Summary 2007 WY 46

Summary of Decision issued March 16, 2007

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Case Name: Walton v. State, ex rel., Wyoming Workers’ Safety and Compensation Division

Citation: 2007 WY 46

Docket Number: 05-289

Appeal from the District Court of Carbon County, the Honorable Wade E. Waldrip, Judge

Representing Appellant (Petitioner/Employee-Claimant): Gregory L. Winn of Schilling & Winn, PC, Laramie, Wyoming.

Representing Appellee (Respondent): Patrick J. Crank, Attorney General; John W. Renneisen, Deputy Attorney General; Steven R. Czoschke, Senior Assistant Attorney General; and Kristi M. Radosevich, Assistant Attorney General.

Issues: Walton: Whether the conclusion of the Medical Commission Hearing Panel that Appellant failed to meet her burden of proof establishing that the injuries to her neck, shoulder, lower back, and her headaches were directly and causally the result of her employment related accident at Memorial Hospital of Carbon County on October 2, 2002 is supported by substantial evidence. Whether the conclusion of the Medical Commission Hearing Panel that Appellant’s injuries to her neck, shoulder, lower back, and her headaches were directly and causally the result of her employment related accident at Memorial Hospital of Carbon County on October 2, 2002 is arbitrary and capricious as that standard is applied as a “safety net” under Newman. Division: The Medical Commission Hearing Panel determined that Walton’s low back injury resolved by October 12, 2004, following her October 2, 2002 work injury. Further, the Medical Commission determined Walton failed to prove the relatedness between her work injury and complaints regarding her neck, left shoulder and headaches. Whether substantial evidence supported the Medical Commission Hearing Panel’s decision denying benefits. Whether the Medical Commission’s decision denying benefits was arbitrary or capricious.
Facts/Discussion: Walton was injured in a work-related accident in 2002. She claims she injured primarily her low back, left shoulder and neck in the accident. The Wyoming Workers’ Compensation Division (Division) denied all claims submitted by Walton for injuries to her left shoulder and neck, determining that such injuries were not causally related to her work accident. Walton also submitted a claim for medication for migraine headaches which was denied on the basis that her migraines were not causally related to the work accident. The Division paid claims relating to Walton’s low back injury until October 2004. The Division denied further claims, determining that Walton’s physical condition with regard to her low back had reached pre-injury status.
After the Medical Commission held a contested case hearing, the Panel upheld the Division’s denial of benefits in all respects. Walton sought review arguing the decision was not supported by substantial evidence and was arbitrary and capricious. The district court affirmed the Medical Commission’s final order in all respects.
Standard of Review: The Court reviews an administrative agency order as if it came directly from the administrative agency affording no deference to the district court’s decision. Where both parties to a contested case submit evidence, appellate review of the evidence is limited to application of the substantial evidence test. Even if sufficient evidence supports the administrative decision uner the substantial evidence test, Newman requires the Court apply the arbitrary and capricious standard as a “safety net” to catch other agency action that may have violated the Wyoming Administrative Procedures Act.
Payment for Migraine Medication: Walton made no specific argument supporting the compensability of the treatment for her migraine headaches. Therefore the Court declined to review the matter.
Low Back: The Court’s careful review of the record revealed there were no basic findings of fact in the content of the Medical Commissions order supporting the ultimate finding. Normally, the Court would remand to the Medical Commission Review Panel for further findings except the record is clear that no evidence supports a finding that Walton’s low back reached pre-injury status at any time before the hearing. The Medical Commission’s conclusion to the contrary was arbitrary and capricious.
Neck and Left Shoulder: The Medical Commission found Walton’s injuries to her neck and left shoulder to be unrelated to her work accident. The Court reviewed the record and noted the Medical Commission failed to make any explicit findings of credibility as to the testimony regarding the neck and left shoulder. The Medical Commission should have expressly ruled on its credibility determinations and findings on the evidence Walton presented. However, even without it, there was substantial evidence to support the Commission’s determination. The record unambiguously reflected that neither the initial injury report nor the emergency room records indicated an injury to Walton’s left shoulder or neck. The testimony of the two doctors treating Walton for her neck and left shoulder complaints stated they would expect symptoms to appear shortly after the work accident. From that evidence, the Court found that the Medical Commission’s upholding of the denial for the claims for neck and left shoulder injury were supported by substantial evidence and not otherwise arbitrary or capricious.
The Court also noted the appropriate function of the Medical Commission is to base its decisions on the evidence presented and not its personal medical opinions.

Holding: The Court stated the record was clear that the decision denying benefits for Walton’s low back were arbitrary and capricious. No evidence supported a finding that Walton’s low back had returned to pre-injury status. The denial for benefits for law back injury was reversed. The Court made it clear they had no comment as to the nature of any future treatment. The denial for benefits for injuries to Walton’s neck and left shoulder was affirmed. Substantial evidence existed to support the finding that any injury was not causally related to the work accident. The denial was not arbitrary or capricious. The denial for benefits for medication for migraine headaches was affirmed because Walton made no argument that her migraines were causally related to the work accident.

Affirmed in part, reversed in part and remanded for further proceedings.

J. Golden delivered the decision.

Link: http://tinyurl.com/23ee6h .