Donald J. Kaufman, Attorney at Law

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IF YOU ARE HURT AT WORK IN COLORADO, WHO YOU HIRE MAY BE ONE OF THE MOST IMPORTANT DECISIONS YOU MAKE IN YOUR ENTIRE CLA...
09/02/2026

IF YOU ARE HURT AT WORK IN COLORADO, WHO YOU HIRE MAY BE ONE OF THE MOST IMPORTANT DECISIONS YOU MAKE IN YOUR ENTIRE CLAIM.
Insurance companies have lawyers. They have adjusters. They have medical professionals, investigators, claims systems, litigation strategies, deadlines, procedures, and decades of institutional experience.
Their job is not to maximize your benefits.
When the law permits it, insurance companies will contest medical treatment, lost wage benefits, permanent partial disability benefits, causation, compensability, average weekly wage, impairment ratings, maximum medical improvement, and virtually every other issue capable of affecting what they ultimately pay.
Claims can be delayed.
Benefits can be denied.
Medical treatment can be disputed.
Cases can be litigated.
Hearings can be postponed.
Permanent impairment can be challenged.
And an injured worker who does not understand the system can very quickly discover that Colorado Workers’ Compensation is considerably more complicated than filling out a form and waiting for a check.
That is why competent representation matters.
Colorado has tens of thousands of practicing attorneys. Yet the number of lawyers who regularly represent injured workers in Colorado Workers’ Compensation claims is remarkably small.
Using the figure of 29,731 actively registered Colorado attorneys and the 75 attorneys identified on the attached claimant attorney list, those 75 lawyers represent approximately 0.25% of that active attorney population.
Think about that.
Roughly ONE QUARTER OF ONE PERCENT.
Workers’ Compensation is its own world. It has its own statutes, regulations, administrative procedures, medical terminology, evidentiary issues, deadlines, judges, appellate decisions, impairment rules, benefit calculations, and peculiarities accumulated over decades.
A brilliant divorce lawyer is not necessarily a Workers’ Compensation lawyer.
A terrific criminal defense lawyer is not necessarily a Workers’ Compensation lawyer.
A lawyer with a giant billboard is not necessarily the lawyer you want handling a complicated occupational disease claim, permanent total disability case, medical benefits dispute, or appeal.
A bus advertisement is advertising.
A television commercial is advertising.
A Google result is advertising.
None of those things, standing alone, tells you whether somebody actually knows what he or she is doing.
SO HOW DO YOU FIND A GOOD COLORADO WORKERS’ COMPENSATION ATTORNEY?
Do some homework.
Interview the lawyer.
Ask questions.
And pay attention to the answers.
Among the things I would consider:
• How many years has the attorney actually practiced Colorado Workers’ Compensation law?
• What percentage of the attorney’s practice is Workers’ Compensation?
• Does the attorney regularly represent injured workers, employers and insurers, or both?
• How many Workers’ Compensation matters has the attorney actually handled?
• Does the attorney personally handle the case, or will most of the work be handed to someone else?
• Does the lawyer regularly appear before Colorado Workers’ Compensation administrative law judges?
• Does the lawyer actually try cases?
• Has the lawyer handled appeals?
• Does the attorney understand permanent impairment and the AMA Guides?
• Does the attorney understand authorized treating physician issues, Division Independent Medical Examinations, maximum medical improvement, medical maintenance, vocational issues, permanent total disability, average weekly wage, offsets, apportionment, occupational disease, reopening, penalties, and settlement?
• Does the attorney understand how medical evidence fits together with the law?
• Does the attorney keep current with changes in Colorado statutes, regulations, administrative decisions, and appellate case law?
• Has the attorney written articles, papers, books, professional materials, or educational publications?
• Has the attorney taught or presented continuing legal education programs?
• Has the attorney been invited to speak publicly about Workers’ Compensation?
• Does the attorney participate in professional Workers’ Compensation organizations?
• What do other attorneys in the field think of the lawyer?
• What is the attorney’s professional reputation?
• Is the lawyer prepared?
• Is the lawyer organized?
• Does the lawyer communicate?
• Does the office return telephone calls?
• Does the office answer emails?
• Does somebody explain what is happening with the claim?
• Does the lawyer tell you the truth even when the truth is something you would rather not hear?
