Enterprise v. ICAO ( 2024 )

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<div>24CA0151 Enterprise v ICAO 10-03-2024 </div>
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<div>COLORADO COURT OF APPEALS </div>
<div> </div>
<div> </div>
<div>Court of Appeals No. 24CA0151 </div>
<div>Industrial Claim Appeals Office of the State of Colorado </div>
<div>WC No. 4<span>-753-828 </span>
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<div>Enterprise <span>Claims Management, Inc., and Cannon Cochran Management </span>
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<div>Services, </div>
<div> </div>
<div>Petitioners, </div>
<div> </div>
<div>v. </div>
<div> </div>
<div>Industrial Claim Appeals Office of the State of Colorado and Fozia H. Mohamed, </div>
<div> </div>
<div>Respondents.<span> </span>
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<div> </div>
<div> </div>
<div>ORDER AFFIRMED </div>
<div> </div>
<div>Division III </div>
<div>Opinion by JUDGE DUNN </div>
<div>Navarro and Gomez, JJ., concur </div>
<div> </div>
<div>NOT PUBLISHED PURSUANT TO C.A.R. 35(e) </div>
<div>Announced October 3, 2024 </div>
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<div>Dworkin, Chambers, Williams, York, Benson &amp; Evans, PC, Gregory K. </div>
<div>Chambers, Denver, Colorado, for Petitioners </div>
<div> </div>
<div>No Appearance for Respondent Industrial Claim Appeals Office </div>
<div> </div>
<div>Kaplan Morrell, LLC, Michael H. Kaplan, Greeley, Colorado, for Respondent </div>
<div>Fozia H. <span>Mohamed </span>
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<div> </div>
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<div>1 </div>
<div>¶ 1<span> <span>In this workers’ compensation <span>action<span>, <span>Enterprise Claims </span></span></span></span></span>
</div>
<div>Management, Inc., and its insurer, Cannon Cochran Management<span></span> </div>
<div>Services (collectively, employer), seek review of the final orde<span></span>r </div>
<div>issued by the Industrial Claim Appeals Office (the Panel) affirming </div>
<div>the award of reasonably necessary medical benefits to claimant </div>
<div>Fozia H. Mohamed<span>. </span>Under the circumstances presented here, we </div>
<div>affirm. </div>
<div>I.<span> <span>Background </span></span>
</div>
<div>A.<span> <span>The Work-Related Injury and Permanent Total Disability </span></span>
</div>
<div>¶ 2<span> </span><span>While working alone a<span>t </span>a gas station at night<span>, </span>Mohamed was </span>
</div>
<div>robbed at gunpoint two different times.<span> </span>After the first robbery in </div>
<div>2007, Mohamed return<span>ed</span> to work, though she experienced some </div>
<div>anxiety and became more vigilant<span>. </span>But in 2008, two men again </div>
<div>robbed the gas station and this time held a gun to Mohamed’s hea<span></span>d<span> </span>
</div>
<div>and pulled the trigger (though the gun didn’t discharge)<span>. After this </span>
</div>
<div>robbery, Mohamed was diagnosed with post-traumatic stress </div>
<div>disorder (PTSD).<span> </span><span> </span>
</div>
<div>¶ 3<span> </span><span>As a result of her PTSD, Mohamed experienced anxiety, panic </span>
</div>
<div>attacks, chronic fear, depression, insomnia, nightmares, </div>
<div>hyperarousal, hypervigilance, agoraphobia, and avoidance </div>
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<div>2 </div>
<div>behaviors<span>. <span> And because being alone exacerbated her symptoms, </span></span>
</div>
<div>since the second robbery Mohamed has relied on the presence of </div>
<div>others to make her feel safe.<span> </span><span> </span>
</div>
<div>¶ 4<span> </span><span>Despite years of therapy, medication, and attempts at </span>
</div>
<div>desensitization<span>, Mohamed’s <span>PTSD symptoms persisted. Thus, <span>in</span> </span></span>
</div>
<div>2014, an administrative law judge (ALJ) determin<span>ed</span> that Moha<span></span>med </div>
<div>was permanently and totally disabled and awarded her permanent </div>
<div>total disability benefits. Employer filed a final admission of liability<span>, </span>
