate health-care practitioners shall be given a reasonable opportunity to be heard as required pursuant to section 24-4-103, C.R.S., prior to fixing the fees, impairment rating guidelines, which shall be based on the revised third edition of the “American Medical Association Guides to the Evaluation of Permanent Impairment”, in effect as of July 1, 1991, and medical treatment guidelines and utilization standards. Fee schedules established pursuant to this subparagraph (I) shall take effect on January 1. The director shall promulgate rules concerning reporting requirements, penalties for failure to report correctly or in a timely manner, utilization control requirements for services provided under this section, and the accreditation process in subsection (3.6) of this section. The fee schedule shall apply to all surgical, hospital, dental, nursing, vocational rehabilitation, and medical services and to expert witness, expert reviewer, or expert evaluator services, whether related to treatment or not, provided after any final order, final admission, or full or partial settlement of the claim. (a) (I)The director shall establish a schedule fixing the fees for which all surgical, hospital, dental, nursing, vocational rehabilitation, and medical services, whether related to treatment or not, pertaining to injured employees under this section shall be compensated. It is unlawful, void, and unenforceable as a debt for any physician, chiropractor, hospital, person, expert witness, reviewer, evaluator, or institution to contract with, bill, or charge any party for services, rendered in connection with injuries coming within the purview of this article or an applicable fee schedule, which are or may be in excess of said fee schedule unless such charges are approved by the director. Fee schedules shall be reviewed on or before July 1 of each year by the director, and appropriate health-care practitioners shall be given a reasonable opportunity to be heard as required pursuant to section 24-4-103, C.R.S., prior to fixing the fees, impairment rating guidelines, which shall be based on the revised third edition of the “American Medical Association Guides to the Evaluation of Permanent Impairment”, in effect as of July 1, 1991, and medical treatment guidelines and utilization standards. Fee schedules established pursuant to this subparagraph (I) shall take effect on January 1. The director shall promulgate rules concerning reporting requirements, penalties for failure to report correctly or in a timely manner, utilization control requirements for services provided under this section, and the accreditation process in subsection (3.6) of this section. The fee schedule shall apply to all surgical, hospital, dental, nursing, vocational rehabilitation, and medical services and to expert witness, expert reviewer, or expert evaluator services, whether related to treatment or not, provided after any final order, final admission, or full or partial settlement of the claim.    Notwithstanding the provisions of subparagraph (I) of this paragraph (a) the fees set forth in the schedule established pursuant to subparagraph (I) of this paragraph (a) shall be those fees in effect immediately prior to July 1, 1991, and such fees shall remain in effect until July 1, 1995.    Notwithstanding the provisions of subparagraph (I) of this paragraph (a), until the impairment rating guidelines and medical treatment guidelines and utilization standards required by subparagraph (I) of this paragraph (a) and subsection (3.5) of this section are adopted and level I accreditation is received, compensation for fees for chiropractic treatments shall not be made more than ninety days after the first of such treatments nor after the twelfth such treatment, whichever first occurs, unless the chiropractor has received level I accreditation.       Medical treatment guidelines and utilization standards, developed by the director, shall be used by health-care practitioners for compliance with this section. (3.5)       “Physician” means, for the purposes of the level I and level II accreditation programs, a physician licensed under the “Colorado Medical Practice Act”. For the purposes of level I accreditation only and not level II accreditation, “physician” means a dentist licensed under the “Dental Practice Act”, article 220 of title 12; a podiatrist licensed under article 290 of title 12; and a chiropractor licensed under article 215 of title 12. (a) (I) (A) “Physician” means, for the purposes of the level I and level II accreditation programs, a physician licensed under the “Colorado Medical Practice Act”. For the purposes of level I accreditation only and not level II accreditation, “physician” means a dentist licensed under the “Dental Practice Act”, article 220 of title 12; a podiatrist licensed under article 290 of title 12; and a chiropractor licensed under article 215 of title 12.    A physician assistant licensed under the “Colorado Medical Practice Act”, article 240 of title 12, may receive level I accreditation. In order for a level I accredited physician assistant to perform medical services requiring level I accreditation, a level I accredited physician must delegate the performance of those medical services to the level I accredited physician assistant.    A physician shall not be deemed accredited under either level I or level II solely by reason of being licensed.    An advanced practice registered nurse with prescriptive authority pursuant to section 12-255-112 may receive level I accreditation for purposes of receiving one hundred percent reimbursement under the medical fee schedule created in accordance with subsection (3) of this section.    Nothing in this subsection (3.5)(a) grants any person other than a physician licensed under the “Colorado Medical Practice Act” the authority to determine that no permanent medical impairment has resulted from the injury pursuant to subsection (3.6)(b) of this section or that a claimant has attained maximum medical improvement pursuant to section 8-42-107 (8)(b)(I).       