• Does the lawyer discuss both the strengths AND weaknesses of your case?
• Does the attorney explain strategy rather than simply telling you to wait?
• Does the lawyer understand the medicine?
• Does the lawyer understand the value of the claim?
• Does the lawyer have the staff and resources necessary to properly manage the case?
• Does the lawyer treat you like a human being instead of another file number?
• Does the lawyer listen?
• Does the lawyer demonstrate judgment?
• Does the lawyer demonstrate professionalism?
• And perhaps most importantly: DO YOU TRUST THIS PERSON?
Knowledge matters.
Experience matters.
Preparation matters.
Judgment matters.
Reputation matters.
Customer service matters.
Wisdom matters.
There is no single lawyer who is right for every injured worker and every case.
That is precisely why I have attached my complete list of attorneys who publicly hold themselves out as representing injured workers in Colorado Workers’ Compensation matters.
Some of these attorneys are friends of mine.
Some are professional colleagues.
Some I know well.
Some I barely know.
Some are certainly not my friends.
That is irrelevant.
They are included because the purpose of this list is NOT to pretend that I am the only lawyer in Colorado capable of handling a Workers’ Compensation case. That would be nonsense.
The purpose is to give an injured worker somewhere intelligent to START.
Interview lawyers.
Research them.
Look at their professional history.
Look at their writing.
Look at their speaking.
Look at their experience.
Ask difficult questions.
Then hire the person YOU trust with your health, your income, your family’s financial security, and potentially years of your life.
I am also happy to discuss your claim with you.
I limit my practice exclusively to Colorado Workers’ Compensation. I have been doing this work for approximately three decades. I have handled more than 100,000 matters during that time.
It is not one department in my office.
It is not something I occasionally do.
Colorado Workers’ Compensation is what I do.
If I can help you, I would be happy to discuss your claim, its potential value, medical benefits, lost wage benefits, permanent disability, litigation, settlement, or how I believe you should proceed.
And if I am not the right lawyer for you, I am perfectly comfortable recommending that you speak with somebody else.
The objective should be getting the injured worker competent help.
I have attached a copy of the COMPLETE LIST.
Save it.
Share it.
Send it to a friend, coworker, family member, union member, employer, physician, physical therapist, or anybody else who someday finds himself or herself injured at work and wondering where to begin.
Because after an injury is usually a terrible time to start learning how complicated Workers’ Compensation really is.
KNOWLEDGE. WISDOM. EXPERIENCE.
They matter.
WORKERS’ COMPENSATION
2520 South Grand Avenue, Suite 110
Glenwood Springs, Colorado 81601-4195
www.glenwoodattorney.com
[email protected]
Direct 970.947.1776 | Fax 970.384.1776 | Cell 970.309.1776

Current as of: Monday, February 10, 2025
The following list includes attorneys who publicly represent injured workers in Colorado Workers’ Compensation claims. This list is neither exhaustive nor exclusive, and it does not prioritize, recommend, or endorse any attorney over another. The information provided is based on publicly available sources and is presented in no specific order, ranking, or emphasis.
