Thursday, March 24, 2011

Summary 2011 WY 52

Summary of Decision March 24, 2011

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

Case Name: Lane-Walter v. State, ex rel., Wyo. Workers’ Safety and Comp. Div.

Citation: 2011 WY 52

Docket Number: S-10-0087


Appeal from the District Court of Johnson County, The Honorable John G. Fenn, Judge

Representing Appellant (Petitioner): George Santini of Ross, Ross & Santini, LLC, Cheyenne, WY.

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

Date of Decision: March 24, 2011

Facts: Appellant, challenged an order of the district court which affirmed the decision of a Medical Commission Hearing Panel (Medical Commission). The Medical Commission’s order denied the benefits Appellant sought for a back surgery procedure. Benefits were denied on the basis that the surgical procedure at issue, to implant a device in the appellant’s back, did not qualify as “reasonable and necessary medical care.” Appellant contended that she was entitled to that “medical care” under the prior settlement agreement that she reached with the Wyoming Workers’ Safety and Compensation Division. In addition, Appellant sought preauthorization for the surgery and was told by the Wyoming Workers’ Safety and Compensation Division (Division) that preauthorization was not required in her case. After the surgery had been successfully completed and Appellant had recovered much of her ability to perform the usual activities of her daily life, albeit with some disability still remaining, all of the claims submitted to the Division by her health care providers were denied.

Issues: 1) Whether the decision of the Medical Commission was arbitrary and capricious for the reason that it omitted material evidence from its Findings of Fact, Conclusions of Law and Order; 2) Whether the Medical Commission improperly [relied] upon medical opinions which were based upon an inadequate foundation? 3) Whether it was arbitrary, capricious, and an abuse of discretion to apply the Wyoming Workers’ Safety and Compensation Division’s preauthorization guidelines to deny claims for medical treatment when the appellant and her treating surgeon were informed by the Division that those guidelines and procedures were not applicable to her claim.

Holdings: To the extent that Appellant had a burden of proof in this case, the Court held there is not substantial evidence to support the agency’s decision to reject the evidence offered by the appellant. The Medical Commission’s determinations that both the treating orthopedic surgeon witness and Appellant were not credible witnesses were not supported by substantial evidence.

The order of the district court affirming the Medical Commission was reversed. Furthermore, the matter was remanded to the district court with directions that it further remand it to the Medical Commission with directions that it direct the Division to pay the claims submitted by Appellant and her health care providers for the reasonable and necessary medical treatment at issue in this case.

J. Hill delivered the opinion for the court.

J. Burke specially concurring, with J. Voigt, joining.

The concurrence agrees with the result reached by the majority, but writes separately in disagreement with the majority’s conclusion that the burden of proof was on the Division “to demonstrate that the treatment the [appellant] received was not reasonable and not medically necessary.” First, the issue was not raised by Claimant at the hearing level, on appeal with the district court, or in the appeal to this Court; Second, placing the burden of proof on the Division conflicts with precedent; Third, the majority cites no legal authority for switching the burden of proof to the Division; and finally, switching the burden of proof to the Division in this case will cause problems in future cases.

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