Enterprise v. ICAO, 24CA0151

Fozia H. Mohamed was robbed at gunpoint twice while working at a gas station, resulting in severe PTSD.
Mohamed was diagnosed with chronic PTSD after the second robbery, experiencing debilitating symptoms that made it unsafe for her to be alone or drive.
She was declared permanently and totally disabled in 2014 and awarded ongoing workers' compensation benefits for maintenance care.
In 2022, Mohamed sought an order requiring her employer (Enterprise Claims Management, Inc. and insurer) to pay for daily attendant services to manage her PTSD.
The administrative law judge (ALJ) found Mohamed's request for attendant care was medically necessary due to her work-related PTSD and ordered the employer to pay for up to 12 hours daily.
The Industrial Claim Appeals Office panel affirmed the ALJ's order; the employer appealed to the Colorado Court of Appeals.

Issue	Mohamed's Argument	Employer's Argument	Held
Are non-medically skilled attendant services compensable	Attendant services relieve PTSD symptoms; thus, are medical	Such services lack required medical training; not compensable	Attendant services are compensable if medically necessary
Must treatment be "medical" or provided by skilled personnel	Plain language does not specify medical training required	Only skilled/medical provider services qualify as "medical"	Plain language does not require medical training
Are services incidental to other medical treatment required	Services themselves are treatment for PTSD, not incidental	Only services incidental to other care are compensable	Attendant services are directly compensable, not incidental
Substantial evidence for medical necessity	Expert/lay testimony shows services prevent exacerbation	Disputes credibility and necessity of such care	Substantial evidence supports ALJ's findings

Suetrack USA v. Industrial Claim Appeals Office, 902 P.2d 854 (Colo. App. 1995) (nonmedical, unskilled home services can be compensable if reasonably necessary for work injury)
Riley Fam. Tr. v. Hood, 874 P.2d 503 (Colo. App. 1994) (nonmedical services are compensable if reasonably necessary to relieve effects of work injury)
Bellone v. Industrial Claim Appeals Office, 940 P.2d 1116 (Colo. App. 1997) (childcare services for medical needs can be compensable as medical treatment)
Metro Moving & Storage Co. v. Gussert, 914 P.2d 411 (Colo. App. 1995) (deference owed to ALJ’s credibility determinations)
Country Squire Kennels v. Tarshis, 899 P.2d 362 (Colo. App. 1995) (services must be shown to be medical or incidental to compensable treatment)
Grover v. Industrial Commission, 759 P.2d 705 (Colo. 1988) (entitlement to maintenance medical benefits after maximum improvement)
Colo. Comp. Ins. Auth. v. Nofio, 886 P.2d 714 (Colo. 1994) (statute requires employer to provide necessary medical treatment)