</div>
<div>admitting to Mohamed’s permanent total disability<span> and authorizing </span>
</div>
<div>continuing maintenance care that was reasonably necessary and </div>
<div>related to the injury.<span> </span>Mohamed continued to receive maintenance </div>
<div>care for the next several years<span>. </span><span> </span>
</div>
<div>B.<span> <span>Request for Additional Medical Treatment </span></span>
</div>
<div>¶ 5<span> </span><span>In<span> 2022, Mohamed filed an application for a hearing, seeking </span></span>
</div>
<div>reasonably necessary medical benefits<span>. </span>As relevant here, Mohamed </div>
<div>asked that employer pay for daily attendant services because she </div>
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<div>3 </div>
<div>experiences terror and <span>de</span>compensates when she is alone.</div>
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<div><div>1</div></div>
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<div>Mohamed sought attendant services only to manage her PTSD and </div>
<div>prevent her symptoms from flaring, not for assistance with activit<span></span>ies </div>
<div>of daily living such as cooking, cleaning, or personal care. But she </div>
<div>did request accompanied transportation because her panic at<span></span>tacks </div>
<div>made her an unsafe driver.<span> </span> </div>
<div>C.<span> <span>The Hearing </span></span>
</div>
<div>¶ 6<span> </span><span>At a hearing on her application, Mohamed presented evidence </span>
</div>
<div>about her PTSD symptoms. She testified that before the armed </div>
<div>robberies she was independent, could drive, and had no problem </div>
<div>being alone.<span> </span>But since the robberies, she testified that she </div>
<div>experiences depression, anxiety, and panic attacks when alone.<span> </span>
</div>
<div>She explained that when she is with someone the fear and pani<span></span>c </div>
<div>subside and she feels safe.<span> </span>And she testified that she lives with one </div>
<div>of her three adult <span>children because she can’t </span>be alone<span>. </span> </div>
<div> </div>
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<div><div>1</div></div>
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<div> Mohamed also requested that employer pay for a full-time </div>
<div>independent living facility. The ALJ determined that Mohame<span></span>d </div>
<div>failed to prove such long-term care <span>“i</span>s reasonably necessary at this </div>
<div>time<span>”</span><span> and dismissed her request as premature. <span>Mohamed didn’t </span></span>
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<div>challenge that determination, <span>and we don’t address it</span> here<span>. </span> </div>
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<div>4 </div>
<div>¶ 7<span> <span>Mohamed’s three <span>adult children also testified. The children </span></span></span>
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<div>collectively stated that, for the past thirteen years, they<span>’ve</span> each </div>
<div>spent between twenty and sixty hours a week supporting Mohame<span></span>d. </div>
<div>They confirmed that Mohamed struggles to be alone for any <span></span>length </div>
<div>of time<span>, <span>can<span>’t</span></span></span> be alone in publ<span>ic</span> or at night, and <span>isn’t safe to </span>drive </div>
<div>due to panic attacks.<span> </span>They also explained how they coordinate their </div>
<div>schedules to provide near-constant support to Mohamed, whethe<span></span>r </div>
<div>by<span> phone calls, companionship, running errands, or providing<span></span> </span>
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<div>transportation. And each child detailed how Mohamed deteriorates </div>
<div>when she <span>is</span> even temporarily alone and how her symptoms improve </div>
<div>when someone is with her. <span> </span>
</div>
<div>¶ 8<span> </span><span>Mohamed next presented Dr. Walter Torres as an expert in </span>
</div>
<div>clinical and forensic psychology. He treats patients with PTSD and </div>
