In Re Worker's Compensation Claim of Payne

993 P.2d 313, 1999 WL 1258913
CourtWyoming Supreme Court
DecidedDecember 29, 1999
Docket98-196
StatusPublished
Cited by3 cases

This text of 993 P.2d 313 (In Re Worker's Compensation Claim of Payne) is published on Counsel Stack Legal Research, covering Wyoming Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Worker's Compensation Claim of Payne, 993 P.2d 313, 1999 WL 1258913 (Wyo. 1999).

Opinion

993 P.2d 313 (1999)

In the Matter of the WORKER'S COMPENSATION CLAIM OF Virgil L. PAYNE, an Employee of Frontier Refining, Inc.:
Virgil L. Payne, Appellant (Petitioner),
v.
Frontier Refining, Inc., Appellee (Respondent).

No. 98-196.

Supreme Court of Wyoming.

December 29, 1999.

*314 Representing Appellant: Daniel E. White of Daniel E. White, P.C., Cheyenne, WY. Argument by Mr. White.

Representing Appellee: Alexander K. Davison and Peter C. Nicolaysen of Patton & Davison, Cheyenne, WY. Argument by Mr. Nicolaysen.

Before LEHMAN, C.J., and THOMAS, MACY, GOLDEN, and HILL, JJ.

LEHMAN, Chief Justice.

After undergoing carpal tunnel syndrome release surgery, appellant Virgil Payne (Payne) sought worker's compensation benefits. A hearing examiner from the Office of Administrative Hearings denied benefits, finding that Payne's injury report was untimely and that Payne failed to rebut the presumption that his claim be denied pursuant to Wyo. Stat. Ann. § 27-14-502(c) (Michie June 1991 Rpl.). Specifically, the hearing examiner found that Payne had failed to establish a lack of prejudice to his employer in monitoring medical treatment. Because we conclude that the hearing examiner's finding is not supported by the record, we reverse.

ISSUES

The injured worker, Virgil Payne, presents two issues for review:

1. Does W.S. § 27-14-502(c) require a worker's compensation claimant to rebut a factual defense relating to the employer's ability to monitor medical treatment which was: (1) not raised by the pleadings; (2) not litigated in the contested case proceedings conducted below; and (3) raised for the first time sua sponte by the Office of Administrative Hearings in its order denying benefits.
2. Does W.S. § 27-14-502(c) require the Appellant to rebut Appellee's defense that it was prejudiced in its ability to monitor medical treatment due to the Appellant's failure to comply with an accident investigation and reporting policy where: (1) the Appellee's human resources manager testified that the policy did not apply to the type of injury which had been sustained by the Appellant; and (2) all of the medial treatment of the Appellant's carpal tunnel syndrome occurred after Appellee had been formally notified of the injury.

*315 Payne's employer, the appellee Frontier Refining, Inc., restates the issues:

1. Whether substantial evidence exists to support a finding that the claimant did not timely report the injury.
2. Whether substantial evidence exists to support the denial of benefits based upon the claimant's failure to show by clear and convincing evidence that the employer's ability to monitor the claimant's medical treatment was not prejudiced.

FACTS

Virgil Payne began working for Frontier Refinery, Inc., (Frontier) in 1969. Since 1985, he has worked as a pump mechanic. Sometime in between approximately 1992 and 1994, Payne began experiencing pain and numbness in his hands and wrists, and loss of sensation in his fingers.

On May 3, 1995, during a routine medical exam of old head and back injuries, Payne complained of pain and numbness in his hands and of some stiffness in his right elbow. Payne's physician determined Payne "probably has carpal tunnel," and advised Payne of that. However, the physician's report indicates they "elected . . . to put off any kind of a workup for now."

On November 24, 1995, Payne again met with his physician. After performing nerve conduction testing, the physician confirmed the diagnosis of carpal tunnel syndrome (CTS). The physician's report indicates that Payne's CTS is "most likely related to work." Payne testified the CTS diagnosis was communicated to him on that date, but the physician did not tell Payne that the condition might be work related. On November 29, 1995, Payne's physician referred Payne to a surgeon, recommending Payne be given "strong consideration for surgical intervention."

On December 19, 1995, Payne told Frontier's Human Resources Manager that he planned to undergo surgery for his CTS. Payne also mentioned that he might file a worker's compensation claim, to which the manager responded that Frontier would contest the claim. Pursuant to Frontier's elective surgery policy, Payne provided written notice to Frontier the next day, December 20, 1995, that surgery on his right wrist was planned. Payne completed a worker's compensation injury report on February 8, 1996, which was filed with the Clerk of the District Court on February 20, 1996.

On April 9, 1996, Payne underwent CTS release surgery on his right wrist. Payne submitted worker's compensation claims for the cost of surgery, medical treatment, and for temporary total disability. In its Final Determination, the Wyoming Worker's Compensation Division (Division) approved Payne's claim for benefits. Frontier objected, however, arguing that Payne's CTS was not work related.

The matter was referred to the Office of Administrative Hearings. Prior to the hearing, Frontier filed a case disclosure statement in which it raised the issue that Payne should be denied benefits because he failed to report the injury in a timely fashion. At the hearing, the evidence focused on two issues: (1) whether Payne's injury was work related, and (2) the timeliness of Payne's report of the injury.

The hearing examiner denied benefits, finding Payne's report of the injury was untimely and Payne failed to rebut the presumption that his claim be denied pursuant to Wyo. Stat. Ann. § 27-14-502(c). Specifically, the hearing examiner found "[t]here does not exist in this case clear and convincing evidence that there was a lack of prejudice to Frontier in monitoring Claimant's medical treatment." Because the hearing examiner decided the case on the injury report issue, it did not reach the issue of whether Payne had established his CTS was work related or whether Payne had established the requirements for an injury occurring over a substantial period of time. Wyo. Stat. Ann. § 27-14-603(a).

Payne petitioned for review with the district court, which affirmed the hearing examiner's denial of benefits. This timely appeal follows.

STANDARD OF REVIEW

The dispositive issue in this case is whether Payne rebutted the presumption *316 that his claim be denied as a result of a tardy injury report. Wyo. Stat. Ann. § 27-14-502(c). The presumption of claim denial may be rebutted if the claimant establishes by clear and convincing evidence a lack of prejudice to the employer or the Division in investigating the accident and in monitoring medical treatment. Neither the employer nor the Division are required to show prejudice. Matter of Zielinske, 959 P.2d 706, 710 (Wyo. 1998). Instead, the claimant has the burden to establish a lack of prejudice as a result of the untimely injury report. Id. This determination is a question of fact. Id. at 709 (citing Curnow v. State ex rel. Workers' Compensation Div., 899 P.2d 875, 878 (Wyo. 1995)).

When, as in this case, a hearing examiner decides that a party charged with the burden of proof has failed to meet that burden, the case is reviewed under the "[a]rbitrary, capricious, an abuse of discretion or otherwise not in accordance with law" standard of Wyo. Stat. Ann.

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993 P.2d 313, 1999 WL 1258913, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-workers-compensation-claim-of-payne-wyo-1999.