Janie Castenada – 303-832-8320, 1385 S. Colorado Blvd., Bldg. A, Ste. 708, Denver, CO 80222
David Webster – 719-633-6620, 985 Pico Point, Colorado Springs, CO 80905
Micah Larson – 719-587-1992, 319 Ross Ave., Alamosa, CO 81101
Erin Montgomery – 720-580-8307, 3000 Youngfield St., Ste. 200, Wheat Ridge, CO 80215
Robert Brovege – 303-795-5900, 555 E. Hampton Ave., Ste. 200, Denver, CO 80231
Adam McClure – 303-237-7373, 940 Wadsworth Blvd., 4th Floor, Lakewood, CO 80215
Jim Anderson – 719-471-1818, 4905 N. Union, Ste. 302, Colorado Springs, CO 80918
Peter McGuire – 303-691-9868, 1325 S. Colorado Blvd., #405, Denver, CO 80222
John Trueax – 303-694-2666, 6025 S. Quebec St., Ste. 240, Centennial, CO 80111
Chris Parks – 318-422-1235, 2880 16th St., Boulder, CO 80304
Cliff Enten – 303-333-2222, 50 S. Steele St., Ste. 875, Denver, CO 80209
Darby Hoggatt – 970-225-2190, 123 N. College Ave., Ste. 160, Ft. Collins, CO 80527
Ronda Cordova – 970-356-9898, 6801 W. 20th St., Ste. 201, Greeley, CO 80634
Jennifer Bisset – 303-894-8900, 1471 Stuart St., Denver, CO 80204
Joseph Merkle – 303-321-1800, 1732 Race St., Denver, CO 80206
Andrew Phillips (Levine Law LLC) – 303-333-8000, 4500 Cherry Creek S. Dr., Denver, CO 80246
Neil O’Toole – 303-595-4777, 226 W. 12th Ave., Denver, CO 80204
Cliff Eley – 720-724-2100, 2000 S. Colorado Blvd., Ste. 2-740, Denver, CO 80222
Jerrod Warr (Falgien Warr & Iyer, P.C.) – 303-731-4790, 4251 Kipling St., Ste. 525, Wheat Ridge, CO 80033
Nicole Gallerani – 719-471-3700, 19 E. Cimarron, Colorado Springs, CO 80903
Sean Knight – 303-551-7701, 1600 Ogden St., Denver, CO 80218
Stephan Marsh – 303-792-5595, 40 Inverness Dr. E., Englewood, CO 80112
Ryan Hoover – 303-757-3300, 14426 E. Evans Ave., Aurora, CO 80014
Michael Dominick – 303-447-2644, 250 Arapahoe Ave., Ste. 301, Boulder, CO 80302
Dan Mahoney – 303-407-0484, 700 17th St., Ste. 1300, Denver, CO 80202
Chris Richter (Killian Davis Richter & Mayle, PC) – 970-241-0707, 202 N. 7th St., Grand Junction, CO 81501
Doug Weddell – 719-633-6464, P.O. Box 636, Colorado Springs, CO 80901
Britton Morrell – 970-356-9898, 6801 W. 20th St., Ste. 201, Greeley, CO 80634
Drew Kraniak – 970-241-0707, P.O. Box 4859, Grand Junction, CO 81502
Regina Adams – 970-506-3892, 7251 W. 20th St., Bldg. G-1, Greeley, CO 80634
Donald J. Kaufman – 970-947-1776, 2520 Grand Ave., Ste. 110, Glenwood Springs, CO 81601
Rick Hull – 303-423-1770, 11178 Huron St., Ste. 2, Northglenn, CO 80234
Paul Haller – 719-633-6464, P.O. Box 636, Colorado Springs, CO 80901
David Mueller – 970-245-9075, 101 S. 3rd, Ste. 265, Grand Junction, CO 81501
Shelley Dodge – 303-250-2388, P.O. Box 509, Longmont, CO 80501
Elaine Corey – 303-443-2700, 5377 Manhattan Cir., Ste. 203, Boulder, CO 80303
Scott Eley – 720-279-9172, 2000 S. Colorado Blvd., Ste. 2-740, Denver, CO 80222
Brett Busch – 970-667-2898, 903 N. Cleveland, Ste. A, Loveland, CO 80537
Michael Clawson – 719-634-1848, 115 E. Vermijo, Ste. 101, Colorado Springs, CO 80903
Matt O’Brien (Alverson + O’Brien, P.C.) – 720-642-6794, 1888 Sherman St., Ste. 370, Denver, CO 80218
John Taussig III – 303-443-2700, 5377 Manhattan Cir., Ste. 203, Boulder, CO 80303
Adán Cerda – 303-831-7670, 6000 E. Evans Ave., Ste. 3-400, Denver, CO 80222
Bethiah Crane – 970-247-1400, 575 E. College Dr., Durango, CO 81301
Drew Vicary – 303-940-9900, 9035 Wadsworth Pkwy., Ste. 4000, Westminster, CO 80021