<div>first diagnosed Mohamed with PTSD in 2009. Dr. Torres </div>
<div>reevaluated Mohamed in 2022 and diagnosed her with chroni<span></span>c </div>
<div>PTSD (and an adjustment disorder with depressed mood)<span>. <span>He</span></span> </div>
<div>explained that a <span>core symptom of PTSD is “re</span><span>-</span><span>experiencing” the </span>
</div>
<div>traumatic event, and that because Mohamed was alone du<span></span>ring both </div>
<div>robberies, being alone causes her to <span>re<span>-</span></span><span>experience the <span></span>“terror” <span>of</span><span> the </span></span>
</div>
<div>robberies. He observed that, while alone, Mohamed </div>
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<div>5 </div>
<div>“decompensates”<span> <span>and “becomes disorganized” and “overwh<span></span>elmed,” </span></span>
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<div>which is “immensely stressful emotionally and physically.” <span>And he </span>
</div>
<div>opined <span>that Mohamed’s aversion to being alone </span><span>is</span> not merely a </div>
<div>“preference” but rather a “profound intolerance of alo<span></span>neness.” <span>He </span>
</div>
<div>testified that providing Mohamed with attendant services would </div>
<div>relieve the “trigger”<span> of aloneness and recommended such care for </span>
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<div>ten to twelve hours a day for an indefinite duration. </div>
<div>¶ 9<span> </span><span>Employer countered with Dr. Timothy Shea, also an expert in </span>
</div>
<div>clinical psychology. Dr. Shea evaluated Mohamed and agreed <span></span>that </div>
<div>she has PTSD<span>. </span>He opined, however, that attendant services were </div>
<div>not clinically indicated because, in his view, Mohamed was </div>
<div>“behaviorally limiting herself” and “[a]<span>ccommodating the behavioral </span>
</div>
<div>avoidance has only contributed to a greater reliance <span>on other<span></span>s.” </span>
</div>
<div>Instead, he recommended that Mohamed become more independent<span></span> </div>
<div>and physically active, though he admitted that <span>Mohamed’s </span>
</div>
<div>symptoms “are relieved when somebody is with her” and that <span>being </span>
</div>
<div>alone exacerbate<span>s </span>her PTSD symptoms. <span> </span>
</div>
<div>¶ 10<span> </span><span>The ALJ also reviewed reports from Dr. Howard Entin, who </span>
</div>
<div>has treated Mohamed since 2009. In a 2022 report, Dr. Entin </div>
<div>noted that despite years of treatment and medication, Mohamed </div>
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<div>6 </div>
<div>still experienced PTSD symptoms, was avoidant and vigilant <span></span>in </div>
<div>public, and relied on the presence of others to make her feel safe.<span> </span>
</div>
<div>He opined within a reasonable degree of medical probability <span></span>that </div>
<div>part of <span>Mohamed’s “</span><span>need<span>”</span></span> to be with others resulted from the t<span></span>wo </div>
<div>robberies.<span> <span> </span></span>
</div>
<div>¶ 11<span> </span><span>Crediting Dr. Torres and Dr. Entin, the ALJ found that </span>
</div>
<div>Mohamed had proved that attendant services are <span>a </span><span>“reasonably </span>
</div>
<div>necessary and causally related medical treatment to prevent furthe<span></span>r </div>
<div>exacerbations and flare up” <span>of</span><span> her continuing chronic and se<span></span>vere </span>
</div>
<div>PTSD. <span>The ALJ therefore concluded that employer “shall <span></span>authorize </span>
</div>
<div>and pay” for <span>up to twelve hours of daily attendant care as </span>
</div>
<div>maintenance treatment for Mohamed’s work<span>-related PTSD. <span> </span></span>
</div>
<div>¶ 12<span> </span><span>In so holding<span>, the ALJ rejected employer’s argument that </span></span>
</div>
<div>attendant services were not compensable because<span>, in employer’s </span>
</div>
<div>view, such services were neither medical in nature nor incidental to </div>