The director shall promulgate rules establishing a system for the determination of medical treatment guidelines and utilization standards and medical impairment rating guidelines for impairment ratings as a percent of the whole person or affected body part based on the revised third edition of the “American Medical Association Guides to the Evaluation of Permanent Impairment”, in effect as of July 1, 1991.       A medical impairment rating system shall be maintained by the director.      This subsection (3.5) is repealed, effective September 1, 2025. (c) (I) This subsection (3.5) is repealed, effective September 1, 2025.    Prior to such repeal the accreditation process created by this subsection (3.5) and subsection (3.6) of this section shall be reviewed as provided for in section 24-34-104, C.R.S. (3.6) The two-tier accreditation system shall comprise the following programs:     A program establishing the accreditation requirements for physicians providing primary care to patients who have, as a result of their injury, been unable to return to work for more than three working days, referred to in this section as “time-loss injuries”, which program shall be voluntary except in the case of chiropractors, for whom it shall be mandatory, and which shall be known as level I accreditation; and (a) (I) A program establishing the accreditation requirements for physicians providing primary care to patients who have, as a result of their injury, been unable to return to work for more than three working days, referred to in this section as “time-loss injuries”, which program shall be voluntary except in the case of chiropractors, for whom it shall be mandatory, and which shall be known as level I accreditation; and    A program establishing the accreditation requirements for physicians providing impairment evaluation of injured workers, which program shall be known as level II accreditation.       A physician who provides impairment evaluation of injured workers shall complete and must have received accreditation under the level II accreditation program. However, the authorized treating physician providing primary care need not be level II accredited to determine that no permanent medical impairment has resulted from the injury. Specialists who do not render primary care to injured workers and who do not perform impairment evaluations do not require accreditation. The facility where a physician provides such services cannot be accredited.    Both the level I and level II accreditation programs shall be implemented and available to physicians. All physicians who are required to be accredited shall complete the level II accreditation program or programs.    The level I and level II accreditation programs shall operate in such a manner that the costs of the program are fully met by registration fees paid by the physicians. The registration fee for each program must cover the cost of all accreditation course work and materials.    The accreditation system shall be established so as to provide physicians with an understanding of the administrative, legal, and medical roles and in such a manner that accreditation is accessible to every licensed physician, with consideration of specialty and geographic diversity.    Initial accreditation shall be for a three-year period and may be renewed for successive three-year periods. The director by regulation may determine any additional training program required prior to accreditation renewal.    The director shall, upon good cause shown, revoke the accreditation of any physician who violates the provisions of this subsection (3.6) or any rule promulgated by the director pursuant to this subsection (3.6), following a hearing on the merits before an administrative law judge, subject to review by the industrial claim appeals office and the court of appeals, in accordance with all applicable provisions of article 43 of this title.    If a physician whose accreditation has been revoked submits a claim for payment for services rendered subsequent to such revocation, the physician shall be considered in violation of section 10-1-128, C.R.S., and neither an insurance carrier nor a self-insured employer shall be under any obligation to pay such claim.    A physician who provides treatment for nontime loss injuries need not be accredited to be reimbursed for the costs of such treatment pursuant to the provisions of the “Workers' Compensation Act of Colorado”.    (Deleted by amendment,L. 96, p. 151, § 2, effective July 1, 1996.)    The division shall make available to insurers, claimants, and employers a list of all accredited physicians and a list of all physicians whose accreditation has been revoked. Such lists shall be updated on a monthly basis.    The registration fees collected pursuant to paragraph (d) of this subsection (3.6) shall be transmitted to the state treasurer, who shall credit the same to the physicians accreditation program cash fund, which is hereby created in the state treasury. Moneys in the physicians accreditation program cash fund are hereby continuously appropriated for the payment of the direct costs of providing the level I and level II accreditation courses and materials.    All administrative costs associated with the level I and level II accreditation programs shall be paid out of the workers' compensation cash fund in accordance with appropriations made pursuant to section 8-44-112 (7).    The director shall contract with the medical school of the university of Colorado for the services of a medical director to advise the director on issues of accreditation, impairment rating guidelines, medical treatment guidelines and utilization standards, and case management and to consult with the director on peer review activities as specified in this subsection (3.6) and section 8-43-501. The medical director shall be a medical doctor licensed to practice in this state with experience in occupational medicine. The director may contract with an appropriate private organization that meets the definition of a quality improvement organization as set forth in 42 U.S.C. sec. 1320c-1 to conduct peer review activities under this subsection (3.6) and section 8-43-501 and to recommend whether or not adverse action is warranted.    Except as provided in this subsection (3.6), neither an insurance carrier nor a self-insured employer or injured worker shall be liable for costs incurred for an impairment evaluation rendered by a physician where there is a determination of permanent medical impairment if such physician is not level II accredited pursuant to the provisions of this subsection (3.6).      