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Certiorari to the Court of Appeals, Court of Appeals
Case No. 11CA1868
Petitioners: Ritsema & Lyon, P.C., Kelly F. Kruegel, Denver, Colorado.
Attorneys for Respondent: The Frickey Law Firm, Janet Frickey, Lakewood, Colorado, Dean Neuwirth P.C. Dean Neuwirth, Denver, Colorado.
Attorneys for Amicus Curiae WCEA: William J. Macdonald P.C., William J. Macdonald, Denver, Colorado.
RICE, CHIEF JUSTICE.
¶ 1 We granted certiorari to consider whether an " unexplained" fall— i.e., a fall with a truly unknown cause or mechanism— satisfies the " arising out of" employment requirement of Colorado's Workers' Compensation Act, section 8-41-301(1)(c), C.R.S. (2013), and is thus compensable as a work-related injury. We also granted certiorari to decide whether an employer fails to meet its burden to modify an admission of liability under section 8-43-201(1), C.R.S. (2013), when it fails to prove that an employee's injuries did not " arise out of" employment.
¶ 2 Respondent Helen Rodriguez injured herself after falling down a flight of stairs at work. While we agree with the court of appeals' holding that Rodriguez's unexplained fall was compensable, we disagree with its reasoning. The court of appeals erred when it endorsed Rodriguez's view that her injuries arose out of employment because " uncertainty about the cause of an injury cannot properly bar a workers' compensation claim if every one of the potential causes satisfie[d] the conditions of recovery." See Rodriguez v. ICAO, 2012 COA 139, ¶¶ 6-7, __ P.3d __. We hold that an unexplained fall necessarily stems from a " neutral" risk, i.e., a risk that is attributable neither to the employment itself nor to the employee him- or herself. Under our longstanding " but-for" test, such an unexplained fall " arises out of" employment if the fall would not have occurred but for the fact that the conditions and obligations of employment placed the employee in the position where he or she was
injured. Rodriguez's unexplained fall arose out of employment under this test.
¶ 3 In addition, we hold that under section 8-43-201(1), a party seeking to modify an issue determined by a general or final admission, a summary order, or a full order has the burden to prove by a preponderance of the evidence that such a modification should be made. Here, Petitioners City of Brighton and the Colorado Intergovernmental Risk Sharing Agency (collectively " the City" ) initially admitted liability for Rodriguez's injuries but later sought to modify that admission. We affirm the court of appeals' holding that the City failed to meet the burden of proof to make this modification. See Rodriguez, ¶ 10.
I. Facts and Procedural History
¶ 4 Rodriguez worked as a special events coordinator for the City of Brighton. On January 8, 2009, Rodriguez was walking to her office, which was located in the basement of the Brighton City Hall building (" City Hall" ). She paused at the top of a flight of concrete stairs running along the outside of City Hall to greet two of her co-workers, Scott Miller and Dennis Williams, who were standing toward the bottom of the stairs. After a brief chat with Miller and Williams, she began to walk down the stairs, which were dry and unobstructed. All of a sudden, she tumbled forward. Rodriguez hit her head, lost consciousness, and did not remember precisely how she fell— for example, she did not know whether she tripped, slipped, lost her balance, or something else entirely. Prior to falling, Rodriguez was not experiencing a headache, neck pain, dizziness, or vision problems.
¶ 5 After her fall, Rodriguez was taken by ambulance to a nearby emergency room. She underwent Computed Tomography (" CT" ) and Magnetic Resonance Angiogram (" MRA" ) scans, which revealed four unruptured aneurysms on the right side of her brain. A few weeks later, she underwent surgery for these aneurysms.
¶ 6 As a result of her fall, Rodriguez experienced head, neck, and back injuries. Twenty days after Rodriguez's fall, the City filed a general admission of liability (" GAL" ) for these injuries. In late 2010, however, the City sought to modify that GAL (and effectively withdraw it entirely), arguing that the injuries resulting from Rodriguez's fall were not compensable because they did not " arise out of" her employment. Specifically, the City argued that either (1) her fall was caused by her brain aneurysms, or (2) her fall was " unexplained." A hearing on this matter was held before Administrative Law Judge Ted A. Krumreich (" the ALJ" ) in December of 2010.
