Doctors often have conflicting diagnoses over the same injury. Unfortunately, in the context of workers’ compensation claims, the administrative law judge (ALJ) is the sole decider of which doctors’ testimony is given the most credibility. The difficulty of this subjective judgment-call was displayed by the claim made by Mr. Simon’s client, Robert Mondragon.
Mr. Mondragon was employed by Excel Energy as a gas meter repairman. His duties included lifting a gas meter (weighing upwards of 90 pounds) from a pallet up and onto a work bench, making necessary repairs, then returning the gas meter back down to the pallet. On Friday September 9, 2005, Mr. Mondragon lifted a gas meter that weighed 80 pounds from the pallet to the workbench and back down, and began to feel pain in his lower back during his drive home after work.
After the pain increased over the weekend, Mr. Mondragon was directed by his supervisor to seek medical attention from Dr. Bilthuis on September 12, 2005. At the visit, Dr. Bilthius recorded a history of lower back pain, which had also moved into the lower abdomen.
On September 16, 2005, the pain reached an unbearable level for Mr. Mondragon, so he elected to visit the emergency room at Swedish Medical Center. An MRI taken showed a central disc protrusion at the L2-3 and L4-5 levels of his lumbar spine. The treating physician, Dr. Kuper, opined that because Mr. Mondragon’s history of back pain chronologically followed lifting at work, the injury was likely work-related.
Unconvinced that the injury was work-related, the respondent forced Mr. Mondragon into a reevaluation by Dr. Shaw. Dr. Shaw testified that research showed that occupation and sport played a small roll in disk degeneration, and that Mr. Mondragon’s injury was not work-related.
Mr. Mondragon then sought a third opinion by Dr. Hughs, who testified that the claimant had sustained a lumbar strain with probable development of an acute annular ligament tear centered around the L3-4 level.
The ALJ conveniently concluded that the opinion of Dr. Shaw was more credible and persuasive than any of the other treating physicians. The ALJ then denied and dismissed Mr. Mondragon’s claim, stating his injuries were not a result of the September 9, 2005, incident.
Undeterred by the ALJ’s judgment, Mr. Simon appealed the decision contending that the ALJ’s determination that Dr. Shaw’s opinion was more credible was not supported by substantial evidence.
To preface the difficulty of an appeal in workers’ compensation claims, there are several key concepts to understand. First, the ALJ is given extremely broad discretion to make finds of fact and inferences, compare the relative worth of all testimonies, and ultimately make a final binding order for the case. City of Aurora v. Vaughn, 824 P.2d 825 (Colo. App. 1991). Second, due to this large discretion, the Panel will only overturn an ALJ for an abuse of discretion when the record reveals abuse rising to a level that exceeds the bounds of reason or if there was fraud. Renz v. Larimer County School District Poudre R-1, 924 P.2d 1177 (Colo. App. 1996); Louisiana Pacific Corp. v. Smith, 881 P.2d 456 (Colo. App. 1994). However, the Panel will uphold an ALJ’s decision if supported by substantial evidence in the record, even if an equally plausible decision could have been reached. Dover Elevator Co. v. Industrial Claim Appeals Office, 961 P.2d 1141 (Colo. App. 1998).
Regardless, Mr. Simon asserted that Dr. Shaw’s opinion contradicted the testimony of the other physicians who found “a job related injury.” Though the panel did not deny that there was contradicting evidence to Dr. Shaw’s opinion, the Panel found that there was sufficient evidence in the medical record to support his conclusion. Therefore, the Panel reemphasized that the judgment of the credibility afforded to each witness was given to the ALJ, and the contradicting evidence did not support a reversal on appeal.
Mr. Simon finally argued that Dr. Shaw had an economic motivation behind his conclusion that Mr. Mondragon’s injury was not job related. Once again, the Panel held that this was an argument to be answered by the ALJ, and was not an allowable judgment on review.
The Panel concluded that the record supported the ALJ’s conclusion and affirmed his decision to deny compensation for Mr. Mondragon’s injury.
Mr. Simon is well-aware of the Panel’s tremendous deference to the ALJ’s decision to award or deny compensation to workers’ compensation claimants. However, Mr. Simon has promised every client that he will do everything within his power to get the compensation that he or she deserves. So, like in the case of Mr. Mondragon, Mr. Simon is fully prepared to fight an uphill battle against a detrimental ALJ decision regardless of the difficulty of appeal.