In Enterprise and Cannon Cochran v. Mohamed, the Colorado Court of Appeals (the Court) held that daily attendant services were reasonably necessary as maintenance care for a claimant who sustained long-lasting mental health conditions from her work-related injuries.
In this case, the claimant was robbed at gunpoint in the course and scope of her employment twice in two years. The claimant developed severe PTSD was adjudged permanently and totally disabled by an ALJ in 2014. The employer filed a final admission of liability admitting to permanent total disability and authorizing maintenance care that was reasonably necessary and related to her PTSD diagnosis. The claimant filed an application for hearing in 2022 seeking medical benefits, specifically daily attendant services (a companion present most of the time) because her symptoms were aggravated when she was alone.
At hearing, the claimant presented lay testimony and expert testimony about how her condition decompensated at any time she was alone. It was established that the claimant needed constant support from her adult children because “aloneness” was a major trigger for the claimant’s PTSD. The employer countered with expert testimony that providing for the claimant to never be alone was enabling her poor adjustment and the claimant was “behaviorally limiting herself.” The employer further argued that attendant services were not medical services at all because the claimant’s children – the main attendants at that point – were not trained medical professionals.
The ALJ found for the claimant and ordered that the employer had to authorize and pay for up to 12 hours per day of attendant services. The ALJ reasoned that these services were causally related to the work injury and were necessary to maintain MMI. This order was appealed to the Court.
The Court noted that the Worker’s Compensation Act specifically requires employers to provide “medical, surgical, dental, nursing, and hospital treatment . . . as may reasonably be needed . . . to cure and relieve the employee from the effects of the injury.” § 8-42-101(1)(a)(I).”
Performing some statutory interpretation, the Panel determined that “nothing in the statute’s plain language requires that medical treatment be provided by a skilled provider or someone with medical training. Rather, the statute requires only that the medical treatment ‘cure and relieve the employee from the effects of the injury.’ § 8-42-101(1)(a)(I). And construing the plain language that way, divisions of this court have concluded that nonskilled services that cure or relieve an employee’s work-related injury may be compensable medical treatment under section 8-42-101(1)(a).”
The Court cited several prior decisions that reached similar conclusions on disputes related to the reasonable necessity of treatments. In fact, in some cases, family members were awarded compensation under the workers’ compensation system for caretaking and attendant type activities. The Panel. articulated an expansive rule for what may be considered medical treatment in Colorado:
Collectively, these cases indicate that a treatment is “medical” in nature — even if inherently nonmedical or provided by someone without medical training — so long as the treatment is reasonably necessary to relieve the symptoms of a claimant’s work-related injury. Thus, the unskilled attendant services requested by Mohamed could be compensable medical treatment if reasonably necessary to relieve the symptoms of her work-related PTSD.
Additionally, whether a particular modality of treatment is reasonably necessary is a factual determination to be resolved by an ALJ. Bellone, 940 P.2d at 1117. Therefore, the claimant’s petition for daily attendant care was reasonably necessary; the Court of Appeals upheld the ALJ’s original determination.
Enterprise Claims Management, Inc., v. Indus. Claim Appeals Office and Mohamed, No. 24CA0151 (Colo. Ct. App. Oct. 3, 2024).
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