In Atencio, the Colorado Court of Appeals (the Court) held that respondents were not required to reopen claimant’s case after filing their final admission of liability to recoup an overpayment.
In this case, the claimant suffered an admitted work-related injury to his right shoulder in February 2020. The claimant was placed at maximum medical improvement approximately two years later with a 17% upper extremity impairment rating. The respondents’ final admission of liability, filed in January of 2022, admitted to partial disability benefits based on a scheduled impairment and overpayment of approximately $500 to be collected from the partial disability benefits. No other overpayments were noted on the final admission.
The claimant subsequently objected to the final admission based on entitlement to conversion of his scheduled impairment rating to a whole person impairment rating. In response, the respondents endorsed the issue of apportionment, based on a right shoulder injury rating the claimant had received in a prior claim that arose from a separate 2006 work-related injury. At hearing, the claimant argued that the respondents’ final admission closed any issue regarding apportionment.
The ALJ denied the claimant’s request for conversion to whole-person impairment and determined that the respondents were entitled to an apportionment of the current rating. In rejecting the claimant’s argument regarding closure of the apportionment issue, the ALJ found that the claimant’s conversion request implicated the entire disability award and, therefore, the admission was not closed with respect to the respondents’ apportionment request. In apportioning the disability benefits, the ALJ held that the claimant was not entitled to disability benefits for the instant claim because the prior injury’s rating exceeded the new injury’s rating.
Four months after the ALJ’s order, the respondents filed an application for hearing, endorsing the issue of recoupment of an overpayment. The respondents did not check the box for reopening the claim on that application.
At the hearing regarding this issue, the claimant argued that the ALJ had no jurisdiction to determine the overpayment issue because “(1) the issue had been closed by the January 2022 admission; and (2) the respondents never endorsed reopening as an issue to be considered.” The ALJ rejected the claimant’s arguments, finding that the overpayment issue was not closed because it had not existed until the August 2022 order. Even if the issue was closed, “nothing in C.R.S. §8-43-303 (2023), mandated the filing of a formal petition to reopen a claim to confer jurisdiction on him to determine whether there was an overpayment.”
On review, the Industrial Claim Appeals Office (the Panel) affirmed the ALJ’s decision, specifically concluding that the overpayment issue was not closed by the respondents’ admission because the claimant had contested it, and because the ALJ’s August 2022 order created overpayment, not the respondents’ admission. The claimant appealed the Panel’s decision.
The Court first reviewed the rules regarding claim closure; specifically:
A workers’ compensation case automatically closes as to issues admitted in the admission if the claimant does not, within thirty days after the date of the admission, contest it in writing and ask for a hearing on any disputed issues that are ripe for a hearing. § 8-43-203(2)(b)(II)(A), C.R.S. 2023; Leewaye, 178 P.3d at 1256; see also Dyrkopp v. Indus. Claim Appeals Off., 30 P.3d 821, 822 (Colo. App. 2001)(an uncontested admission automatically closes a case as to issues admitted in the admission). Once a case has been closed by the filing of an uncontested admission, the issues raised in it cannot be litigated further unless the claim is reopened under section 8-43-303. See Berg v. Indus. Claim Appeals Off., 128 P.3d 270, 272 (Colo. App. 2005). In cases involving an overpayment, as described in section 8-42-113.5, C.R.S. 2023, the judge shall order recovery of overpayments in accordance with that section. § 8-43-303(1).
Further, the Court stated that the statute addressing overpayments provides that a party may recover an overpayment after an admission has been filed, provided that any such request for a recovery is “asserted within one year after the time the requester knew of the existence of the overpayment.” §8-42-113.5(1)(b.5)(I). Importantly, no language in that statute requires the party seeking the overpayment file a petition to reopen to recoup it; rather, it only requires the party file an application for hearing within one year of knowing of the overpayment’s existence.
The Court held that, contrary to the claimant’s assertion, the overpayment was not created by the admission. Rather, as the ALJ and the Panel decided, the overpayment did not exist until the ALJ determined that the claimant’s current disability rating was affected by the prior injury. The Court further held: “Regardless of whether the respondents knew or should have known about the claimant’s prior injury, (1) because the claimant’s challenge to the admission implicated the entire disability award; (2) any overpayment issue could not have been known at the time the admission was filed; since (3) the amount of the disability payment was disputed until the judge decided the apportionment of the injury.”
The Court ultimately agreed with the Panel and ALJ that the respondents were not required to reopen the claim to recoup the overpayment of disability benefits. By filing an application for hearing to recoup that overpayment within one year of the order that created the overpayment, the judge had jurisdiction to hear the overpayment issue and to order claimant to repay any overpayment.
Atencio v. Indus. Claims Appeals Office, Rio Grande County, and County Workers’ Compensation Pool, No. 23CA2245 (Colo. App. Aug. 1, 2024)
Want to know more? Contact Katherine Lee at [email protected] or 877-259-5693.