For purposes of this paragraph (p): (p) (I) For purposes of this paragraph (p):   “Case management” means a system developed by the insurance carrier in which the carrier shall assign a person knowledgeable in workers' compensation health care to communicate with the employer, employee, and treating physician to assure that appropriate and timely medical care is being provided.    “Managed care” means the provision of medical services through a recognized organization authorized under the provisions of parts 1, 3, and 4 of article 16 of title 10, C.R.S., or a network of medical providers accredited to practice workers' compensation under this subsection (3.6).       Every employer or its insurance carrier shall offer at least managed care or medical case management in the counties of Denver, Adams, Jefferson, Arapahoe, Douglas, Boulder, Larimer, Weld, El Paso, Pueblo, and Mesa and shall offer medical case management in all other counties of the state.       The division is authorized to accept moneys from any governmental unit as well as grants, gifts, and donations from individuals, private organizations, and foundations; except that no grant, gift, or donation may be accepted by the division if it is subject to conditions which are inconsistent with this article or any other laws of this state or which require expenditures from the workers' compensation cash fund which have not been approved by the general assembly. All moneys accepted by the division shall be transmitted to the state treasurer for credit to the workers' compensation cash fund.      This subsection (3.6) is repealed, effective September 1, 2025. (r) (I) This subsection (3.6) is repealed, effective September 1, 2025.    Prior to such repeal the accreditation process created by subsection (3.5) of this section and this subsection (3.6) shall be reviewed as provided for in section 24-34-104, C.R.S. (3.7) On and after July 1, 1991, all physical impairment ratings used under articles 40 to 47 of this title shall be based on the revised third edition of the “American Medical Association Guides to the Evaluation of Permanent Impairment”, in effect as of July 1, 1991. For purposes of determining levels of medical impairment pursuant to articles 40 to 47 of this title a physician shall not render a medical impairment rating based on chronic pain without anatomic or physiologic correlation. Anatomic correlation must be based on objective findings.                   Once there has been an admission of liability or the entry of a final order finding that an employer or insurance carrier is liable for the payment of an employee's medical costs or fees, a medical provider shall under no circumstances seek to recover such costs or fees from the employee.    If any party files an application for hearing on whether the claimant is entitled to medical maintenance benefits recommended by an authorized treating physician that are unpaid and contested, and any requested medical maintenance benefit is admitted fewer than twenty days before the hearing or ordered after application for hearing is filed, the court shall award the claimant all reasonable costs incurred in pursuing the medical benefit. Such costs do not include attorney fees.      If an employer receives notice of injury and the employer or, if insured, the employer's insurance carrier, after notice of the injury, fails to furnish reasonable and necessary medical treatment to the injured worker for a claim that is admitted or found to be compensable, the employer or carrier shall reimburse the claimant, or any insurer or governmental program that pays for related medical treatment, for the costs of reasonable and necessary treatment that was provided. An employer, insurer, carrier, or provider may not recover the cost of care from a claimant where the employer or carrier has furnished medical treatment except in the case of fraud.    If a claimant has paid for medical treatment that is admitted or found to be compensable and that costs more than the amount specified in the workers' compensation fee schedule, the employer or, if insured, the employer's insurance carrier, shall reimburse the claimant for the full amount paid. The employer or carrier is entitled to reimbursement from the medical providers for the amount in excess of the amount specified in the worker's compensation fee schedule.       A claimant must submit a request for mileage expense reimbursement for travel reasonably necessary and related to obtaining compensable treatment, supplies, or services specified in subsection (1)(a) of this section to the employer or, if insured, to the employer's insurer no later than one hundred twenty days after the date the expense is incurred unless good cause for a later submission is shown. Good cause includes a failure by the employer or employer's insurer to provide the notice in the brochure required by section 8-43-203 (3)(c)(IV). Within thirty days after the date the claimant submits the request for mileage expense reimbursement, the employer or employer's insurer shall pay the mileage expenses or, if denying the request, provide written notice to the claimant stating the reason the request was denied.     