Summary 2007 WY 108

Summary of Decision issued July 12, 2007

[SPECIAL NOTE: This opinion uses "Universal Citation" and was given an "official" citation when issued. You should use this citation whenever you cite the opinion, with a P.3d parallel citation. You will note that all of the paragraphs are numbered. When you need to provide a pinpoint citation, the universal portion of the citation will use that paragraph number. The pinpoint citation in the P.3d portion should include the reporter page number. If you need assistance, please contact the Wyoming State Law Library.]

Summaries are prepared by Law Librarians and are not official statements of the Wyoming Supreme Court.

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

Citation: 2007 WY 108

Docket Number: 06-113

Appeal from the District Court of Laramie County, the Honorable Nicholas G. Kalokathis, Judge

Representing Appellant (Petitioner): Bill G. Hibbler of Bill G. Hibbler, PC, Cheyenne, Wyoming.

Representing Appellee (Respondents): Patrick J. Crank, Attorney General; John W. Renneisen, Deputy Attorney General; Steve Czoschke, Senior Assistant Attorney General; Keith J. Dodson, Legal Intern. Argument by Mr. Dodson.

Issues: Whether the Medical Commission order is supported by substantial evidence. Whether the Medical Commission order is contrary to law because Worker’s Compensation Division failed to comply with Wyo. Stat. § 27-17-605(a). Whether the Medical Commission order is contrary to law because it determined a non-medically contested issue concerning the application of Wyo. Stat. § 27-14-605(a). Whether the Medical Commission panel abused its discretion in failing to consider the testimony of the claims analyst.

Facts/Discussion: Appellant filed a claim for benefits with the Division alleging he had suffered a back injury at work. The Division determined his injury to be an aggravation of a pre-existing condition and awarded him benefits. Several months later, the Division determined that Appellant’s condition was pre-existing and declined further benefit payments. Appellant requested a hearing and the Division referred the case to the OAH. The OAH transferred the case to the Medical Commission. After a hearing the Commission issued an order upholding the denial of benefits. Appellant appealed to the district court which also upheld the appeal.
Standard of Review: In an appeal from a district court decision on a petition for review of administrative action, the Court reviews the case as if it came directly from the agency.
Sufficiency of the Evidence: The Court reviewed the evidence in the record and concluded the Commission’s findings of fact and conclusions of law were supported by substantial evidence presented at the hearing. The Court reached a similar conclusion with respect to Appellant’s claim that the Commission improperly disregarded Dr. Beer’s testimony. The Court weighed Dr. Beer’s testimony against Appellant’s inconsistent reports concerning his back problems. They also considered a written report from John Bender, O.D. who reviewed the file. It was apparent the Commission fully considered Dr. Beer’s testimony and reasonably concluded his opinions were based on incomplete and incorrect information.
Medical Commission Authority to Decide this Case (a) the Commission’s authority to decide this case after the Division initially awarded benefits and then denied benefits: The Division’s uncontested award of benefits to Appellant in November did not preclude the Division from challenging the payment of future benefits in April. The Division did not contest the compensability of Appellant’s original claim or seek to retract payments already made. The Division challenged his right to payment of future benefits. Therefore, § 27-14-605 was not applicable and Appellant was required to prove that he was entitled to receive benefits for his unpaid claims despite the previous award. The Commission had authority to decide the contested case and properly allocated the burden of proof.
b) the Commission’s authority to decide this medically contested case: Looking at the plain and ordinary meaning of the language, it was clear the Division was required to refer medically contested cases to the Commission for hearing and the Division’s decision in that regard was not subject to challenge at the administrative level. Once the Division has referred a case, the Commission has jurisdiction to decide all issues related to those identified in the hearing request. In the instant case, the Division referred the case to the OAH which then transferred the case to the Commission. The record does not reflect whether the OAH obtained the parties’ agreement before transferring the case to the Commission. Appellant’s case was transferred as a “medically contested case.” The Court reviewed the language of the administrative rules and concluded that the definition allowed for referral to the Commission cases that primarily involved medically contested issues including but not limited to those identified in subsections (A) through (D) of the rule. Conflicting medical testimony requiring the application of medical judgment to complex medical facts was presented at the hearing on the primary medical issue of whether Appellant’s back problems resulted from normal degeneration or became symptomatic as a result of work injury. The fact that the Commission may also be asked to consider non-medical issues does not deprive it of authority to decide the case. So long as the primary issue for determination was the medically contested issue of whether Appellant’s back problems were caused by a work-related injury, the Commission had authority to decide the case.
Failure to Consider Testimony: The Court found no error in the Commission’s decision not to consider testimony. The Commission concluded that when a case is referred from a contested hearing, it becomes its responsibility to independently determine the issues presented. The primary issue was whether his injury was causally related to his work. The Commission allowed the testimony and then determined the testimony was not relevant to its determination of the issue.

Holding: The Commission’s order was supported by substantial evidence and was not arbitrary and capricious. The Commission had authority to decide this medically contested case. Section 27-14-605 did not apply to these proceedings. The Commission did not err in declining to consider the Division’s reasons for discontinuing benefits and making its own independent decision concerning causation based upon Appellant’s testimony and the medical evidence presented at the hearing.

Affirmed.

J. Kite delivered the decision.

J. Golden, dissenting which C.J. Voigt joined: The Justices dissented because they did not believe the Commission had jurisdiction to decide the case. The case contained no medically contested issues and was not properly referred to the Commission.
Prior to the hearing, Appellant questioned the burden of proof which is a question of law. The Commission does not possess the expertise to answer questions of law. The Justices suggested the legal question was primary and therefore placed jurisdiction with the OAH and not the Commission.
The Justices were also concerned about the process by which the case was referred to the Commission. Once referred, the Commission must evaluate on a continuing basis to ensure the issue involved is primarily a medically contested issue. If it appears it is not, the Commission must return the case to the Division. Although administrative review is not available to the parties to challenge the Division’s referral, that does not remove the statutory restraints on the Commission’s subject matter jurisdiction.
The record contained no indication that prior to the referral the parties were contacted or consented to the same. The Justices believed this rendered the referral void. They disagreed that silence on the record equaled consent. The referral order should state that the OAH has received consent or it exceeds its statutory authority in referring the case. A case should only go before the Commission when it is a medically contested case. Here, the nature of the injury was not determinative of whether or not the injury was work-related. The medical expertise of the panel was not required and should never have been invoked.

Link: (available later), or check the Judiciary page.