Mark Miller – 303-922-5900, 6860 S. Yosemite Ct., Ste. 2000, Centennial, CO 80112
Ken Daniels – 303-331-9444, 1800 W. Littleton Blvd., Littleton, CO 80120
Erika Alverson (Alverson + O’Brien, P.C.) – 720-642-6794, 1888 Sherman St., Ste. 370, Denver, CO 80218
Penny Merkle – 303-321-1800, 1732 Race St., Denver, CO 80206
Michael Kaplan (Kaplan Morrell, LLC) – 303-780-7329, 2373 Central Park Blvd., Ste. 100, Denver, CO 80238
Scott Smith – 303-443-2700, 5377 Manhattan Cir., Ste. 203, Boulder, CO 80303
Erica West – 303-839-1100, 837 E. 17th Ave., Ste. 102, Denver, CO 80218
Cameron Lucke – 970-225-2190, 123 N. College Ave., Ste. 160, Ft. Collins, CO 80527
Nick Fogel (Burg Simpson) – 303-792-5595, 40 Inverness Dr. E., Englewood, CO 80112
James Olsen – 303-893-9800, 1899 Wynkoop St., Ste. 700, Denver, CO 80202
Sean Goodbody – 970-245-9075, 101 S. 3rd, Ste. 265, Grand Junction, CO 81501
Christina Hayes – 303-893-9800, 1899 Wynkoop St., Ste. 700, Denver, CO 80202
Machelle Gielarowski – 719-264-0729, 712 N. Tejon St., Ste. 1, Colorado Springs, CO 80903
Abel Alvarado – 303-867-6666, 2121 S. Oneida St., Ste. 626, Denver, CO 80224
F. Lee Maes – 303-922-0300, 3045 S. Broadway, Englewood, CO 80113
Lucas Maes – 303-922-0300, 3045 S. Broadway, Englewood, CO 80113
Frank Culkin – 303-830-1110, 1776 S. Jackson St., Denver, CO 80210
Robert Turner – 720-528-4424, 6161 S. Syracuse Way, Ste. 340, Greenwood Village, CO 80111
John Sbarbaro (Law Office of O’Toole & Sbarbaro, P.C.) – 303-595-4777, 226 W. 12th Ave., Denver, CO 80204
Stephanie Tucker – 303-683-5033, 4600 S. Ulster St., Ste. 800, Denver, CO 80237
David Keating – 50 S. Steele St., Ste. 875, Denver, CO 80209
Andrew Newcomb (Newcomb Law, LLC) – 303-653-3766, 1312 17th St., Ste. 666, Denver, CO 80202
Kim Roepke – 719-375-1414, 1259 Lake Plaza Dr., Ste. 260, Colorado Springs, CO 80906
Teresa Marra – 303-433-4600, 6990 W. 38th Ave., Ste. 102, Wheat Ridge, CO 80033
Katie McClure – 303-551-7701, 1600 Ogden St., Denver, CO 80218
Mark Elliott (The Elliott Law Offices, P.C.) – 303-424-5319, 7884 Ralston Rd., Arvada, CO 80002
Gordon Heuser – 719-520-9909, 625 N. Cascade, Ste. 300, Colorado Springs, CO 80903
Brennan Heuser – 719-520-9909, 625 N. Cascade, Ste. 300, Colorado Springs, CO 80903
Matthew Kaufman – 970-945-2396, 401 23rd St., Ste. 302, Glenwood Springs, CO 81601
Aaron Kennedy (McDivitt Law Firm, P.C.) – 719-471-3700, 19 E. Cimarron, Colorado Springs, CO 80903
DISCLAIMER & IMPORTANT NOTES
• This is not a referral or recommendation.
• This list does not rank or evaluate attorneys by skill, expertise, or competence.
• It is not inclusive or exclusive but serves only as a starting point to help locate attorneys representing injured workers in Colorado Workers’ Compensation claims.
• This is not intended as legal advice, a formal referral, or an attempt to establish an attorney client relationship.
If you are seeking legal representation, you should promptly interview and choose an attorney you trust based upon your personal needs and their qualifications. Delaying legal counsel may negatively impact your claim.

Email: [email protected] | [email protected]

“DEEMED AUTHORIZED” HAS LIMITS, BUT DID ICAO PUT THE LIMIT IN THE WRONG PLACE?A Closer Look at Thompson v. D Casa Invest...
08/26/2026

“DEEMED AUTHORIZED” HAS LIMITS, BUT DID ICAO PUT THE LIMIT IN THE WRONG PLACE?