History. Source: L. 90: Entire article R&RE, p. 485, § 1, effective July 1. L. 91: (3)(b) repealed, p. 694, § 4, effective April 20; (1)(b) and (3) amended and (3.5), (3.6), and (3.7) added, p. 1296, § 10, effective July 1. L. 92: (3.5)(a)(II) amended, p. 2165, § 1, effective June 2; (3.6)(p)(I)(B) amended, p. 1723, § 2, effective July 1. L. 94: (1)(b) amended, p. 311, § 1, effective March 22; (3.5)(k) and (3.6)(r) amended, p. 1457, § 7, effective May 25; (3)(a)(II) amended, p. 2001, § 2, effective July 1. L. 95: (3.6)(g) amended, p. 234, § 1, effective April 17. L. 96: (3.6)(b) and (3.6)(o) amended, p. 268, § 1, effective April 8; (3)(a)(I), (3)(b), (3.5), and (3.6) amended, p. 151, § 2, effective July 1. L. 2002: (1)(c) added, p. 441, § 2, effective May 16. L. 2003: (3.5)(c)(I) and (3.6)(r)(I) amended, p. 918, § 2, effective July 1; IP(3.6) and (3.6)(h) amended, p. 614, § 4, effective July 1; (1)(c) amended, p. 1613, § 4, effective August 6. L. 2004: (3)(a)(I) amended, p. 396, § 4, effective August 4. L. 2007: (3)(a)(I) and (3.6)(k) amended, p. 1471, § 1, effective May 30. L. 2008: (1)(b) and (3)(a)(I) amended, p. 1675, § 1, effective July 1. L. 2009: (3)(a)(I) amended,(SB 09-243), ch. 269, p. 1222, § 2, effective July 1. L. 2010: (5) added,(SB 10-187), ch. 310, p. 1456, § 2, effective July 1. L. 2013: (6) added,(SB 13-285), ch. 301, p. 1593, § 1, effective July 1. L. 2014: (3.5)(a)(I) amended,(HB 14-1227), ch. 363, p. 1735, § 36, effective July 1; (3.5)(c)(I), (3.6)(d), and (3.6)(r)(I) amended,(HB 14-1278), ch. 293, pp. 1197, 1198, §§ 1, 3, effective July 1. L. 2015: (2)(b) added,(SB 15-264), ch. 259, p. 942, § 8, effective August 5. L. 2016: (3.5)(a)(I) amended,(SB 16-158), ch. 204, p. 720, § 3, effective August 10. L. 2019: (3.5)(a)(I)(D) and (3.5)(a)(I)(E) added,(HB 19-1105), ch. 77, p. 281, § 1, effective August 2; (3.6)(n) amended,(SB 19-241), ch. 390, p. 3463, § 3, effective August 2; (3.5)(a)(I)(A) and (3.5)(a)(I)(B) amended,(HB 19-1172), ch. 136, p. 1647, § 22, effective October 1. L. 2021: (1)(a) amended and (7) added,(HB 21-1050), ch. 384, p. 2569, § 1, effective September 7.    Editor's note:    This section is similar to former § 8-49-101 as it existed prior to 1990.    Although subsection (3)(b) was repealed by House Bill 91-1100, the repeal was harmonized with the amendments to the entire subsection (3) by Senate Bill 91-218.    Amendments to subsection (3.6) by House Bill 96-1040 and House Bill 96-1126 were harmonized.      Section 13(2)(d) of chapter 384 (HB 21-1050), Session Laws of Colorado 2021, provides that the act amending subsection (1)(a) applies to injuries occurring on or after September 7, 2021. (4) (a) Section 13(2)(d) of chapter 384 (HB 21-1050), Session Laws of Colorado 2021, provides that the act amending subsection (1)(a) applies to injuries occurring on or after September 7, 2021.    Section 13(2)(a) of chapter 384 (HB 21-1050), Session Laws of Colorado 2021, provides that the act adding subsection (7) applies to workers' compensation claims pending or filed on or after September 7, 2021.        Cross references:   For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016.   ANNOTATION   Law reviews. For article, “Primer on Permanent Disability in the Colorado Workmen's Compensation Law”, see 57 Den. L.J. 573 (1980). For article, “A Review of Medical Issues in Worker's Compensation”, see 19 Colo. Law. 667 (1990).   Annotator's note. (1) Since § 8-42-101 is similar to § 8-49-101 as it existed prior to the 1990 repeal and reenactment of the “Workers' Compensation Act of Colorado”, articles 40 to 47 of this title, relevant cases construing that provision have been included in the annotations to this section.   (2) Many of the cases annotated below which arose prior to July 1, 1987, were decided under the former provisions of § 8-49-101 which have been substantially amended or which have been repealed.   (3) Cases included in the annotations which refer to the industrial commission were decided prior to the 1969 amendment which removed powers formerly exercised by the industrial commission and vested them in the division of labor and its director.   Property interest created requiring procedural due process. A claimant has a property interest in receiving treatment and supplies that may reasonably be needed at the time of injury or occupational disease and thereafter during the disability to cure and relieve the employee from the effects of the injury. Colo. Comp. Ins. Auth. v. Nofio, 886 P.2d 714 (Colo. 1994).   Litigation expenses not exempt. The director's authority to establish a fee schedule under this section is not limited to fees for treatment but may extend to the amount charged by a physician for review of a deposition in connection with a hearing. Janssen v. Indus. Claim Appeals Office, 40 P.3d 1 (Colo. App. 2001), rev'd on other grounds sub nom. Indus. Claim Appeals Office v. Zarlingo, 57 P.3d 736 (Colo. 2002).   Failure of the director of the division of workers' compensation to adopt rules for rating psychological impairment pursuant to this section did not deprive employer and the compensation insurance authority of due process where the appropriate report form for impairment ratings was used, the provider that gave the impairment rating was accredited, and an opinion of independent medical examiner was not sought pursuant to § 8-42-107 (8)(b) after the initial medical impairment assessment. City of Boulder v. Dinsmore, 902 P.2d 925 (Colo. App. 1995).   This section requires all physical impairment ratings to be based on the AMA Guides. Gonzales v. Advanced Component Sys., 949 P.2d 569 (Colo. 1997).   The AMA Guides do not preclude a physician from concluding that an injury primarily occurred to or affected only one side of the back. Wackenhut Corp. v. Indus. Claim Appeals Office, 17 P.3d 202 (Colo. App. 2000).   The date of maximum medical improvement is not relevant in and of itself to applying the AMA guidelines. Therefore, a date of maximum medical improvement does not invalidate a physician's findings that a condition, such as pain, has existed after such date, and applying such findings to the AMA guidelines. McLane W. Inc. v. Indus. Claim Appeals Office, 996 P.2d 263 (Colo. App. 1999).   Neither subsection (3.7) of this section nor the AMA Guides can be read as superseding or overriding the express legislative directive in § 8-42-107 (1) regarding how benefits are to be calculated for employees who have sustained only scheduled injuries. Kolar v. Indus. Claim Appeals Office, 122 P.3d 1075 (Colo. App. 2005).   Disabling industrial injury suffered prior to July 1, 1987. A worker who has been awarded temporary partial disability benefits and who has been directed to undergo a vocational rehabilitation evaluation is entitled to receive temporary partial disability benefits until the commencement of a vocational rehabilitation program or the entry of an administrative ruling that vocational rehabilitation is not necessary to render the worker fit for a remunerative occupation. Allee v. Contractors, Inc., 783 P.2d 273 (Colo. 1989); Gerber v. CAN-USA Constr., Inc., 783 P.2d 269 (Colo. 1989); Phillips v. Indus. Claim Appeals Office, 783 P.2d 271 (Colo. 1989); Indus. Claim Appeals Office v. Mid-Continent Res., Inc., 783 P.2d 290 (Colo. 1989); Arndt v. Elec. Metal Prods., Inc., 783 P.2d 290 (Colo. 1989); Ne. Junior Coll. v. Kenyon, 783 P.2d 853 (Colo. 1989) (decided prior to 1987 repeal of subsections (4) and (5)).   