Summary of Decision May 25, 2012
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Case Name: Mitcheson v. State, ex rel., Wyo. Worker’s Safety and Comp. Div.
Citation: 2012 WY 74
Docket Number: S-11-0236
Appeal from the District Court of Converse County, The Honorable John C. Brooks, Judge
Representing Appellant (Petitioner): Robert A. Nicholas, Nicholas & Crank, PC, Cheyenne, Wyoming.
Representing Appellee (Respondent): Gregory A. Phillips, Attorney General; John D. Rossetti, Deputy Attorney General; Michael J. Finn, Senior Assistant Attorney General; Kelly Roseberry, Assistant Attorney General.
Date of Decision: May 25, 2012
Facts: The Wyoming Workers’ Safety and Compensation Division awarded benefits to Appellant after he fell at work and injured his tailbone in 2007. Months later, Appellant found a job driving a truck, which required a commercial driver’s license (CDL). On the health history portion of each of his medical examinations for his CDL, Appellant did not report a history of spinal injury or disease, or chronic low back pain. Approximately twenty months after his workplace injury, and approximately five months after he began working as a truck driver, Appellant returned to the hospital and reported that he had been having pain in his lower back since the accident in 2007. The treating physician ordered an x-ray, determined that Appellant’s complaints stemmed from his 2007 injury, and submitted a bill to the Division along with a request for authorization for an MRI.
The Division denied payment and subsequently issued a final determination denying payment for medical care that Appellant claimed was related to his workplace injury. Appellant requested a contested case hearing, and the Office of Administrative Hearings (OAH) upheld the Division’s determination. Appellant appealed to the district court, which upheld the OAH’s order. He challenged the district court’s decision in this appeal.
Issues: 1) Whether the OAH Order is arbitrary and unsupported by substantial evidence; 2) Whether the OAH Order denying payment for treatment of Appellant’s tailbone injury is arbitrary; and 3) Whether the OAH Order denying payment for medical care is contrary to the “Rule Out” Rule and therefore contrary to law.
Holdings: The Court found that the hearing examiner’s findings are supported by substantial evidence. Specifically, the Court determined that the hearing examiner could reasonably conclude that Appellant’s account of unrelenting pain since his injury was inconsistent with the failure to report his back symptoms for over twenty months after his injury. Second, the hearing examiner’s finding that Appellant’s testimony was not consistent with the symptoms documented in his medical history also found support in the record. Finally, the hearing examiner could reasonably determine that Appellant’s explanations for his failure to report his back symptoms for nearly two years, as well as his failure to report his symptoms on his department of transportation medical exams, reflected poorly on his credibility.
In regards to the second issue of denial of payment for treatment of the tailbone injury, the Court found that the physiologic connection between the claimant’s injury and the diagnostic measure at issue was absent in this case. Given the lack of such a connection, the Court concluded that the treatment was not compensable as a diagnostic test.
In regards to the final issue, because there was no indication that any treatment received was intended to “rule out” the possible causes of Appellant’s back pain, the Court found no basis for Appellant’s claim that treatment received was compensable as a diagnostic measure.
J.Burke delivered the opinion for the court.
Friday, May 25, 2012
Summary of Decision May 25, 2012