Court Opinion

ID: 9757636
Source: CourtListenerOpinion
Date Created: 2023-08-28 22:50:30.426532+00
Date Added: 2024-06-11T07:28:41.767169
License: Public Domain

Judge RICHMAN
dissenting.
I respectfully dissent from the majority's conclusion for the following reasons.
In addition to stating that claimant was at MMI and setting forth his opinion of claimant's impairment rating, the report of the DIME physician suggested the possibility that claimant may be entitled to future medical benefits. Specifically, the report recommended, as part of his maintenance care, that claimant have repeat x-rays of the lumbar spine, including flexion extension films, and possible surgical evaluation.
As the majority notes, in its application for a hearing, employer listed "overcoming" the DIME's impairment rating as one of the issues to be decided. Claimant filed a response to the application for hearing listing as issues the penalty sought by the employer for the safety rule violation, and "overcoming" the DIME's impairment rating, but made no mention of a request for hearing on the future medical benefits.
When employer's counsel stated on the record at the hearing before the ALJ on June 4, 2009, that it was withdrawing its opposition to the DIME's impairment rating and only wished to contest the requested reduction in benefits due to the safety violation, the ALJ asked claimant's counsel if there were any issues from claimant's perspective. His counsel responded: "No. We believe it's [employer's] burden. It's a safety violation, and that's what we're here for." Thereafter, the record reflects no mention of future medical benefits. Moreover, the ree-ord reflects no request by either party to the ALJ to reserve any issue.
The only issue listed for decision in the ALJ's June 19, 2009, corrected summary order is whether claimant's injury was caused by his willful failure to obey a reasonable safety rule. The order rejects employer's request to reduce benefits due to the alleged safety violation, directs employer to pay PPD benefits based on the DIME's impairment rating, allows an offset to employer for an overpayment of benefits, and adds statutory interest on all amounts due. The order makes no mention of future medical benefits. Applying the rule of Grover and Milco Construction v. Cowan, 860 P.2d 539, 541 (Colo.App.1992), at this point claimant's right to future medical benefits was waived by not being substantiated at the time of hearing on the final award for permanent disability benefits. "[There must be substantial evidence in the record to support a determination that future medical treatment will be reasonably *637necessary ... [alnd, this need must be substantiated at the time of hearing on the final award for permanent disability." Milco, 860 P.2d at 541 (internal citation omitted).
Claimant argues, and the majority agrees, that because paragraph 12 of the summary order states that "issues not expressly decided herein are reserved to the parties for future determination," claimant's right to future medical benefits was reserved. I find nothing in the record that would support this sentence as referring to, or encompassing, a reservation of the issue of future medical benefits. From the record, there would be no reason for the ALJ to contemplate that future medical benefits was an issue.
Nonetheless, the majority interprets the Hanna decision as applicable here, stating that nothing in Hanna supports employer's contention that a reservation clause must expressly refer to medical benefits. I disagree.
Honma holds that "unless an ALJ's award of benefits expressly reserves other issues for future determination, the 'award' closes the claim...." 77 P.3d at 866. Hanna does not explain what is required for an order to "expressly reservel ]" other issues. Id. However, because it cites to Brown & Root, and correctly describes that decision as containing an "express reservation of jurisdiction over the subject of permanent disability," Hanna, 77 P.3d at 866, I view Hanno as requiring specificity of the issue reserved in order to prevent the award from having the effect of closing the claim.
Here, the ALJ's reservation did not specify any issue that was reserved. Rather, it used the expression "(issues not expressly decided herein." There could have been any number of issues not expressly decided in the ALJ's order, and I cannot conclude that they all were reserved. However, as future medical benefits were not specified in the reservation clause, and admittedly were not raised before the ALJ, I cannot agree that this reservation language reserved the issue of future medical benefits.
Thus, I would set aside the Panel's order.