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Court of Appeals upholds Administrative Law Judge’s application of “Significant Causative Factor” Test to Deny Permanent Total Disability Benefits to a Worker Without Prior Permanent Restrictions

In a prior post I analyzed an Order of an Administrative Law Judge which denied Permanent Total Disability benefits to an injured worker because the Administrative Law Judge found the injury was not a significant causative factor to her overall disability and inability to earn wages even though the claimant did not have any prior work restrictions and was released to work full duty at the time of the injury. The claimant appealed the Findings of Fact, Conclusions of Law and Order to the Industrial Claim Appeals Office, which affirmed the Administrative Law Judge’s denial of Permanent Total Disability benefits.

The claimant appealed the denial of benefits to the Court of Appeals, arguing that the Administrative Law Judge effectively found that the claimant was permanently totally disabled before the injury. The Court of Appeals disagreed, and affirmed the denial of Permanent Total Disability benefits. Apprill v. Industrial Claim Appeals Office, 14CA2234 (July 2, 2015)(Not Selected for Official Publication). In Apprill, the Administrative Law Judge found that the claimant’s physical condition from her non-work related medical problems had deteriorated to the point that she no longer was capable of working in any position for King Soopers without significant modification even before the industrial injury, even though no physician had provided any work restrictions prior to the industrial injury. Therefore, the Administrative Law Judge found that the claimant had failed to prove that the injury was a significant causative factor in her inability to earn wages. On appeal, the claimant argued that the Administrative Law Judge actually found that the claimant was permanently totally disabled prior to the injury and, therefore, did not apply the substantial causative factor test properly.

The Court of Appeals disagreed, finding that there was substantial evidence to support the plausible inference that the claimant was not capable of performing her job prior to the injury, even though she was working “full time for full wages.” The Court concluded that the critical inquiry was not on the claimant’s condition prior to the injury, but only on whether the work injury caused or directly contributed to her subsequent inability to work. As such, the Court of Appeals concluded that the Administrative Law Judge correctly applied the substantial causative factor test in finding that the claimant failed to prove the injury was a substantial causative factor in her inability to earn wages.

The Administrative Law Judge’s decision clearly turned on the unique facts of the case (i.e. the injured worker was of significantly advanced age, and medical records and employment records documented a significant deterioration in the claimant’s overall physical condition in the twelve months prior to her industrial injury which prevented her from being able to work any position for the employer without substantial modification). However, the decision shows that an employer can defeat a claim for Permanent Total Disability benefits by showing that the claimant’s condition before the injury was so deteriorated that the industrial injury did not further contribute to the injured worker’s subsequent inability to work.

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