## Facts

- Dale Ruff injured his knee while working for the City of Manassa and sought workers’ compensation benefits.
- Ruff’s treating physician did not believe Ruff had reached maximum medical improvement (MMI).
- The employer/carrier arranged an independent medical examination (IME) with a physician who had ongoing financial relationships with the carrier, Pinnacol Assurance.
- The IME physician received referrals through Pinnacol’s SelectNet program, and about 25% of his income came from those referrals.
- The physician also served as a medical advisor to Pinnacol, receiving a daily rate for that work, and his contract required him to exercise independent medical judgment.
- The IME physician opined Ruff had reached MMI and had a permanent impairment rating.
- Ruff sought a protective order to bar or disqualify the IME physician based on alleged conflict of interest or appearance of conflict.
- An administrative law judge (ALJ) denied disqualification; a later ALJ allowed Ruff to present bias evidence but Ruff presented none, and the ALJ credited the IME opinion.
- The Industrial Claim Appeals Office (ICAO) affirmed the ALJs; the court of appeals remanded for reconsideration under a broader “appearance of conflict” reading of the rule.

## Issues

1. Whether an IME physician’s contractual and financial ties to a workers’ compensation insurer constitute a disqualifying conflict of interest (including an “appearance of conflict”) under Workers’ Compensation Rule of Procedure 11-2.
2. Whether an appellate court may substitute its own interpretation of Rule 11-2 for the ICAO’s reasonable interpretation of its rule.
3. Whether, absent evidence of actual bias or improper conduct in the examination, the ALJ may rely on the IME opinion despite the physician’s insurer relationships.

## Decision

- The Colorado Supreme Court reversed the court of appeals and reinstated the ICAO’s and ALJs’ orders.
- The Court held the ICAO’s interpretation of Rule 11-2 was entitled to deference because it was reasonable and consistent with the rule.
- The Court held the IME physician’s insurer relationships, without more, did not create a disqualifying conflict of interest or appearance-based ground for disqualification under Rule 11-2.
- The Court upheld reliance on the IME opinion where the claimant presented no case-specific evidence of actual bias or improper influence.

## Legal Principles

- A reviewing court should defer to a reasonable administrative agency interpretation of the agency’s own procedural rule unless the interpretation is plainly erroneous or inconsistent with the rule.
- Workers’ Compensation Rule of Procedure 11-2 does not impose per se disqualification of an IME physician based solely on an ongoing financial or contractual relationship with an insurer.
- A generalized allegation that an IME physician frequently performs work for an insurer is insufficient to invalidate an IME absent a direct, case-related conflict or evidence of actual bias or improper conduct.
- Credibility and weight determinations regarding IME opinions are for the ALJ, and are sustained when supported by the record and consistent with governing rules.

## Conclusion

The Colorado Supreme Court upheld the IME and the benefits determinations based on it, ruling that the ICAO’s narrower conflict standard under Rule 11-2 controlled and that the insurer’s business relationships with the IME physician, without proof of case-specific bias or a direct conflict, did not require disqualification.


City of Manassa v. Ruff, 235 P.3d 1051 (Colo. 2010)