Opinion ID: 4535064
Heading Depth: 2
Heading Rank: 2

Heading: Whether an ALJ Can Determine MMI Status

Text: ¶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 13 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.
¶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 14 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-four- 5We 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. 15 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.