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The Respondents May Bear the Burden of Proving Previously-Admitted Maintenance Medical Treatment No Longer Reasonable and Necessary

It long has been settled law that where the respondents file a final admission admitting for maintenance medical benefits, the respondents are not precluded from later contesting their liability for a particular treatment. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo. App. 1997). Moreover, when the respondents contest liability for a particular medical benefit, the burdeno f proof is on the claimant to prove that such contested treatment is reasonably necessary to treat the industrial injury and is related to that injury. Snyder v. Industrial Claim Appeals Office, supra.

However, section 8-43-201 was amended in 2009 to place the burden on the party seeking to modify an issue determined by an admission of liability or Order of an Administrative Law Judge. The Industrial Claim Appeals Office has determined that the amendment to § 8-43-201 could change the burden of proof to Respondents to show that medical treatment for which the respondents previously have admitted liability is not reasonable, necessary or causally related. Dunn v. St. Mary Corwin Hospital, W. C. No. 4-754-838 (October 1, 2013).  In Dunn, the respondents previously filed a Final Admission of Liability admitting for reasonable and necessary medical care causally related to the injury.  Several years later the respondents obtained an Independent Medical Examination, which opined that none of the claimant’s treatment after Maximum Medical Improvement was causally related to the original injury. At the hearing, the Administrative Law Judge determined that the practical effect of the respondents’ argument was that they were no longer liable for ongoing maintenance medical benefits,  which was contrary to the final admission of liability in which they had admitted for maintenance medical benefits. Therefore, the Administrative Law Judge placed the burden on the respondents to “prove by a preponderance of the evidence that none of the treatment by [the authorized treating physician] is reasonably necessary to cure or relieve the effects of the work injury.”

Interestingly, if the physician performing the IME for the respondent had opined that only some of the treatment the authorized treating physician was providing to the claimant was not causally related to the injury, then the burden of proof would have been on the claimant to prove the treatment in issue was causally related.  Therefore, respondents should be cognizant of this case and the effect a request to terminate all treatment will have on the burden of proof.

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