A Closer Look at Thompson v. D Casa Investments LLC, W.C. No. 5 253 927, and Colorado Workers’ Compensation Rule 16
The Industrial Claim Appeals Office recently issued an important Remand Order in Keri Thompson v. D Casa Investments LLC, W.C. No. 5 253 927. For attorneys representing injured workers, the decision deserves considerably more attention than the relatively narrow proposition that Rule 16 7 1(C) applies only when an insurer schedules an IME after receiving a request for prior authorization.
The Order was signed by Panel members Brandee DeFalco Galvin and David G. Kroll.
I respectfully believe the Panel's construction of Rule 16 is incorrect.
More importantly, the decision may have an unintended practical consequence: it potentially provides respondents with a procedural roadmap for avoiding the very deadlines and consequences the prior authorization rule was designed to impose.
The factual and procedural background
The claimant sustained an admitted industrial back injury on March 23, 2023. At respondents' request, she underwent an IME with Dr. L. Qing Min Chen on August 16, 2024.
According to the Panel's factual findings, Dr. Chen's report did not contain the attestation concerning billing compliance or documentation required by Rule 18 7(G)(5). The report was provided to claimant's counsel on September 18, 2024.
Six days later, on September 24, 2024, Dr. Levy, an authorized orthopedic spine surgeon within the chain of referral, requested prior authorization for an L5 S1 laminectomy and transforaminal interbody lumbar fusion.
Respondents denied the request on October 3, 2024. Their denial expressly invoked Rule 16 7 1(B) and relied upon Dr. Chen's preexisting IME report.
Dr. Levy submitted another authorization request on January 21, 2025.
Respondents again denied the surgery, again invoking Rule 16 7 1(B), and again relying upon the same August 2024 IME.
The claimant eventually sought a determination that the surgery was deemed authorized under Rule 16 7 1(C), arguing, among other things, that Dr. Chen's report had not been concurrently served within 20 days of the examination and lacked the Rule 18 attestation.
The Director agreed.
The Director reasoned that Dr. Levy's authorization request established a prima facie entitlement to the requested treatment and that respondents had failed to rebut that showing through an IME report complying with the Division's rules. The Director therefore deemed the surgery authorized.
ICAO set that determination aside.
The textual problem
The dispute should begin with the actual language of Rule 16 7 1(C):
“Failure of the Payer to timely comply in full with all Prior Authorization requirements shall be deemed authorization for payment of the requested treatment unless the Payer has scheduled an independent medical examination (IME) and notified the requesting Provider of the IME within the time prescribed for responding.”
The operative language is remarkably broad:
“timely comply in full”
and
“all Prior Authorization requirements.”
The difficulty I have with Thompson is grammatical as much as legal.
The first clause establishes a general consequence: failure to comply fully and timely with all prior authorization requirements results in deemed authorization.
The second clause begins with “unless.”
Ordinarily, “unless” introduces an exception or condition to the proposition preceding it.
ICAO appears to reverse that structure.
Because respondents did not schedule an IME after Dr. Levy submitted the prior authorization request, the Panel concluded that subsection C did not apply at all. In the Panel's words, respondents denied the request under Rule 16 7 1(B)(2)(b) “using a medical report that was in existence prior to Dr. Levy's request.” Because respondents did not schedule a subsequent IME under subsection C, the Panel held subsection C inapplicable.
That interpretation effectively transforms the exception into a prerequisite.
The rule says, in substance:
Failure to comply with all prior authorization requirements results in authorization, UNLESS an IME is scheduled.
The Panel's construction approaches:
The deemed authorization provision applies IF an IME is scheduled after the request.
Those are materially different propositions.
The significance of the word “all”
The Panel's construction also raises a basic interpretive question.
If subsection C applies exclusively to the deadlines governing a newly scheduled IME, why did the Director use the phrase:
“all Prior Authorization requirements”?
The rule could easily have said:
“Failure to comply with the requirements of this subsection shall result in deemed authorization.”
It does not.
Instead, it expressly refers to all prior authorization requirements.
Under ordinary principles of statutory and regulatory construction, words should not be treated as surplusage if a reasonable construction gives them effect.
Indeed, the Panel itself recognized that administrative regulations are interpreted according to the same principles applicable to statutes, that provisions should be read together as a whole, and that an agency interpretation cannot contradict the plain language of its own rule.
That makes the breadth of the opening sentence difficult to dismiss.
