Barba v. Industrial Claim Appeals Office.
2026 COA 15. No. 25CA0859. Workers’ Compensation—Medical Impairment Benefits—Final Admission of Liability.
March 12, 2026
Barba sustained a back injury while employed with Cardinal Health 200, Inc. (Cardinal). Barba subsequently had surgery and physical therapy, and his authorized treating physician (ATP) placed him at maximum medical improvement (MMI) on December 1, 2015. The ATP assigned a 25% whole person impairment rating and recommended post-MMI maintenance treatment. Cardinal’s insurance carrier was XL Specialty Insurance Company (XL), and XL’s third-party administrator was Sedgwick Claims Management Services, Inc. TPA (Sedgwick) (collectively, insurer). On behalf of Cardinal, insurer filed a final admission of liability (FAL) form that was consistent with the ATP’s report. Barba objected to the FAL and received a Division Independent Medical Examination (DIME) that confirmed the MMI date of December 1, 2015, and assigned a 24% whole person impairment rating. Insurer filed an amended FAL consistent with the DIME, and Barba’s case was then closed. Barba’s case was later reopened because he had experienced a change in condition causally connected to his original work injury, and in 2024, he underwent another DIME by Dr. Alvarez, who concluded that Barba had reached MMI on December 1, 2015, and assigned a 17% whole person impairment rating. In April 2024, the Division of Workers’ Compensation (division) issued a notice of “DIME Process Concluded.” In response, Sedgwick claims adjuster Spring filed an FAL on behalf of Cardinal and insurer stating that Cardinal and insurer admitted liability consistent with the report. As relevant here, on the FAL form Spring checked the “Yes” box for maintenance and care and wrote, “Pursuant to Dr. Bryan Alvarez’s medical report dated 03/28/2024.” Springer summarized Cardinal and insurer’s position regarding the benefits to which Barba was entitled “[p]ursuant to” the Alvarez report. Barba asserted that he was entitled to penalties under CRS § 8-43-304(1) because the reference to the Alvarez report in the FAL violated § 8-42-107(8)(f) in limiting his maintenance medical benefits by “t[ying]” them to the Alvarez report’s treatment recommendation. The administrative law judge (ALJ) denied Barba’s request for penalties, determining that whether the reference to the Alvarez report in the FAL constituted an improper limitation on maintenance benefits was a question of fact, which the ALJ found to simply indicate the rationale for Cardinal and insurer’s general admission to such benefits. An Industrial Claim Appeals Office Panel (panel) affirmed the ALJ’s order.
On appeal, Barba argued that insurer violated § 8-42-107(8)(f) by adding, next to the FAL’s “Yes” box for maintenance care after maximum medical improvement, a reference to Alvarez’s report recommending a specific maintenance program. Barba acknowledged that his appeal focused on an interpretation of § 8-42-107(8)(f). The Workers’ Compensation Act of Colorado requires employers submitting an FAL to admit liability for medical benefits by an authorized treating physician when an ATP recommends medical benefits after MMI and there is no contrary medical opinion in the record. The court of appeals interpreted the § 8-42-107(8)(f) provision stating that the “related reasonable and necessary medical benefits” admitted in an FAL “are not limited to any specific medical treatment” to mean that an employer can’t limit maintenance medical benefits to a specific medical treatment, and any attempt to do so is a nullity. Further, § 8-42-107(8)(f) neither prohibits an employer from referring to a physician’s report in a FAL when admitting liability for maintenance medical benefits nor implies that such a reference would constitute an impermissible limitation on benefits. Accordingly, the panel did not err in interpretating § 8-42-107(8)(f).
The panel’s order was affirmed.