Treatment From Unauthorized Provider

In Auto Owners Insurance, Petitioner settled a third-party claim for $5 million. The claim was brought against third parties involved in a workplace accident that left Petitioner disabled and receiving ongoing workers’ compensation benefits. Auto Owners Insurance Company, the employer’s workers’ compensation insurance carrier, began paying Petitioner’s medical and wage benefits, but stopped paying ongoing benefits once the third-party settlement had been reached. At that point, $2.1 million had been paid to Petitioner’s attorneys for attorney fees and other expenses associated with the third-party action. Additionally, the insurer paid $1.57 million in medical and indemnity benefits. The Workers’ Compensation Act allows for, and requires, that employers and carriers share in the recovery a Petitioner obtains resulting from third-party settlement.

In Hargon, the claimant was a retired military intelligence member of the United States Army. The claimant began work as a contract intelligence analyst, performing short-term contracts for various employers, including Respondent-Employer, for durations of approximately two to three weeks at a time. The claimant suffered a work injury in February 2024 while working with Respondent-Employer. Respondent-Employer admitted to an average weekly wage (“AWW”) of $123.10 initially, before later amending the admission of liability to reflect an AWW of $382.65 as calculated based on the claimant’s pre-injury earnings from another employer, CSA Global, LLC. The claimant contested the admitted AWW, arguing that the admitted rate failed to fully capture her lost earnings.

In Bane, the claimant was a school bus driver for the Lewis Palmer School District. On October 18, 2024, the claimant suffered a compensable work injury when he was exposed to exhaust from the school bus that he was driving. The claimant heard a whirring sound while driving and called dispatch to report the issue. The claimant was given a copy of the Lewis Palmer Driver’s Handbook at the beginning of his employment, which required a pre-trip vehicle inspection. The ALJ found that Respondents failed to present any credible or persuasive evidence to support the theory that the claimant violated a safety rule by failing to identify the leaking exhaust clamp in his pre- or post-trip inspections.

The claimant worked for the Colorado Department of Revenue from 2006 to 2012. In 2012, the claimant slipped and fell while working, suffering an admitted work injury. The claimant was placed at Maximum Medical Improvement and assigned a permanent impairment rating by Dr. Olson in April 2013. Respondents filed a Final Admission of Liability, admitting to Dr. Olson’s report. The claimant objected to the Final Admission of Liability; however, a settlement agreement was reached prior to any litigation. The claimant filed an application for a hearing to reopen her settlement pursuant to C.R.S. § 8-43-303, alleging that the settlement had been obtained through fraud and asserting that her cognitive issues had prevented the claimant from recognizing the alleged fraud.