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Hall v. Industrial Claim Appeals Office of the State of Colorado2/27/2003
ORDER AFFIRMED
OPINION PREVIOUSLY ANNOUNCED AS "NOT PUBLISHED PURSUANT TO C.A.R. 35(f)" on February 27, 2003, IS NOW SELECTED FOR PUBLICATION April 10, 2003
In this workers' compensation proceeding involving a request for medical utilization review (MUR), Timothy O. Hall (provider) seeks review of the final order of the Industrial Claim Appeals Office (Panel) upholding the change of physician order entered by the director of the Division of Workers' Compensation and the administrative law judge (ALJ). We affirm.
On August 22, 1996, Nancy Glass (claimant) sustained an industrial injury to her tailbone and hip area. She subsequently developed low back pain and anterior pelvic pain.
On March 22, 1999, the division received the request of the insurance company for a review of provider's treatment. The members of the MUR panel unanimously agreed that the provider's care was not reasonably appropriate according to professional standards to cure and relieve the claimant of the effects of her on-the-job injury. They also unanimously agreed that the provider's treatment plan did not follow the medical treatment guidelines and that the deviations were not reasonable and necessary. The members unanimously recommended that the provider should not continue to treat the patient. Thus, on July 22, 1999, the director entered an order changing claimant's provider in accordance with the MUR panel's recommendations and § 8-43-501(4), C.R.S. 2002.
Both the ALJ and the Panel upheld the director's order on review.
I.
The provider first contends that the MUR panel erroneously relied on the division's medical treatment guidelines to determine that his medical care of claimant was not reasonably appropriate. We disagree.
The division's medical treatment guidelines, which are contained in Dep't of Labor & Employment Rule XVII, 7 Code Colo. Regs. 1101-3, were established by the director pursuant to an express grant of statutory authority. See § 8-42-101(3.5)(a)(II), C.R.S. 2002 (to be repealed effective July 1, 2003). The guidelines are to be used by health care practitioners when furnishing medical aid under the Workers' Compensation Act. Section 8-42-101(3)(b), C.R.S. 2002. Further, Dep't of Labor & Employment Rule XV (H)(2), 7 Code Colo. Regs. 1101-3, specifically provides that MUR panel members must consider all applicable medical treatment guidelines and authorizes the division to provide copies of the guidelines to panel members upon request.
Given the foregoing authority, we are convinced that the statutory and regulatory scheme for a MUR contemplates that the division's medical treatment guidelines are to be regarded as the accepted professional standards for care under the Workers' Compensation Act.
The provider, however, asserts that the guidelines specifically state that they are not to be considered the legal standard of professional care and, therefore, claims that the MUR panel members incorrectly used the guidelines to determine whether the provider's treatment was reasonably appropriate according to accepted professional standards. We disagree.
The provider relies upon the introduction included in each treatment guideline, which states:
The Division recognizes that acceptable medical practice may include deviations from these guidelines. Therefore, these guidelines are not relevant as evidence of a provider's legal standard of professional care. E.g. Dep't of Labor & Employment Rule XVII, Exhibit A, Low Back Pain Medical Treatment Guidelines, 7 Code Colo. Regs. 1101-3.
However, contrary to the provider's position, we agree with the Pa
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