This section imposes upon an employer the duty of furnishing medical, surgical, nursing and hospital treatment and supplies and apparatus for a fixed time and to a fixed minimum regardless of the compensation allowed, and where such bills are not paid but are included in the award they are paid direct to those who have rendered the service or furnished the supplies. Jacobson v. Doan, 136 Colo. 496 , 319 P.2d 975 (1957); Publix Cab Co. v. Colo. Nat'l Bank, 139 Colo. 205 , 338 P.2d 702 (1959).   The act authorizes an award of medical benefits reasonably necessary to relieve the injured worker from the effects of the industrial injury. Employers have been required to provide services which are either medically necessary for the treatment of a claimants's injuries or incidental to obtaining such treatment. Atencio v. Quality Care, Inc., 791 P.2d 7 (Colo. App. 1990); Colo. Comp. Ins. Auth. v. Nofio, 886 P.2d 714 (Colo. 1994).   A prosthetic hip is an internal device that may be replaced when the treating physician deems it necessary; therefore, an employee who suffers a left hip prosthetic shift is entitled to workers' compensation benefits. Because the prosthesis is an internal device, it is not subject to the same limitations as an external device. Am. Appliances, Inc. v. Indus. Claim Appeals Office, 166 P.3d 267 (Colo. App. 2007).   Treatments for a condition not caused by employment are not compensated. Claimant was not entitled to increased costs for cancer treatment even when the increased costs were caused by an employment injury. The condition being treated was not caused by employment; therefore, the treatments will not “relieve the employee of the effects of the injury.” Owens v. Indus. Claim Appeals Office, 49 P.3d 1187 (Colo. App. 2002).   In certain instances an employer can be held liable for treatment of a nonindustrial condition necessary to prepare a claimant for surgery to treat a compensable industrial injury. Pub. Serv. Co. v. Indus. Claim Appeals Office, 979 P.2d 584 (Colo. App. 1999).   Obligation of employer. This section obligates the employer to furnish the necessary medical assistance for treatment of the claimant's injury both at the time of the injury “and thereafter during the disability”. Granite Constr. Co. v. Leonard, 40 Colo. App. 20, 568 P.2d 500 (1977).   Disability is determined as of the time physicians notify claimant they can do nothing further for him. There is no provision of the workmen's compensation act which specifies the time at which disability is to be determined, and the industrial commission has authority to fix the disability as of the time physicians for the employer and insurance carrier notify claimant they can do nothing further for him. This is true notwithstanding that the employee, by undergoing further surgical treatment at his own expense, is able to decrease the extent of his disability below the percentage fixed by the division. London Guarantee & Accident Co. v. Indus. Comm'n, 72 Colo. 177 , 210 P. 70 (1922).   The language of this section is clear and unambiguous in stating that the employer, through his insurance carrier, shall not be required to pay for medical expenses beyond $7,500 (now $20,000). Weaver-Beatty Motor Co. v. Billen, 36 Colo. App. 442, 541 P.2d 120 (1975).   Income maintenance benefits are not included in listing of benefits to be offset by any disability annuity payments; to extend this section to include such benefits would not only be tantamount to indulging in judicial legislation but would ignore the express statutory language. State Comp. Ins. Fund v. Velasquez, 628 P.2d 190 (Colo. App. 1981).   Director may not extend rehabilitation beyond 52 weeks. The director does not have any discretion to extend the period of vocational rehabilitation once the 52-week limitation of subsection (4) is reached. In re Sterling v. Indus. Comm'n, 662 P.2d 1096 (Colo. App. 1982).   Claimant's temporary disability benefits should not have been suspended because he withdrew monthly amounts from his company's assets for living expenses, where claimant was not earning any income. Winters v. Indus. Comm'n, 736 P.2d 1256 (Colo. App. 1986).   Determination of permanent disability under former subsection (5). Former subsection (5) required that permanent disability be determined as if the employee had successfully completed the rehabilitation program. From the commission's finding that, since the claimant voluntarily withdrew from the rehabilitation program, the industrial disability equaled physical impairment, it cannot be determined that the physical disability was assessed from subsection (5)'s perspective. Thus, further findings on this issue are needed. Churchill v. Sears Roebuck & Co., 720 P.2d 171 (Colo. App. 1986) (decided prior to 1986 abolishment of the industrial commission).   Assertion of permanent disability claim not necessary for vocational rehabilitation. This section does not impose a burden upon one who seeks vocational rehabilitation to assert first a permanent disability claim. Timberline Sawmill & Lumber, Inc. v. Indus. Comm'n, 624 P.2d 367 (Colo. App. 1981).   And ineligibility for vocational rehabilitation benefits not inconsistent with award of disability benefits. A finding that a claimant is not eligible for vocational rehabilitation benefits is not inconsistent with its award of permanent partial disability benefits. Sw. Inv. Co. v. Indus. Comm'n, 650 P.2d 1355 (Colo. App. 1982).   Issue of the claimant's entitlement to vocational rehabilitation must be reevaluated where there is further medical treatment for her disability and her subsequent ability to perform work for which she has previous training or experience. This issue is not precluded by an initial determination that the claimant does not meet the statutory standards for vocational rehabilitation. Dziewior v. Mich. Gen. Corp., 672 P.2d 1026 (Colo. App. 1983).   