Subsection A makes the issue even more interesting
Rule 16 7 1(A) demonstrates that the Director knew exactly how to address medical opinions predating a prior authorization request.
The rule specifically permits a medical review, IME report, or ATP report concerning relatedness to precede the prior authorization request when certain requirements are satisfied, including issuance within 365 days before the request.
That provision matters because it demonstrates deliberate drafting.
The rule expressly contemplates the use of preexisting medical evidence in a defined circumstance.
Subsection B, meanwhile, imposes specific requirements when a payer denies authorization for medical reasons. Among other things, the payer must obtain the required physician review and furnish a written denial explaining the specific medical reasons, identifying the reviewing provider and credentials, providing the reviewer's opinion, citing applicable Medical Treatment Guidelines when appropriate, and identifying information likely to influence reconsideration when applicable.
The important question therefore should not simply be whether respondents wrote “Rule 16 7 1(B)” on their denial.
The more fundamental question is whether the payer timely complied in full with all prior authorization requirements.
That is the question subsection C itself appears to ask.
The practical consequence of Thompson
This is where the decision becomes particularly important for claimant attorneys.
If respondents receive a surgical request and decide to schedule an IME, Rule 16 imposes substantial time limitations.
The IME generally must occur within 30 days, or at the first available appointment, and ordinarily cannot exceed 60 days absent an order extending the deadline.
The IME physician must concurrently serve all parties with the report within 20 days.
The payer must then respond to the authorization request within 10 days after receiving the IME report.
These deadlines have an obvious purpose.
An injured worker should not wait indefinitely while an insurer searches for another medical opinion before deciding whether treatment will be authorized.
But consider the incentive created by Thompson.
Suppose an insurer already possesses an IME report opposing treatment.
If it schedules another IME in response to the new surgical request, it enters subsection C and becomes subject to the examination, service, and response deadlines.
If instead it relies upon the old report, characterizes the response as a subsection B denial, and schedules no new IME, Thompson says subsection C does not apply.
That creates an obvious structural concern.
The interpretation potentially makes compliance with subsection C dependent upon the payer's own procedural election.
The insurer can decide whether to enter the regulatory framework carrying the stricter deadlines.
That is difficult to reconcile with a rule whose opening command expressly addresses failure to comply with “all Prior Authorization requirements.”
The purpose of Rule 16 cannot be ignored
The Panel itself recognized that Rule 16 was promulgated in furtherance of the legislative objective of assuring the quick and efficient delivery of medical benefits at a reasonable cost.
Prior authorization exists to resolve the compensability of proposed treatment before the provider renders it, thereby protecting providers from delivering treatment for which payment will subsequently be disputed.
That purpose is not incidental.
It should inform how ambiguities in the rule are understood.
A construction that creates an easily identifiable route around the rule's strongest deadlines deserves careful scrutiny precisely because it may undermine the mechanism the rule was intended to create.
The Director's reasoning deserves more credit
The Director's analysis was not merely a technical effort to award surgery because somebody missed a deadline.
The Director reasoned that Dr. Levy's prior authorization request established a prima facie case for the requested treatment.
The Division's rules then provided respondents with a mechanism for rebutting that request.
According to the Director, the medical report respondents relied upon did not comply with the applicable regulatory requirements. Therefore, respondents had not successfully rebutted the claimant's prima facie showing.
ICAO rejected that reasoning, concluding that the absence of concurrent service or the required attestation did not itself establish that treatment was reasonable, necessary, and related. The Panel further observed that the defects might have supported a penalty claim, but no penalty request had been made within the applicable one year period.
There is certainly logic to distinguishing substantive proof of medical necessity from procedural compliance.
But there is an equally significant counterpoint:
The entire purpose of a deemed authorization provision is to prescribe a substantive consequence for procedural noncompliance.
If a claimant must independently prove entitlement to treatment notwithstanding satisfaction of the conditions creating deemed authorization, the regulatory remedy risks becoming circular.
Waiver and estoppel: the second major holding
The Panel alternatively concluded that disputed factual issues concerning waiver and estoppel required an evidentiary hearing.
This portion of Thompson should command the immediate attention of claimant attorneys.
The claimant had Dr. Chen's report in September 2024. Respondents denied the surgery the following month. Claimant subsequently pursued medical benefits, participated in prehearing proceedings, addressed a proposed 24 month DIME, and took other litigation positions without asserting the Rule 16 defects as a basis for deemed authorization.
