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Rook v. Industrial Claim Appeals Office of the State of Colorado1/13/2005
ORDER AFFIRMED
Taubman and Ney, JJ., concur
In this workers' compensation proceeding involving a request for medical utilization review (MUR), Jack Rook, M.D. (provider), seeks review of a final order of the Industrial Claim Appeals Office (Panel) upholding the change of physician order entered by the director of the Division of Workers' Compensation and affirmed by the administrative law judge (ALJ). We affirm.
Marie Kilwein (claimant) sustained an admitted injury in 1980. Provider first evaluated claimant in 1990 and treated her thereafter, continuing after she reached maximum medical improvement in 1994.
In 2001, Safeco Insurance (insurer) requested an MUR to review provider's care. The request was accompanied by a sixty-two-page "medical chronology" prepared by a registered nurse, as well as over 1,000 pages of medical records. Claimant and provider submitted additional records.
A three-physician MUR panel reviewed the records and unanimously recommended that provider not continue to treat claimant. Giving "great weight" to the MUR panel's recommendation, the director entered a change of provider order. Provider then moved to strike the order based on insurer's asserted noncompliance with the statutory requirement that it submit a review of the services rendered along with its MUR request. The director denied the motion, finding that the nurse's medical chronology qualified as the report required by the statute.
Provider sought review of the director's orders in accordance with § 8-43-501(5)(a), C.R.S. 2004, and the ALJ upheld the orders. The Panel affirmed.
I.
Provider contends that insurer did not comply with the requirements set forth in § 8-43-501(2)(b), C.R.S. 2004, for commencing an MUR review, and that the director, the ALJ, and the Panel erred in reaching a contrary conclusion. We disagree.
A.
As an initial matter, we agree with provider that the current version of § 8-43-501(2)(b), enacted in 1994, rather than the earlier version cited by insurer, sets forth the procedure applicable to insurer's MUR request. See Kinninger v. Indus. Claim Appeals Office, 759 P.2d 766 (Colo. App. 1988) (while substantive rights and liabilities of parties in workers' compensation cases are determined by statute in effect at time of claimant's injury, procedural statutory amendments are applicable to all cases pending at time new statute becomes effective unless General Assembly has expressed a contrary intent); see also Division of Child Support Enforcement v. Indus. Claim Appeals Office, ___ P.3d ___ (Colo. App. No. 04CA0523, Dec. 2, 2004)(statute authorizing attachment of settlement proceeds for unpaid child support was procedural and could be applied retroactively); American Compensation Ins. Co. v. McBride, ___ P.3d ___ (Colo. App. No. 02CA2416, May 20, 2004)(procedural statutes in workers' compensation cases relate to remedies or modes of procedure to enforce rights or liabilities of parties).
Section 8-43-501(2)(b) states:
Prior to submitting a request for a utilization review pursuant to this section, an insurer, self-insured employer, or claimant shall hire a licensed medical professional to review the services rendered in the case. A report of the review shall be submitted with all necessary medical records, reports, and the request for utilization review.
B.
Provider argues that, (1) as a jurisdictional prerequisite to a request for MUR, § 8-43-501(2)(b) calls for an independent medical examination and a report analogous to the certificate of review required under § 13-20-602(3)(a), C.R.S. 2004, in professional malpra
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