¶ 7 Miller and Williams, the only witnesses to Rodriguez's fall, testified at this hearing. Both were located toward the bottom of the stairs when they paused to chat with Rodriguez. Neither knew why Rodriguez fell as she did. For example, neither saw her trip, slip, or lose her balance. Both testified that the stairs appeared to be dry and unobstructed. Specifically, Miller stated that Rodriguez took two-to-four steps, and then " all of a sudden just went forward." Williams testified that he observed Rodriguez descend a few steps prior to pitching forward, and that it appeared as if someone " just literally yanked a rug out from underneath her." Miller and Williams also testified that Rodriguez had been speaking and acting normally immediately prior to her fall.
¶ 8 At the hearing, the ALJ also heard testimony from Dr. Jeffrey Wunder, who had performed an independent medical examination of Rodriguez at the City's request. Dr. Wunder opined that the " most likely" cause of Rodriguez's fall was a fainting or dizziness episode caused by Rodriguez's brain aneurysms, although he could not state this conclusion with a " reasonable degree of medical probability." The ALJ also reviewed two opposing reports from Dr. Lynn Parry and Dr. Alexander Feldman. Both Dr. Parry and Dr. Feldman opined that Rodriguez's brain aneurysms were not the cause of her fall, as the aneurysms were asymptomatic prior to the fall.
¶ 9 In his Order, the ALJ specifically discredited Dr. Wunder's testimony and credited the testimony of the two other doctors. The ALJ found that Rodriguez's fall was not precipitated by her brain aneurysms, nor was
it caused by her tripping or missing a step or by any dangerous condition on the stairs. The ALJ noted that the witnesses to the fall were unable to state precisely why it occurred and that Rodriguez herself could not remember. Thus, he concluded that Rodriguez's fall was " unexplained." As a result, he concluded that her injuries were noncompensable, because in failing to describe her fall's precise causal mechanism, Rodriguez also failed to show that her injury " arose out of" her employment as required by section 8-41-301(1)(c). Accordingly, the ALJ allowed the City to modify its GAL, concluding that it had sustained its burden under section 8-43-201(1). The Industrial Claims Appeals Office (" ICAO" ) affirmed the ALJ's decision, and Rodriguez appealed.
¶ 10 The court of appeals set aside the ICAO's order. Because the City initially admitted liability for Rodriguez's injuries and then later contested liability based on the " arising out of" requirement of the Act, the court of appeals held that the City was required to prove that Rodriguez's injuries did not " arise out of" her employment. Rodriguez, ¶ 10 (citing § 8-43-201(1)) (" [A] party seeking to modify an issue determined by a general or final admission ... shall bear the burden of proof for any such modification." ). Consequently, the court of appeals held that the City did not carry its burden because " the ALJ's finding— that the fall was unexplained— signal[ed] a failure of proof on [the City's] part." Id. Rodriguez's injuries were therefore held to be compensable under the Act. Although not central to its holding regarding compensability, the court of appeals also endorsed Rodriguez's argument that " uncertainty about the cause of an injury cannot properly bar a workers' compensation claim if every one of the potential causes satisfies the conditions of recovery." Id. at ¶ 6. We granted certiorari.
II. Standard of Review
¶ 11 The determination of whether an employee's injuries arose out of employment is a question of fact for resolution by the ALJ. See In re Question Submitted by U.S. Court of Appeals for the Tenth Circuit, 759 P.2d 17, 20 (Colo.1988) (" The determination of whether an employee's injuries arose out of an employment relationship depends largely on the facts presented in a particular case." ). " The totality of the circumstances must be examined in each case to see whether there is a sufficient nexus between the employment and the injury." Id. The ALJ's factual findings must be upheld if they are supported by substantial evidence. § 8-43-301(8), C.R.S. (2013); see also Panera Bread, LLC v. ICAO, 141 P.3d 970, 972 (Colo.App.2006) (describing the substantial evidence standard).
¶ 12 Unlike factual findings, this Court reviews an administrative agency's conclusions of law de novo. Colo. Dep't of Labor & Emp't v. Esser, 30 P.3d 189, 193 (Colo.2001). Thus, while we give considerable weight to the ICAO's reasonable interpretations of its own enabling statute, we are not bound by its legal interpretations. SeeAnderson v. Longmont Toyota, Inc., 102 P.3d 323, 326 (Colo.2004); see also § 8-43-308, C.R.S. (2013) (providing that an appellate ...