Workers’ Compensation—Impairment—Maximum Medical Improvement—Permanent Partial Disability—Division-Sponsored Independent Medical Examination—Permanent Total Disability—Maintenance Medical Benefits—Causation—Due Process.

In 2012 claimant sustained serious injuries in a work-related accident in which he was struck in the head and shoulder and knocked to the ground by a robotic arm. In 2015 claimant’s primary authorized treating physician (ATP) assessed him as suffering from narcolepsy that was likely related to traumatic brain injury and placed him at maximum medical improvement (MMI) with a permanent impairment rating of 67% of the whole person. Mental health and medical experts that employer retained did not agree that the narcolepsy was caused by trauma from the work-related accident. A division-sponsored independent medical examination (DIME) agreed with the ATP that claimant reached MMI in 2015 and had narcolepsy, but he gave claimant a lower impairment rating. The DIME physician deferred to claimant’s ATP on the cause of claimant’s narcolepsy. Employer did not contest the DIME physician’s opinions, and filed a final admission of liability (FAL) accepting the MMI date and admitting claimant’s entitlement to permanent partial disability (PPD) benefits. However, employer did not admit liability for any continuing post-MMI maintenance benefits.

Claimant then filed for a hearing seeking permanent total disability (PTD) and future maintenance medical benefits. An administrative law judge (ALJ) denied and dismissed his claims, and a divided panel of the Industrial Claim Appeals Office affirmed the ALJ’s order.

On appeal, claimant contended that the ALJ erred in requiring him to prove his entitlement to PTD and maintenance medical benefits by a preponderance of the evidence. He asserted that the ALJ should have given the DIME opinion presumptive weight as to the cause of his injury and that employer should have been required to overcome the DIME’s causation opinion with clear and convincing evidence. A DIME physician’s opinions concerning MMI and impairment are afforded presumptive weight, but a DIME’s opinion as to the cause of a claimant’s injury does not have similar presumptive weight. Here, claimant’s claims involved neither MMI nor permanent impairment because those issues had already been conceded by employer in its FAL. Therefore, claimant bore the burden of establishing his entitlement to PTD and maintenance medical benefits, including proof of causation, by a preponderance of the evidence. Accordingly, the ALJ did not err in denying and dismissing claimant’s claims for PTD and maintenance medical benefits.

Claimant also argued that he was deprived of his property rights without due process. He asserted that by requiring him to apply for further permanency and medical benefits, employer was able to avoid its burden to overcome the DIME’s opinion by clear and convincing evidence, and the burden to prove the cause of claimant’s narcolepsy was improperly shifted to him. No improper burden shifting occurred because it was claimant’s burden to prove his entitlement to the benefits he sought. Further, claimant had no protected property interest in PTD and maintenance medical benefits, and he had two hearings on his request for benefits. There was no due process violation because claimant failed to show he was deprived of a protected right to liberty or property without due process of law.

The order was affirmed.