<div>other medical treatment.<span> </span>The ALJ explained that, because </div>
<div>Mohamed requested attendant services to treat symptoms that are </div>
<div>causally related to her work-related PTSD, the services were a </div>
<div>medical treatment and were <span>“</span>clearly part of her maintenance </div>
<div>treatment in order to maintain maximum medical improvement and </div>
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<div>7 </div>
<div>prevent flare-<span>ups or aggravation of her PTSD.”</span><span> </span>And as to </div>
<div>maintenance care specifically, t<span>he</span> ALJ recognized that in it<span></span>s final </div>
<div>admission of liability employer had authorized continuing </div>
<div>maintenance care that was reasonably necessary and related to </div>
<div>Mohamed’s <span>injury. <span> </span></span>
</div>
<div>¶ 13<span> </span><span>On appeal, the Panel recognized that ongoing medical benefits </span>
</div>
<div>may be awarded after maximum medical improvement when </div>
<div>substantial evidence supports a determination that future </div>
<div>treatment is reasonable and necessary to relieve the eff<span></span>ects of the </div>
<div>injury or prevent a deterioration of a condition<span>. </span> The Panel affirmed </div>
<div>the <span>ALJ’s </span><span>order</span><span>, </span>concluding that <span>it</span> was <span>“</span>supported by substantial </div>
<div>evidence and applicable law.<span>”</span><span> </span> </div>
<div>II.<span> <span>Analysis </span></span>
</div>
<div>¶ 14<span> </span><span>Employer maintains that attendant <span>services aren’t </span><span>a </span></span>
</div>
<div>compensable medical treatment under the Workers<span>’</span> Compensation </div>
<div>Act of Colorado (the Act).<span> </span>Under the circumstances here, we </div>
<div>disagree.<span> <span> </span></span>
</div>
<div>¶ 15<span> </span><span>The Ac<span>t </span>provides a range of benefits to employees injured on </span>
</div>
<div>the job<span>. </span> <span>See generally</span> §§ 8-<span>42</span>-101 to -<span>12</span>7, C.R.S. 2024.<span> <span>A<span>n </span></span></span>
</div>
<div>employer is specifically required to provide an injured em<span></span>ployee </div>
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<div>8 </div>
<div>“<span>medical, surgical, dental, nursing, and hospital treatment <span></span>. . . <span>as </span></span>
</div>
<div>may reasonably be needed <span>. . . </span>to cure and relieve the employee </div>
<div>from the effects of the injury.” §<span> 8-<span>42</span><span>-101(1)(a)(I)</span><span>; </span><span>see Colo. Comp. </span></span>
</div>
<div>Ins. Auth. v. Nofio<span>, 886 P.2d 714, 716 (Colo. 1994)<span>. </span> </span>
</div>
<div>¶ 16<span> </span><span>We review de novo whether the ALJ and the Panel correctly </span>
</div>
<div>applied the law<span>. </span><span>See Fisher v. Indus. Claim Appeals Off.</span>, 2021 COA </div>
<div>27, ¶ 14; § 8-<span>43</span>-308, C.R.S. 2024. </div>
<div>¶ 17<span> </span><span>As we understand it, employer argues that because the </span>
</div>
<div>requested attendant services <span>aren’t provided by</span> someone with </div>
<div>“<span>specific medical training,</span>”<span> <span>those services aren’t </span>a directly </span>
</div>
<div>compensable <span>“</span><span>medical<span>”</span></span> treatment under section 8-<span>42</span>-101(1)(a)(I). </div>
<div>But nothing in the statute<span>’s plain language requires that</span> medical </div>
<div>treatment be provided by a skilled provider or someone with </div>
<div>medical training. Rather, the statute requires only that the medical </div>
<div>treatment “cure and relieve the employee from the effects of t<span></span>he </div>
<div>injury.” <span>§ 8-<span>42</span>-101(1)(a)(I). And construing the plain language that </span>
</div>
<div>way, divisions of this court have concluded that nonskilled services </div>
<div>that cure or relieve an employee’s work<span>-related injury may be </span>
</div>
<div>compensable medical treatment under section 8-<span>42</span><span>-101(1)(a).</span><span> </span> </div>
