Summary 2010 Wy 152

Summary of Decision November 23, 2010

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

Citation: 2010 WY 152

Docket Number: S-10-0051

URL: http://tiny.cc/3p8mc

Appeal from the District Court of Natrona County, Honorable Scott Skavdahl, Judge

Representing Appellant (Petitioner): Stephenson D. Emery of Williams, Porter, Day & Neville, Casper, Wyoming

Representing Appellee (Respondent): Bruce A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; James Michael Causey, Senior Assistant Attorney General.

Date of Decision: November 23, 2010

Facts: Appellant appeals from the district court’s order affirming the Office of Administrative Hearing’s (OAH) denial of her claim for temporary total disability (TTD) benefits.

Issues: Whether the Office of Administrative Hearings (OAH) acted arbitrarily and capriciously, and contrary to law, in denying payment of temporary total disability benefits (“TTD”) to Appellant, even though she was “temporarily and totally incapacitated from performing employment at any gainful employment or occupation for which she was reasonably suited by experience or training. Wyo. Stat. §27-14-102(a)(xviii).

Holdings: The OAH’s decision denying TTD benefits did not focus on whether Appellant met the definition of TTD under Wyo. Stat. 27-14-102(a)(xviii) (LexisNexis 2009), i.e., whether she was “temporarily and totally incapacitated from performing employment at any gainful employment or occupation for which she was reasonably suited by experience or training.” Instead, it ruled that the procedural deficiencies in her application for benefits warranted denial of her claim.

The OAH’s decision denying TTD benefits did not focus on whether Appellant met the definition of TTD under Wyo. Stat. 27-14-102(a)(xviii) (LexisNexis 2009), i.e., whether she was “temporarily and totally incapacitated from performing employment at any gainful employment or occupation for which she was reasonably suited by experience or training.” Instead, it ruled that the procedural deficiencies in her application for benefits warranted denial of her claim. The hearing examiner articulated two independent grounds for denying Appellant TTD benefits: 1) there was no evidence that she submitted her application for TTD benefits to the Division; and 2) her application did not include a proper certification from her health care provider. The district court determined that the record did not contain sufficient evidence to support the hearing examiner’s ruling on the first basis, but the OAH decision on the second matter was correct and dispositive.

The claimant has the burden of proving the essential elements of her claim by a preponderance of the evidence. The claimant also must establish her compliance with the rules and procedures set forth in the Wyoming Worker’s Compensation Act. Wyo. Stat. 27-14-404(d) and 501(b) and (e) and the Division Rule require certification by the treating health care provider that the worker is temporarily and totally disabled. The Division Rule mandates that the application for benefits be submitted on a form provided by the Division and the health care provider specify the reasons for the disability and the expected period of disability. Appellant filled out the employee’s section of her application for TTD benefits and signed and dated it. The health care provider’s certification was not completed or signed by her doctor, although Appellant filled in some of that section herself. Appellant claims that, despite the fact the Division’s form was not completed by her physician, the legal requirements were satisfied by a combination of the employee part of her application for TTD benefits and a signed Return to Work/School Statement indicating that Appellant’s work status was “No work unable to work until seen by an orthopedic doctor.” However, this document was not the form provided by the Division for TTD certification and, consequently, did not meet the requirement. It did not include a certification that Appellant was temporarily totally disabled under Wyoming law or set forth the reasons for the disability or expected period of disability as required by the Division Rule and Wyo. Stat. 27-14-404(d) and 501(b). Moreover, it did not provide detailed information about the health care provider or Appellant’s diagnosis, treatment plan, or prognosis. Given that Appellant did not fulfill the statutory or regulatory requirements for health care provider certification, she was not entitled to TTD benefits.

Appellant claims that we should overlook the procedural deficiencies and decide the case on its merits. In support of her assertion, she directs us to part of Wyo. Stat. 27-14-101(b) ( 2009), which provides that “benefit claims cases [should] be decided on their merits.” A review of the entire statutory section reveals that Appellant is taking that phrase out of context and misinterpreting the legislature’s intent. The language of this section indicates a clear intent to abrogate the common law rule that workers’ compensation laws were interpreted in favor of injured employees. The reference to deciding benefit claims cases “on their merits” was in the context of nullifying the historical liberal construction in favor of coverage. Contrary to Appellant’s assertion, there is nothing in the section indicating that the legislature intended that procedural deficiencies be overlooked simply because the claimant appears to meet the definition of TTD.

Appellant also claims that the Division cannot insist on strict compliance with the procedural requirements of the Wyoming Workers’ Compensation Act because it did not fulfill its procedural responsibilities. In particular, she claims the Division violated Wyo. Stat. 27-14-601(d) by not telling her that she had not filed the proper form for TTD benefits and § 27-14-404(k) by failing to advise her that she was entitled to receive interim TTD benefits. Wyo. Stat. 27-14-601(d) provision does not require the Division to inform the claimant that she filed an incorrect form or did not fill it out correctly. It simply requires the Division to make a determination as to whether the claimant is eligible for benefits and provide notice of that determination to the interested parties.
Wyo. Stat. 27-14-404(k) provides for interim TTD benefits if the employer objects to a division determination that an injury is compensable and the employee’s health care provider has certified the employee as temporarily totally disabled . That provision does not apply in this case because: 1) the Division originally determined Appellant’s injury was not compensable; 2) she does not identify any evidence in the record indicating that, once the Division determined her injury was compensable, the employer objected; and 3) as we stated earlier, her health care provider did not properly certify that she was temporarily totally disabled under Wyoming law. Moreover, Appellant does not direct us to any legal authority stating that the Division is obligated to notify her of all potential benefits.

Appellant did not comply with the statutory and regulatory requirements for filing an application of TTD benefits. Her failure to file a proper health care provider’s certification was fatal to her claim. The OAH correctly denied her claim for TTD benefits.

Affirmed.

C.J. Kite delivered the opinion for the court.