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Conklin v. Core-Mark International/Cor., W.C. No. 4-828-815 (2011).
Industrial Claim Appeals Office
Michael Conklin was hired as a driver by Core-Mark International/Cor on April 19, 2010. Unfortunately, Mr. Conklin sustained a work-related injury on June 28, 2010 that forced him into a medical leave. Equally unfortunate for Mr. Conklin, was his employer’s policy that health insurance was available to full-time employs only after 90 days of active, continuous employment.
In order to receive the benefits he needed for his injury, Mr. Conklin turned to Mr. Simon to help navigate the complications of the workers’ compensation injury. Mr. Simon, aware of the employer’s 90-day health insurance coverage policy, believed that Mr. Conklin was entitled to an increase in his adjusted weekly wage (AWW) in order to cover the cost of obtaining health insurance through Mr. Conklin’s employer or purchasing a similar or lesser plan.
Mr. Simon asserted that, under 8-42-102(3) C.R.S., an administrative law judge (ALJ) has discretion in the computation of the AWW of an injured worker. Therefore, due to the unique circumstances presented by the short time span between Mr. Conklin’s date of hire and date of injury, the ALJ should properly exercise his discretion to include into his computation the cost of obtaining health insurance for Mr. Conklin. The ALJ, relying upon the Colorado statutory definition for “wages” concluded that, since Mr. Conklin had not yet received any health insurance benefits, there was no “cost” associated with Mr. Conklin obtaining a health insurance plan on his own which could be included in his AWW.
Still under the belief that there was certainly a cost attributable to Mr. Conklin obtaining health insurance, Mr. Simon appealed the ALJ decision to the Industrial Claim Appeals Office (the Panel). 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).
The Panel ultimately upheld the decision of the ALJ and denied any increase to Mr. Conklin’s AWW.
Though the outcome was ultimately not in Mr. Conklin’s favor, Mr. Simon still fought an uphill battle against both a company policy and an ALJ decision for Mr. Conklin. This is the level of dedication which Mr. Simon exhibits for all of his clients to get them benefits that they deserve.