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<div>9 </div>
<div>¶ 18<span> </span><span>For example, in <span>Suetrack USA v. Industrial Claim Appeals </span></span>
</div>
<div>Office<span>, 902 P.2d 854 (Colo. App. 1995), the <span>claimant’s</span> wife provide<span></span>d </span>
</div>
<div>him with home attendant services, such as assisting him into and </div>
<div>out of bed, helping him walk and exercise, and maintaining his </div>
<div>hygiene and cleanliness. <span>Id.</span> at 855. An ALJ awarded compensation </div>
<div>for the wife<span>’s services,</span> and the Panel affirmed<span>. <span>Id<span>.</span></span> </span>On appeal, the </div>
<div>employer argued that the attendant services weren’t com<span></span>pensable </div>
<div>because the wife was not a licensed healthcare provider as req<span></span>uired </div>
<div>by other state regulations. <span>Id.</span><span> <span>A </span></span>division of this court rejected this </div>
<div>argument, concluding that <span>the spouse’s</span> attendant services were </div>
<div>compensable because, as the ALJ had found with substantial </div>
<div>evidentiary support, such services were reasonably necessa<span></span>ry to </div>
<div>treat the <span>claimant’s work</span>-related injury. <span>Id.</span> at 855-56.<span> </span>As the </div>
<div>division observed, even “legally recognized nonmedical treatment” is </div>
<div>compensable so long as it’s “reasonably necessary to relieve </div>
<div>claimant from the effects of an industrial injury.” <span>Id.</span><span> at 855; <span>a<span></span>ccor<span>d </span></span></span>
</div>
<div>Riley Fam. Tr. v. Hood<span>, 874 P.2d 503, 504 (Colo. App. 1994)<span>. </span> </span>
</div>
<div>¶ 19<span> </span><span>Similarly, in <span>Bellone v. Industrial Claim Appeals Office</span>, 940 </span>
</div>
<div>P.2d 1116 (Colo. App. 1997), the claimant, a single parent, </div>
<div>experienced a work-related head injury that caused seizures, </div>
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<div> </div>
<div>10 </div>
<div>extreme fatigue, depression, mental confusion, and <span></span>a sleep disorder.<span> </span>
</div>
<div>Id.<span> at 1117-18.<span> </span>In addition to other medical treatment, t<span></span>he </span>
</div>
<div>claimant’s provider prescribed childcare services to permit the </div>
<div>claimant to attend medical appointments and to rest <span></span>during the </div>
<div>day. <span>Id.</span><span> </span>The employer refused to pay for childcare <span></span>services for the </div>
<div>purpose of allowing the claimant to rest or engage i<span></span>n other </div>
<div>nonmedical appointment activities. <span>Id.</span><span> </span>An ALJ awarded the </div>
<div>childcare services, but the Panel reversed, determining <span></span>that the </div>
<div>childcare services were<span>n’t</span> compensable because they were neithe<span></span>r </div>
<div>medical in nature nor incidental to obtaining necessary me<span></span>dical </div>
<div>treatment<span>. </span><span>Id.</span><span> <span>A <span>division of this court disagreed, concluding that<span></span> </span></span></span>
</div>
<div>the childcare services were medical in nature because, as the ALJ </div>
<div>ha<span>d found with substantial evidentiary support, the services </span>
</div>
<div>relieved the symptoms <span>of the claimant’s </span>work-related head injury </div>
<div>and were directly associated with claimant<span>’</span>s physical needs.</div>
</div>
<div><div>2</div></div>
<div>
<div> <span>Id.</span> at </div>
<div>1118<span>; <span>cf. Kuziel v. Pet Fair, Inc.<span>, 931 P.2d 521, 522-23 (Colo. App. </span></span></span>
</div>
<div> </div>
</div>
<div><div>2</div></div>
<div>
<div> Though not relevant for our purposes, the division in <span>Bellone</span> </div>
<div>alternatively concluded that the childcare services were incidental </div>
<div>to medical treatment, and therefore compensable, because the </div>
<div>services were provided as part of an overall home healthcare </div>
