Peitz v. Industrial Claim Appeals Office
2024 COA 102
| Colo. Ct. App. | 2024Background
- Jason Peitz, a mechanic, suffered a work-related lower back injury and later developed hip and groin pain.
- Peitz received multiple treatments, including lumbar fusion and bilateral hip replacement; disputes arose over whether his hip/groin symptoms were related to his work injury.
- An administrative law judge (ALJ) initially ruled Peitz’s hip and groin issues were not work-related and denied medical benefits for those conditions.
- After the authorized treating physician found Peitz at maximum medical improvement (MMI) with a 30% impairment, respondents requested a Division Independent Medical Examination (DIME), on which only “lumbar spine” was checked.
- The DIME physician (Dr. Ogden) opined Peitz was not at MMI due to chronic pain and left hip issues; the ALJ restricted this opinion to only the lumbar spine per the DIME form.
- On appeal, the Colorado Court of Appeals addressed whether the DIME physician's evaluation could extend to body parts not listed on the DIME form and whether earlier decisions precluded reevaluation of causality for Peitz’s other symptoms.
Issues
| Issue | Peitz's Argument | Respondents' Argument | Held |
|---|---|---|---|
| Can a DIME physician consider body parts not designated on the DIME form? | DIME can assess all relevant body parts in determining MMI. | DIME physician is limited to only the body parts checked on the DIME form per WCRP 11-5. | DIME may consider all relevant body parts, regardless of DIME form selections. |
| Does issue preclusion apply to the prior ALJ decision on hip and groin causation? | No, since prior issue (treatment eligibility) is not identical to current issue (MMI/impairment). | The prior adjudication that hip/groin are unrelated precludes further consideration of causation. | Issue preclusion does not apply; treatment and MMI are distinct and standards differ. |
| Was Dr. Ogden’s opinion on psychological treatment wrongly excluded? | Dr. Ogden tied need for psychological treatment mainly to back injury. | Dr. Ogden’s psychological recommendations were related only to hip/groin, already found unrelated. | The Panel erred; the chronic pain (psychological) need was mainly from the back injury. |
| Must the case be remanded after these rulings? | Yes, so ALJ can address all issues in line with court’s conclusions. | Not directly addressed. | Yes, the case is remanded with directions for the ALJ to reconsider issues appropriately. |
Key Cases Cited
- Leprino Foods Co. v. Indus. Claim Appeals Off., 134 P.3d 475 (Colo. App. 2005) (DIME physician may address diagnosis and causation of all components related to work injury in MMI determination)
- Martinez v. Indus. Claim Appeals Off., 176 P.3d 826 (Colo. App. 2007) (DIME physician’s scope includes assessment of all conditions related to the industrial injury)
- Sunny Acres Villa, Inc. v. Cooper, 25 P.3d 44 (Colo. 2001) (issue preclusion requires identical issues and same incentives to litigate in both proceedings)
- Holnam, Inc. v. Indus. Claims Appeals Off., 159 P.3d 795 (Colo. App. 2006) (issue preclusion inappropriate where different standards of proof apply)