Subrogation has no effect on limits of liability under this section. The right of subrogation granted to the state fund under § 8-52-108 is a separate and distinct right which has no effect on the limits of liability under this section established by the general assembly. Weaver-Beatty Motor Co. v. Billen, 36 Colo. App. 442, 541 P.2d 120 (1975).   Because subrogation would be meaningless if the limit of liability fluctuated with every recovery. Weaver-Beatty Motor Co. v. Billen, 36 Colo. App. 442, 541 P.2d 120 (1975).   When limit is reached, application under § 8-66-108 is appropriate. The general assembly established the limit of liability under this section, and when this limit has been initially reached, application for major medical benefits under § 8-66-108 is appropriate. A later recovery or lack of recovery will only affect the employer's loss experience and premium charges; it cannot affect the question of whether the statutory limit of liability has been exhausted. Weaver-Beatty Motor Co. v. Billen, 36 Colo. App. 442, 541 P.2d 120 (1975).   Initial responsibility for identifying the need for a vocational rehabilitation plan rests with the employer or insurance carrier. Travelers Ins. Co. v. Savio, 706 P.2d 1258 (Colo. 1985).   Rules of procedure relative to vocational rehabilitation allows a claimant the remedy of securing official intervention when an insurer delays or denies providing rehabilitation services. This remedy does not compensate a claimant for any injury caused by a bad faith delay or denial by the employer or insurance carrier. Travelers Ins. Co. v. Savio, 706 P.2d 1258 (Colo. 1985).   Requisites for major medical insurance fund liability for vocational rehabilitation benefits are that the employee suffer a compensable injury rendering him incapable of employment for which he has training or experience and that total benefits expended by the employer for medical and vocational rehabilitation benefits exceed $20,000. White v. State Comp. Ins. Fund, 700 P.2d 923 (Colo. App. 1985).   Claimant remained eligible to recover vocational rehabilitation benefits from the major medical insurance fund despite his settlement with the state compensation insurance fund which recited that it was not to compromise claims against the major medical fund. White v. State Comp. Ins. Fund, 700 P.2d 923 (Colo. App. 1985).   Injured employee must have permanent physical impairment which renders him unable to work in order to receive vocational rehabilitation benefits. However, no determination need be made of the employee's degree of permanent partial disability until after completion of the rehabilitation program. Freilinger v. Gates Rubber Co., 733 P.2d 1214 (Colo. App. 1987).   The authority to determine a claimant's eligibility for vocational rehabilitation is not an unconstitutional delegation of authority because the legislative standards and procedural safeguards are sufficient to protect against an arbitrary exercise of administrative discretion. Electron Corp. v. Wuerz, 820 P.2d 356 (Colo. App. 1991).   Vocational rehabilitation benefits denied. Where the evidence establishes that the injury to claimant's thumb neither permanently precludes him from engaging in his usual and customary occupation, nor has it rendered him unable to perform work for which he has previous training or experience, the commission correctly held that claimant was not entitled to vocational rehabilitation benefits. Smith v. Indus. Comm'n, 735 P.2d 921 (Colo. App. 1986).   Injured employee not entitled to vocational rehabilitation benefits where accident which occurred at most recent work place did not result in any permanent disability and was not the cause of the employee's inability to work. Freilinger v. Gates Rubber Co., 733 P.2d 1214 (Colo. App. 1987).   Vocational rehabilitation benefits may be suspended when claimant declines offer of suitable gainful employment. Employability in general labor market may be considered but is not essential to the determination of such employment. Roe v. Indus. Comm'n, 734 P.2d 138 (Colo. App. 1986).   Waiver of right to retraining in another field was not waiver of all rights under vocational rehabilitation statute and therefore the commission should adopt claimant's plan so long as it is feasible and could reasonably be expected to accomplish its goals. Winters v. Indus. Comm'n, 736 P.2d 1256 (Colo. App. 1986).   Retraining plan may be approved even if it might not be completed in one year, but income maintenance and other vocational rehabilitation benefits would cease after one year. Winters v. Indus. Comm'n, 736 P.2d 1256 (Colo. App. 1986).   A vocational rehabilitation “plan” which attempts to help a claimant start his own business is contrary to the language and intent of this section. Husson v. Babbit, 728 P.2d 750 (Colo. App. 1986).   Claimant withdrew from rehabilitation program voluntarily and without good cause. Where claimant testified she thought she had left the rehabilitation program voluntarily because “it wasn't working out”, where there was evidence that claimant was informed before termination of the areas and improvement necessary and made little effort to improve, and where the record revealed that for claimant's position no prior experience or training was necessary, there was ample evidence that claimant withdrew from the program voluntarily without good cause. Churchill v. Sears Roebuck & Co., 720 P.2d 171 (Colo. App. 1986).   Child care services were compensable to extent necessary to allow claimant to attend medical appointments and to allow her to rest. Bellone v. Indus. Claim Appeals Office, 940 P.2d 1116 (Colo. App. 1997).   Recovery of child care expenses allowed during period of vocational rehabilitation as a necessary service under former subsection (4). Grover v. Indus. Comm'n, 759 P.2d 705 (Colo. 1988).   Claim is allowed only for injury arising out of and in the course of employment. A claim for medical expenses rendered to an injured employee at the instance of the employer or insurance carrier in cases where the injury is not caused by accident arising out of and in the course of employment may be enforced in an independent action, but cannot be allowed in a proceeding under the workmen's compensation act. Employers' Mut. Ins. Co. v. Indus. Comm'n, 89 Colo. 475 , 3 P.2d 1079 (1931); Morey Mercantile Co. v. Flynt, 97 Colo. 163 , 47 P.2d 864 (1935).   