<div>program designed to treat the claimant<span>’</span>s condition.<span> </span><span>Bellone v. </span>
</div>
<div>Indus. Claim Appeals Off.<span>, 940 P.2d 1116, 1118 (Colo. App. <span></span>1997). </span>
</div>
</div>
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<div> </div>
<div>11 </div>
<div>1996) (holding that childcare services were<span>n’t</span> a compensable </div>
<div>medical benefit because, among other things, the services did<span>n’t</span> </div>
<div>relieve the symptoms or effects of the work-related injury and </div>
<div>were<span>n’t</span><span> directly associated with the claimant</span><span>’</span><span>s physical needs). </span>
</div>
<div>¶ 20<span> </span><span>Collectively, these cases indicate <span>that a treatment is “medical” </span></span>
</div>
<div>in nature <span>—</span> even if inherently nonmedical or provided by s<span></span>omeone </div>
<div>with<span>out</span><span> medical training </span><span>—</span><span> so long as the treatment is reason<span></span>ably </span>
</div>
<div>necessary to relieve the symptoms <span>of a claimant’s work</span>-related </div>
<div>injury. Thus, the unskilled attendant services requested by </div>
<div>Mohamed could be a compensable medical treatment if reasonably </div>
<div>necessary to relieve the symptoms of her work-related PTSD. </div>
<div>¶ 21<span> </span><span>And whether a particular requested service is medically </span>
</div>
<div>necessary to treat a claimant’s <span>work-related injury (or incidental to </span>
</div>
<div>obtaining other treatment) is a factual question. <span>E.g.</span><span>, </span><span>Bellone</span>, 940 </div>
<div>P.2d <span>at</span> <span>1117. We must uphold the ALJ’s factual findings if<span></span> </span>
</div>
<div>substantial evidence supports them. <span>Fisher</span><span>, ¶</span> 14; § 8-<span>43<span>-<span>308</span></span></span><span>.</span><span> </span> </div>
<div>¶ 22<span> </span><span>On this factual question, the ALJ found that the attendant </span>
</div>
<div>services were <span>causally related to Mohamed’s work</span>-related PTS<span></span>D and </div>
<div>reasonably necessary to prevent the exacerbation and flareu<span></span>p of her </div>
</div></div>
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<div> </div>
<div>12 </div>
<div>PTSD symptoms<span>. </span>As detailed above, th<span>ese</span> findings are supported </div>
<div>by substantial record evidence and testimony that showed that </div>
<div>•<span> <span>as a result of her PTSD, Mohamed struggles to be alone for </span></span>
</div>
<div>any length of time<span>, can’t leave the house alone, and isn’t </span>
</div>
<div>safe to drive; </div>
<div>•<span> <span>to avoid being alone, Mohamed primarily relies on the </span></span>
</div>
<div>presence and aid of her three adult children, who have each </div>
<div>dedicated between twenty and sixty hours a week to </div>
<div>supporting Mohamed since her injury in 2008; </div>
<div>•<span> <span>when alone, Mohamed re-experiences the trauma </span></span>
</div>
<div>underlying her injury, which worsens her PTSD symptoms, </div>
<div>causes her to decompensate, and is physically and </div>
<div>emotionally stressful for her; </div>
<div>•<span> <span>when in the presence of others, Mohamed<span>’s PTSD symptoms </span></span></span>
</div>
<div>improve and she feels safe; and </div>
<div>•<span> <span>the requested attendant services would prevent Mohamed </span></span>
</div>
<div>from being alone and thus relieve the symptoms of her </div>
<div>work-related PTSD.<span> </span> </div>
<div>¶ 23<span> </span><span>To the extent that employer argues that other inferences could </span>
</div>
<div>be drawn from the evidence, it<span>’s</span> <span>the ALJ’s province —</span> not ours <span>—</span> t<span></span>o </div>
</div></div>
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<div> </div>
<div>13 </div>
<div>resolve disputed factual issues and to determine witnesses’ </div>
<div>credibility, the weight to accord testimony, and the inferences t<span></span>o be </div>
