City of Manassa v. Ruff

Dale Ruff (plaintiff) injured his knee while employed with the City of Manassa (defendant). Ruff was treated by his physician and filed for workers’-compensation benefits against Manassa and its insurer, Pinnacol Assurance (Pinnacol) (defendant). Ruff’s treating physician did not find that Ruff reached maximum medical improvement. An independent medical examination (IME) was performed by another physician. Ruff applied for a protective order, contesting the IME physician’s connection with Pinnacol. The IME physician contracted with Pinnacol to participate in the SelectNet program, from which he received referrals in workers’-compensation cases from employers that were insured by Pinnacol. About 25 percent of the IME physician’s income came from these referrals. The IME physician’s contract with SelectNet indicated he was to exercise his independent, professional medical judgment in performing services. At a hearing before an administrative-law judge (ALJ), evidence revealed the IME physician was also a medical advisor for Pinnacol, earning $600 each day he worked. Based on the examination, the IME physician found Ruff had achieved maximum medical improvement and suffered permanent impairment. Relying on positions taken by the Industrial Claim Appeals Office (ICAO), the ALJ found the IME physician’s connections with Pinnacol did not create a conflict of interest and denied Ruff’s request for a protective order. Ruff applied for another hearing before a different ALJ. The second ALJ refused to hear issues on the qualifications of the IME physician but found that Ruff could challenge the physician’s opinion by introducing evidence of bias. Ruff did not present evidence showing bias. The second ALJ entered an order upholding the prior findings. Ruff appealed. The court of appeals found the ALJ did not sufficiently consider the IME physician’s relationship with Pinnacol and, relying on its own interpretation of the workers’-compensation rules, remanded the case for reconsideration on whether there was a conflict of interest. Ruff, Manassa, and Pinnacol filed for review.