85 Sanchez v. Industrial Claim Appeals Office
2017 COA 71
Colo. Ct. App.2017Background
- Michael Sanchez, a Denver Water employee, injured his back at work in March 2015; initial treating physician diagnosed thoracic (mid‑back) injury and released him to full duty by May 2015.
- After MMI for the mid‑back, Sanchez reported worsening low‑back pain; imaging showed age‑related degenerative changes and specialists and treating physician (Dr. Macaulay) disagreed on causation.
- Sanchez sought temporary partial and total disability (TPD/TTD) benefits; an ALJ found his low‑back condition not work‑related and that he had no wage loss, denying benefits.
- The Industrial Claim Appeals Office (Panel) affirmed the denial but remanded on the physician‑change issue; Sanchez appealed, raising constitutional (separation of powers, equal protection) and statutory/evidentiary challenges.
- The Court of Appeals affirmed the Panel: rejected constitutional challenges, held Denver Water’s on‑site clinic met the statutory exemption, and found substantial evidence supporting the ALJ’s causation finding.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Separation of powers — use of executive‑branch ALJs and Panel | Hearing by executive‑branch ALJs/Panel violates separation of powers; workers’ compensation involves private rights needing judicial officers | Existing scheme permits executive adjudication with appellate review by courts; overlap of branches is permissible | Rejected; prior precedent upheld scheme and judicial review by appellate courts protects judicial function |
| Equal protection — standard of review | Sanchez: hearing rights implicate fundamental right so strict scrutiny applies | Defendants: benefits and claimants are not a suspect class nor a fundamental right; rational‑basis applies | Rational‑basis applies; claimants not suspect class and workers’ comp benefits not fundamental |
| Equal protection — use/selection of ALJs and Panel (not gubernatorial/voter selected) | Executive selection/indefinite tenure leads to unequal treatment vs. civil litigants | Workers’ comp litigants are a distinct class surrendered to statutory scheme; executive adjudication furthers efficiency and prompt resolution | Rejected; classification rationally related to legitimate governmental purposes; prior Colorado cases support constitutionality |
| Equal protection — Panel named as party and represented by AG | Naming Panel as defendant and AG representation creates improper dual role and bias | Statute expressly requires naming Panel; similar practices exist elsewhere; AG representation is proper for enforcement and review | Rejected: no showing of actual partiality or impermissible appearance; naming Panel and AG representation are not arbitrary |
| Equal protection — §8‑43‑404(5)(a)(II)(A) exemption (govt employers not required to provide list of 4 physicians) | Exemption deprives governmental employees of physician choice and singles them out | Exemption limited to entities with occupational health systems; rational basis: such entities can operate internal provider systems, reducing cost and increasing efficiency | Rejected: exemption rationally related to legitimate legislative purpose; not arbitrary |
| Statutory/regulatory compliance & causation (non‑constitutional) | Denver Water’s clinic lacks required physician supervision; ALJ lacked substantial evidence to find low‑back pain non‑work‑related; evidentiary rulings erroneous | Clinic met regulation (physician reasonably available and provides medical supervision); ALJ credited treating physician; record supports causation finding and evidentiary rulings | Rejected: clinic satisfies "reasonably available" supervision; ALJ’s causation finding is supported by substantial evidence; evidentiary complaints undeveloped or unpersuasive |
Key Cases Cited
- Dee Enters. v. Indus. Claim Appeals Office, 89 P.3d 430 (Colo. App. 2003) (upholding workers’ compensation administrative scheme against separation‑of‑powers challenge)
- Culver v. Ace Elec., 971 P.2d 641 (Colo. 1999) (explaining equal protection review standards)
- Mathews v. Eldridge, 424 U.S. 319 (U.S. 1976) (due process balancing in administrative benefit termination contexts)
- Dillard v. Indus. Claim Appeals Office, 134 P.3d 407 (Colo. 2006) (holding workers’ compensation claimants are not a suspect class and benefits not a fundamental right)
- Faulkner v. Indus. Claim Appeals Office, 12 P.3d 844 (Colo. App. 2000) (proof of causation is threshold and ALJ determinations on causation are factual and entitled to deference)
- Pepper v. Indus. Claim Appeals Office, 131 P.3d 1137 (Colo. App. 2005) (burden on challenger to prove statute unconstitutional beyond a reasonable doubt)