<div>drawn from the evidence. <span>See Metro Moving &amp; Storage Co. v. </span>
</div>
<div>Gussert<span>, <span>914 P.2d 411, 415 (Colo. App. 1995) (We must <span>“</span>defer to the </span></span>
</div>
<div>ALJ’s credibility determinations and <span>. . . resolution of conf<span></span>licts in </span>
</div>
<div>the evidence, including the medical evidence.<span>”</span><span>).</span><span> </span> </div>
<div>¶ 24<span> <span>We aren’<span>t </span>persuaded otherwise by employer’s related </span></span>
</div>
<div>contention <span>that the attendant services aren’t compensable be<span></span>cause </span>
</div>
<div>they aren’t incidental to other medical treatment. <span>See, e.g.<span>, </span>Count<span></span>ry </span>
</div>
<div>Squire Kennels <span>v. </span><span>Tarshis</span><span>, 899 P.2d 362, 363-64 (Colo. App. 1<span></span>995) </span>
</div>
<div>(collecting cases). Under these unique circumstances, the </div>
<div>requested attendant <span>services aren’t</span> incidental to the medical </div>
<div>treatment <span>that relieves Mohamed’s symptoms </span>(such as </div>
<div>housekeeping services); rather, the attendant services are the </div>
<div>treatment that relieves Mohamed’s symptoms<span>. <span>And Dr. Torres </span></span><span>—</span><span> </span>
</div>
<div>who<span>se testimony the ALJ expressly credited <span>—</span> clarified that he </span>
</div>
<div>recommended attendant services <span>“<span>solely</span><span>” for “</span><span>Mohamed</span><span>’</span></span>s work-</div>
<div>related psychological condition<span>” and not “to help her with . .<span></span> . </span>
</div>
<div>cleaning the bathroom and cooking, for example.<span>”</span><span> <span>Th</span></span>us, as the ALJ </div>
<div>and the Panel correctly identified<span>, </span>the requested attendant services </div>
</div></div>
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<div> </div>
<div>14 </div>
<div>are a directly compensable medical treatment because those </div>
<div>services are <span>causally related to Mohamed’s work</span>-related PTSD and </div>
<div>reasonably necessary to relieve her PTSD symptoms. <span> </span>
</div>
<div>¶ 25<span> <span>All this said, we see no legal error with the ALJ’s or the Panel’<span></span>s </span></span>
</div>
<div>application of section 8-<span>42</span>-101(1)(a)(I). And because substantial </div>
<div>evidence supports the ALJ’s finding<span>s that unskilled attendant </span>
</div>
<div>services are <span>causally related to Mohamed’s work</span>-related PTSD and </div>
<div>reasonably necessary to prevent the exacerbation and flareup of her </div>
<div>symptoms<span>, the Panel didn’t err by affirming the ALJ’s order.</span>
</div>
</div>
<div><div>3</div></div>
<div>
<div> <span> </span>
</div>
<div>III.<span> <span>Disposition </span></span>
</div>
<div>¶ 26<span> </span><span>We affirm t<span>he</span> <span>Panel’s order</span><span>. </span> </span>
</div>
<div>JUDGE NAVARRO and JUDGE GOMEZ concur. </div>
<div> </div>
</div>
<div><div>3</div></div>
<div>
<div> The <span>ALJ also found that the attendant services are “clea<span></span>rly part of </span>
</div>
<div>[Mohamed’s] maintenance treatment in order to maintain <span></span>maximum </div>
<div>medical improvement and prevent flare-ups or aggravation of <span></span>her </div>
<div>PTSD.” <span>See Grover v. Indus. Comm’n<span>, 759 P.2d 705, 710 (Col<span></span>o. </span></span>
</div>
<div>1988) (discussing entitlement to medical maintenance benefits after </div>
<div>maximum medical improvement). And employer admitt<span></span>ed in its </div>
<div>final admission of liability that Mohamed was entitled to </div>
<div>maintenance benefits. This seems to be a separate basis of </div>
<div>compensability that employer doesn’t <span>appear to challenge or </span>
</div>
<div>address. <span>See</span> § 8-<span>43</span>-201(1), C.R.S. 2024 (specifying the party </div>
<div>seeking to modify an issue determined by a final admission <span></span>of </div>
<div>liability bears the burden of proof).<span> </span> </div>
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