Summary 2011 WY 118

Summary of Decision August 11, 2011


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Case Name: Middlemass v. State ex rel. Workers’ Safety and Compensation Division

Citation: 2011 WY 118

Docket Number: S-11-0007

URL: http://wyomcases.courts.state.wy.us/applications/oscn/DeliverDocument.asp?CiteID=464136

Appeal from the District Court of Park County, Honorable Steven R. Cranfill, Judge

Representing Appellant (Petitioner): Matthew D. Winslow of Keegan & Winslow, Cody, Wyoming.

Representing Appellee (Respondent): Gregory A. Phillips, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; James Michael Causey, Senior Assistant Attorney General; Kelly Roseberry, Assistant Attorney General.

Date of Decision: August 11, 2011

Facts: Appellant appeals from the district court’s affirmance of the Office of Administrative Hearings (OAH) decision upholding the Wyoming Workers’ Safety and Compensation Division’s (Division) denial of her request for worker’s compensation benefits for an injury to her shoulder. She claims the OAH’s determination that she failed to meet her burden of proving the injury resulted from her work activities is not supported by substantial evidence and the OAH erred by ruling that medical evidence was necessary to establish the cause of her shoulder injury.

Issues: Whether there is substantial evidence to support the hearing examiner’s conclusion that Appellant did not meet her burden of proving that her shoulder injury was caused by her work activities. Whether the OAH correctly conclude that expert medical evidence was necessary to establish causation.

Holdings: A worker’s compensation claimant has the burden of proving all of the essential elements of her claim by a preponderance of the evidence. This burden includes establishing the cause of the condition for which compensation is claimed and proving that the injury arose out of and in the course of employment. An employee who has a pre-existing condition may recover if her employment aggravated, accelerated, or combined with the disease or infirmity to produce the death or disability for which compensation is sought. To prove aggravation of a preexisting condition, a claimant must demonstrate by a preponderance of the evidence that the work contributed to a material degree to the aggravation of the condition.

The hearing examiner held that Appellant’s physician’s testimony was insufficient to establish that Appellant’s work activities caused her injury. The physician was only able to state that it was “conceivable” or “possible” that the injury was related to her work activities. Medical testimony stating the claimant’s work “contributed to” the injury or the injury was “most likely” or “probably” the product of the workplace is sufficient to satisfy the requirements. However, “opinions expressed by medical experts in terms of ‘can,’ ‘could,’ or ‘possibly’ are not sufficient to meet an employee’s burden of proof.” In the present action, testimony that it was “conceivable” or “possible” that the injury was caused by her work activities falls within the latter category of insufficient medical proof. Additionally, the hearing examiner also discounted the physician’s opinion because conflicting testimony indicated that he did not have a correct understanding of Appellant’s work activities. A hearing examiner is not bound by a medical expert’s opinion when it is unreasonable, not adequately supported by the facts upon which the opinion is based, or based upon an incomplete and inaccurate medical history provided by the claimant. Under these circumstances, there was substantial evidence to support the hearing examiner’s finding that the medical testimony did not establish that Appellant’s injury was work related.

Medical expert testimony is not always required to establish causation. Nevertheless, it is also recognized that in many cases expert testimony will be required. In the case at bar, there is a claimant with a complex medical history and a complex diagnosis. She had three distinct pathologies in her shoulder, two of which were clearly preexisting. Under the circumstances presented here, the hearing examiner properly ruled expert medical testimony was required to establish that Appellant’s work activities caused the injury. This is not a case where the injury was immediately and directly or naturally and probably the result of work activities. Appellant’s history of an injury to her right shoulder in a severe automobile accident, coupled with the fact that two of the conditions she was suffering from at the time of the workplace incident clearly were not work-related, made expert medical testimony critical to establish causation.

Affirmed.

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