June 16, 2019

Colorado Supreme Court: Plain Language of Statute Prohibits Offsets for Medical Payment Benefits

The Colorado Supreme Court issued its opinion in Calderon v. American Family Mutual Insurance Co. on Monday, November 7, 2016.

Statutory Construction—Automobile Insurance Coverage—Automobile Insurance Setoffs— Uninsured or Underinsured Motorist Policy Coverage.

Calderon sustained injuries caused by an uninsured driver. Calderon was insured under policies issued by American Family Mutual Insurance Co., which paid the $5,000 policy limit of Calderon’s medical payments (MedPay) coverage but disputed the amount due under the uninsured/underinsured motorist (UM/UIM) coverage. Calderon filed suit, and the jury returned a verdict of $68,338.97 in his favor. The trial court reduced the award, pursuant to a provision of the policy agreement, by the $5,000 that had already been paid under MedPay coverage. The Colorado Court of Appeals affirmed, interpreting the language of C.R.S. § 10-4-609(1)(c), which prohibits setoffs from “[t]he amount of the [UM/UIM] coverage available pursuant to this section,” as barring only those setoffs that would reduce the coverage limit, or $300,000. The Colorado Supreme Court reversed and held that “[t]he amount of the [UM/UIM] coverage available pursuant to this section” refers to the amount of UM/UIM coverage available on a particular claim (here, $68,338.97), rather than the amount available in the abstract (here, $300,000). Therefore, C.R.S. § 10-4-609(1) barred the setoff of MedPay payments from Calderon’s UM/UIM claim.

Summary provided courtesy of The Colorado Lawyer.

Colorado Supreme Court: MMI Not Statutorily Significant Where No Final Admission of Liability Filed

The Colorado Supreme Court issued its opinion in Harman-Bergstedt, Inc. v. Loofbourrow on Monday, January 27, 2014.

Workers’ Compensation—Temporary Total Disability Benefits—Maximum Medical Improvement—Final Admission of Liability—Division-Sponsored Independent Medical Examination.

Harman-Bergstedt, Inc. and its insurer sought review of a court of appeals’ judgment reversing a decision of the Industrial Claim Appeals Office (Panel). The Panel had disallowed claimant’s award of total temporary disability (TTD) benefits, reasoning that once her treating physician placed her at maximum medical improvement (MMI), notwithstanding the failure of her injury to result in any work loss, TTD benefits could not be awarded for the injury for which she initially had been treated in the absence of a division-sponsored independent medical examination (DIME) challenging that placement. The court of appeals found that under the unique circumstances of this case—including the fact that claimant had never been awarded TTD benefits and her employer had never filed a final admission of liability from which the statutory window for seeking a DIME could be measured—a DIME was not a prerequisite to an award of TTD benefits.

The Supreme Court affirmed the court of appeals’ judgment. The Court held that because a determination of MMI has no statutory significance with regard to injuries resulting in the loss of no more than three days or shifts of work time, claimant’s award of TTD benefits was not barred by her failure to first seek a DIME.

Summary and full case available here.