And an injury takes place when the claimant, as a reasonable man, should recognize the nature, seriousness, and probable compensable character of his injury. Crest Fence Co. v. Cec, 175 Colo. 21 , 485 P.2d 709 (1971).   The provision of § 8-44-107 that compensation awarded against employer may be increased 50 percent, does not apply to an award for medical, surgical, nursing, and hospital treatment. Indus. Comm'n v. Hammond, 77 Colo. 414 , 236 P. 1006 (1925).   Medical expense paid for a claimant under the workmen's compensation act is compensation within the meaning of the act. Morey Mercantile Co. v. Flynt, 97 Colo. 163 , 47 P.2d 864 (1935), citing Indus. Comm'n v. Globe Indem. Co., 74 Colo. 52 , 218 P. 910 (1923); Indus. Comm'n v. Lockard, 89 Colo. 428 , 3 P.2d 416 (1931).   And an employer is required to pay medical expenses only in cases in which he would be charged with the duty of paying other compensation. Morey Mercantile Co. v. Flynt, 97 Colo. 163 , 47 P.2d 864 (1935), citing Indus. Comm'n v. Globe Indem. Co., 74 Colo. 52 , 218 P. 910 (1923).   But if an injury is compensable, the employer has an absolute duty to provide medical and kindred relief at the employer's own expense. It cannot be made to depend upon any requirement of payment of medical assessments by the employee; such a requirement, in case of compensable injury, would be unlawful. Frank v. Indus. Comm'n, 96 Colo. 364 , 43 P.2d 158 (1935).   Employer's duty to provide future medical treatment. The fact that an employee had reached maximum medical improvement would not prohibit an award requiring an employer to provide future medical treatment reasonably necessary to relieve the claimant from the effects of an industrial injury. Grover v. Indus. Comm'n, 759 P.2d 705 (Colo. 1988); Milco Const. v. Cowan, 860 P.2d 539 (Colo. App. 1992).   However, there must be substantial evidence in the record to support a determination that future medical treatment will be reasonably necessary to accomplish the statutory purpose. Grover v. Indus. Comm'n, 759 P.2d 705 (Colo. 1988); Milco Const. v. Cowan, 860 P.2d 539 (Colo. App. 1992).   Where the administrative law judge failed to determine whether a physician's report constituted substantial evidence that future knee replacement surgery would be reasonably necessary, the industrial claim appeals office had no authority to conclude that such report did constitute such evidence. Milco Const. v. Cowan, 860 P.2d 539 (Colo. App. 1992).   In the absence of a recommendation for treatment that has a reasonable prospect for improving claimant's condition, the claimant may be found to be at maximum medical improvement. Gonzales v. Indus. Claim Appeals Office, 905 P.2d 16 (Colo. App. 1995).   Workers' compensation insurer not liable to reimburse no-fault automobile insurer for any medical expenses covered by director's fee schedule to the extent any fee listed in the schedule is exceeded. Law requires that parties undertake comparison of each expenditure for medical or other services covered by the schedule with the scheduled fee. Employers Fire Ins. v. Lumbermens Mut., 964 P.2d 591 (Colo. App. 1998).   Claimant has no right to receive medical care from a particular medical provider or to receive a particular type of treatment. Colo. Comp. Ins. Auth. v. Nofio, 886 P.2d 714 (Colo. 1994).   Treatment contemplated by the act includes all treatment, including legally recognized nonmedical treatment, reasonably necessary to relieve claimant from effects of an industrial injury. Suetrack v. Indus. Claim Appeals Office, 902 P.2d 854 (Colo. App. 1995).   Treatment to “relieve the employee from the effects of the injury” under subsection (1). If the evidence establishes that, but for a particular course of medical treatment, a claimant's condition can reasonably be expected to deteriorate so that the claimant will suffer a greater disability than sustained thus far, such treatment, irrespective of its nature, must be viewed as treatment designed to relieve the effects of the injury or to prevent deterioration of the claimant's present condition. Milco Const. v. Cowan, 860 P.2d 539 (Colo. App. 1992).   Employer not liable for costs of conservator or guardianship services for permanently and totally disabled claimant where the services do not cure or relieve the claimant of the effects of the injury. Such services are not “medical treatment” under subsection (1)(a). Nanez v. Indus. Claim Appeals Office, 2018 COA 162 , 444 P.3d 820.   Transportation expenses incidental to medical treatment. Claimant entitled to transportation expenses incidental to authorized medical treatment. Sigman Meat v. Indus. Claim Appeals Office, 761 P.2d 265 (Colo. App. 1988).   Expenses of exploratory operation disclosing disease precipitated by accident. Where claimant slipped and fell in course of employment, and the accident precipitated symptoms of a kidney disease, which was disclosed during an exploratory operation, resulting in removal of one kidney, regardless of any aggravation of claimant's preexisting condition, he was entitled to recover the amounts he expended for surgical and hospital treatment which was deemed by competent physicians reasonably necessary to relieve him from the effects of the accident. Merriman v. Indus. Comm'n, 120 Colo. 400 , 210 P.2d 448 (1949).   The mandate of this section is clear that in “all cases” a prosthetic device be furnished as may be reasonably required as a replacement where an employee has suffered a loss of a member or part of his body. Arkin v. Indus. Comm'n, 145 Colo. 463 , 358 P.2d 879 (1961).   Whether a hot tub was equipment reasonably necessary at the time of injury is applied in City and County of Denver v. Indus. Comm'n, 682 P.2d 513 (Colo. App. 1984).   Housekeeping services may be compensable if it can be demonstrated that such services are incident to any medically necessary attendant care services and are central to a claimant's physical injury. Valdez v. Gas Stop, 857 P.2d 544 (Colo. App. 1993).   Panel did not err in determining that child care services did not constitute a compensable medical benefit under subsection (1)(a). Kuziel v. Pet Fair, Inc., 931 P.2d 521 (Colo. App. 1996).   