Lizarraga v. southern/hartford
1 CA-IC 16-0075
| Ariz. Ct. App. | Oct 26, 2017Background
- Claimant injured his lower back lifting at work and filed a compensable workers’ compensation claim for lumbar strain/sprain with radicular symptoms.
- Hartford (carrier) initially closed the claim based on an IME by Dr. Lampert finding the claimant medically stationary; claimant protested and ALJ Halas awarded ongoing active medical treatment per treating Dr. Patel.
- Hartford did not seek review of that award but obtained a new IME by Dr. Borowsky and issued a second closure finding the claimant medically stationary and awarding limited supportive care.
- Claimant protested the reclosure; at hearings Dr. Patel reiterated need for additional physical therapy and trigger-point injections, while Dr. Borowsky concluded the condition was stationary and only allowed completion of ongoing therapy.
- ALJ Eaton adopted Dr. Borowsky’s opinion, closed active medical benefits, and awarded limited physical therapy; claimant appealed arguing issue/claim preclusion barred relitigation of the earlier award.
- The Court of Appeals held ALJ Eaton erred because Hartford’s new IME offered no qualitatively different evidence from the previously rejected IME, so preclusion prevented relitigation; the award was set aside.
Issues
| Issue | Claimant's Argument | Hartford's Argument | Held |
|---|---|---|---|
| Whether ALJ Eaton could adopt a new IME and reclose active medical benefits after a prior ALJ award ordering continued treatment | Preclusion bars relitigation; prior ALJ’s award of continuing treatment was final and Hartford’s new IME offered no qualitatively different evidence | This was a simple medical conflict; new IME permitted reclosing the claim | Court: Preclusion applies; ALJ erred adopting Dr. Borowsky because his opinion duplicated the previously rejected IME and was not qualitatively different |
Key Cases Cited
- Young v. Indus. Comm’n, 204 Ariz. 267 (discussing de novo review of legal questions)
- Lovitch v. Indus. Comm’n, 202 Ariz. 102 (evidence viewed in light most favorable to upholding ALJ findings)
- Circle K Corp. v. Indus. Comm’n, 179 Ariz. 422 (res judicata effect of ICA awards via issue and claim preclusion)
- Red Bluff Mines, Inc. v. Indus. Comm’n, 144 Ariz. 199 (elements and effect of issue preclusion)
- W. Cable v. Indus. Comm’n, 144 Ariz. 514 (application of claim preclusion to ICA proceedings)
- Stainless Specialty Mfg. Co. v. Indus. Comm’n, 144 Ariz. 12 (reopening not allowed for mere change in medical opinion)
- Bayless v. Indus. Comm’n, 179 Ariz. 434 (reopening allowed only when later evidence is qualitatively different and could not have been presented earlier)