The Rule 16 defects were not raised for that purpose until October 22, 2025, more than a year after claimant received the report.
Importantly, ICAO did not hold that waiver had been established.
It held that the evidence, if credited, could support waiver or estoppel and therefore required an evidentiary hearing.
The Panel correctly recited that waiver requires an intentional relinquishment of a known right and must be voluntary, knowing, and intelligent. Equitable estoppel requires proof of knowledge, conduct intended or reasonably understood to induce reliance, ignorance of the true facts by the party asserting estoppel, and reasonable detrimental reliance.
Thus, Thompson should not be cited for the proposition that delayed assertion automatically waives a Rule 16 violation.
It does not.
Nevertheless, the practical lesson is unmistakable:
Claimant's counsel should identify and preserve Rule 16 objections immediately.
An untimely report, improper service, deficient denial, missing attestation, defective medical review, or other Rule 16 problem should be raised contemporaneously.
Waiting may convert what appears to be a legal question into a factual trial concerning waiver, estoppel, reliance, litigation conduct, and what counsel knew at various stages of the case.
There is also a penalty lesson
The Panel specifically acknowledged that failures to comply with Rule 16 and Rule 18 may potentially support penalties of up to $1,000 per day under C.R.S. § 8 43 304.
It then observed that no penalty claim concerning these defects had been asserted within the one year statutory period.
That is another important practice point.
A claimant may have several distinct theories arising from the same procedural violation.
Deemed authorization is one.
Penalties may be another.
The underlying entitlement to reasonable, necessary, and related medical treatment remains another.
Counsel should consider each separately and preserve each within its applicable procedural framework.
The broader question
The significance of Thompson extends beyond this particular spinal fusion.
Administrative rules governing medical authorization are effective only if their mandatory language remains mandatory.
“Timely” must have meaning.
“Comply in full” must have meaning.
“All Prior Authorization requirements” must have meaning.
And most importantly, “shall be deemed authorization” must have meaning.
There is a legitimate difference between construing a regulation and effectively rewriting its grammatical structure.
In my view, Thompson crosses that line.
The Panel takes language structured as a broad command followed by an exception and effectively transforms the exception into a condition precedent to application of the command.
That interpretation may also produce a peculiar practical result: a payer that elects to obtain a new IME becomes subject to strict deadlines, while a payer possessing a sufficiently recent older report may potentially avoid those same provisions simply by invoking subsection B.
Whether that is what the Director intended when Rule 16 was promulgated is a question worth asking.
Whether that construction advances the statutory objective of quick and efficient delivery of medical benefits is an even more important question.
For claimant attorneys, however, the immediate practice lesson is clear.
Read every prior authorization denial as carefully as you would read a pleading.
Determine precisely which subsection respondents invoke.
Examine the medical opinion relied upon.
Determine when it was written, when it was received, when it was served, what it actually addresses, whether it satisfies the applicable Rule 16 requirements, and whether the physician and report comply with the governing rules.
If there is a defect, raise it immediately.
Preserve deemed authorization.
Preserve the medical benefits issue.
Evaluate penalties.
Calendar the statutory deadline.
And do not assume that respondents' characterization of their denial determines which provisions of Rule 16 actually govern.
Thompson is an important decision.
I also believe it is wrongly decided.
The strongest criticism is not simply that ICAO construed subsection C narrowly.
It is that the Panel appears to have transformed the exception contained in Rule 16 7 1(C) into a limitation upon the opening command of the rule itself, potentially giving respondents a roadmap for avoiding the very deadlines Rule 16 was designed to impose.
The text should remain the starting point:
“Failure of the Payer to timely comply in full with all Prior Authorization requirements shall be deemed authorization for payment of the requested treatment unless...”
The word “all” is there.
The word “shall” is there.
And the word “unless” is there.
None should be treated as surplusage.
Keri Thompson v. D Casa Investments LLC, W.C. No. 5 253 927
Industrial Claim Appeals Office, Remand Order, mailed July 28, 2026.
Panel members: Brandee DeFalco Galvin and David G. Kroll.

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2520 Grand Avenue, Suite 110
Glenwood Springs, CO
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