Panel did not err in determining that claimant was not entitled to prepayment of hotel and meal expenses incurred while traveling to see his authorized treating physician. Winter v. Indus. Claim Appeals Office, 2013 COA 126 , 321 P.3d 609.   Medical prescription alone is insufficient to support a claim for compensation for housekeeping services where claimant testified that she was unable to perform only certain household duties and was able to continue to work and attend a vocational education program. Valdez v. Gas Stop, 857 P.2d 544 (Colo. App. 1993).   Housekeeping services provided by attendant compensable. Facts were sufficient to support the ALJ's finding that the attendant care services were necessary assistance, were reasonable, and were compensable under subsection (1)(a). Atencio v. Quality Care, Inc., 791 P.2d 7 (Colo. App. 1990).   Housekeeping services are not compensable under this section unless the services either enable the claimant to obtain medical care or treatment or, alternatively, are relatively minor in comparison to the medical care and treatment. Country Squire Kennels v. Tarshis, 899 P.2d 362 (Colo. App. 1995).   This section requires an employer to compensate an employee's spouse who provides home care services to the employee, if such services are more than ordinary household services and the injury is of a nature that requires an attendant to remain nearby or on call. The fact that a spouse performs household tasks when not actually providing specific services to the injured employee does not affect the nature of the home care services provided to the employee by the spouse. Edward Kraemer & Sons, Inc. v. Downey, 852 P.2d 1286 (Colo. App. 1992).   Home health care services provided to claimant by claimant's wife were compensable where authorized physician referred claimant to and for such services, but none were available in claimant's rural locale. Suetrack v. Indus. Claim Appeals Office, 902 P.2d 854 (Colo. App. 1995).   Award to claimant for room and board during the time when claimant, although discharged from the hospital, was required to remain in Denver for treatment, and during that period he was paying rent for an apartment at Granby, must be considered correct as being incident to secondary hospital services. Indus. Comm'n v. Pacific Employers Ins. Co., 120 Colo. 373 , 209 P.2d 908 (1949).   But where no hospitalization was indicated and claimant was not required to maintain two places of residence, but was living with his wife and going to the physician's office for treatments, an award for room and board was not proper. Indus. Comm'n v. Pac. Employers Ins. Co., 120 Colo. 373 , 209 P.2d 908 (1949).   Snowblower is not an “apparatus” necessary to relieve the claimant from the effects of his injury. ABC Disposal Servs. v. Fortier, 809 P.2d 1071 (Colo. App. 1990).   Stair glider is not “apparatus” necessary for the treatment of the claimant's injury or for therapeutic relief from the effects of the claimant's injury. Cheyenne County Nursing Home v. Indus. Claim Appeals Office, 892 P.2d 443 (Colo. App. 1995).   Wheelchair-accessible van is not a medical aid reasonably necessary for treatment of claimant's injury. Van does nothing to care for or remedy injury and does not provide therapeutic medical relief from effects or symptoms of injury. Bouge v. SDI Corp., Inc., 931 P.2d 477 (Colo. App. 1996).   Employer must make such improvements or modifications to the claimant's residence as may be necessary to allow the claimant access to, and the use of, those portions of the residence that provide for the claimant's health and medical necessities. Cheyenne County Nursing Home v. Indus. Claim Appeals Office, 892 P.2d 443 (Colo. App. 1995).   Lawn care services held not medically necessary. Unlike housekeeping services such as cooking, lawn care does not bear a direct relation to a person's physical needs. Hillen v. Tool King, 851 P.2d 289 (Colo. App. 1993).   The benefit ceiling on prosthetic devices does not deny claimant equal protection of the law and the statute is not unconstitutional. Reynolds v. Indus. Claim Appeals Office, 794 P.2d 1083 (Colo. App. 1990).   Where not necessitated by anatomical change, a finding that no replacement prosthesis would be awarded was correct. Reynolds v. Indus. Claim Appeals Office, 794 P.2d 1080 (Colo. App. 1990).   The industrial commission may not disregard the provisions of this section, and impose upon the employer or insurance carrier a burden greater than that fixed by statute. John Thompson Grocery Stores Co. v. Indus. Comm'n, 85 Colo. 576 , 277 P. 789 (1929).   Thus, industrial commission may not award compensation for permanent disability when there is none. The fact that an injured employee might have suffered a permanent disability equal to the loss of a leg at the knee, had he not had additional medical and surgical treatment after having exhausted the statutory amount furnished by the employer, did not justify the commission in awarding compensation for such a permanent disability when in fact there was no such result from the injury. John Thompson Grocery Stores Co. v. Indus. Comm'n, 85 Colo. 576 , 277 P. 789 (1929).   Order requiring employer to give bond is not unreasonable. Order of the industrial commission requiring employer to give bond in the sum of $1,500, to insure the payment of medical expense and awarded compensation, is not unreasonable under this section. Kamp v. Disney, 110 Colo. 518 , 135 P.2d 1019 (1943).   No “particular” or specific course of treatment is necessary to warrant award for maintenance care. Stollmeyer v. Indus. Claim Appeals Office, 916 P.2d 609 (Colo. App. 1995).   But a showing of need for treatment is not met by simply proving that degenerative changes will occur. Where it appears that no treatment could prevent or relieve degeneration, an award of ongoing medical benefits is inappropriate. Stollmeyer v. Indus. Claim Appeals Office, 916 P.2d 609 (Colo. App. 1995).   Burden is on claimant to prove entitlement to ongoing medical benefits by a preponderance of the evidence. Lerner v. Wal-Mart Stores, Inc., 865 P.2d 915 (Colo. App. 1993).   Applied in Robbolino v. Fischer-White Contractors, 738 P.2d 70 (Colo. App. 1987).