Wisconsin Insurance Security Fund v. Labor & Industry Review Commission

2005 WI App 242, 707 N.W.2d 293, 288 Wis. 2d 206, 2005 Wisc. App. LEXIS 921
CourtCourt of Appeals of Wisconsin
DecidedOctober 20, 2005
Docket2004AP2157
StatusPublished
Cited by6 cases

This text of 2005 WI App 242 (Wisconsin Insurance Security Fund v. Labor & Industry Review Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wisconsin Insurance Security Fund v. Labor & Industry Review Commission, 2005 WI App 242, 707 N.W.2d 293, 288 Wis. 2d 206, 2005 Wisc. App. LEXIS 921 (Wis. Ct. App. 2005).

Opinion

LUNDSTEN, PJ.

¶ 1. This is a worker's compensation case. An employer, Eau Galle Cheese Factory, and the Wisconsin Insurance Security Fund appeal an order *209 of the circuit court affirming an order of the Labor and Industry Review Commission regarding a worker's compensation claim. The Commission's order granted employee David Kallstrom's claim for compensation for a back injury, and ordered that Eau Galle Cheese reimburse Kallstrom's health insurance carrier, Benefit Plan Administrators, for reasonably required medical expenses it incurred. The Fund is involved because Eau Galle Cheese's worker's compensation insurer was in liquidation.

¶ 2. Eau Galle Cheese argues that the Commission misinterpreted the law governing compensable occupational diseases. 1 According to Eau Galle, in the absence of identifiable traumatic injury-causing events, there can be no occupational disease injury. Eau Galle Cheese also argues that the evidence is insufficient to support the Commission's finding of a compensable occupational back injury. The circuit court rejected these arguments. We likewise reject them, and affirm the circuit court.

¶ 3. On a separate topic, Eau Galle Cheese argues that the Commission erred when it ordered Eau Galle to reimburse Kallstrom's health care insurer for expenses that the insurer incurred treating Kallstrom's compensable occupational back injury. Eau Galle Cheese argues that when a subrogated insurer, such as *210 Kallstrom's health care insurer, has paid medical expenses that arise from a compensable occupational injury under the worker's compensation statutes, and when, as here, the employer's worker's compensation insurance carrier is in liquidation, Wis. Stat. § 646.31(11) (2003-04) 2 precludes the Commission from ordering the employer to reimburse the subro-gated insurer. We agree and, therefore, reverse both the circuit court and the Commission in this respect.

Background

¶ 4. David Kallstrom began working for Eau Galle Cheese Factory in 1985. His work there required him to manually cut small blocks of cheese from larger blocks and manually stack the smaller blocks. The smaller blocks, together with the hoop used in stacking, averaged about thirty-five pounds. In August of 2000, Kallstrom was diagnosed with a herniated disk. An orthopedic surgeon, Dr. T. Sunil Thomas, diagnosed Kallstrom's condition as degenerative disk disease and disk herniation. Kallstrom underwent two surgeries to relieve the pain. He now suffers a 15% permanent partial disability as a result of his back problems. Kallstrom's health insurance carrier, Benefit Plan Administrators, covered $27,155.36 in medical expenses relating to this back injury.

¶ 5. In 2001, Kallstrom filed a claim with the Worker's Compensation Division of the Department of Workforce Development. Kallstrom asserted that his back injury was due to working fifteen years as a cheese maker at Eau Galle Cheese. The claim alleged that years of "extensive, frequent, and repetitive bending, *211 lifting and twisting while cutting, forming and pressing cheese" was responsible for the injury. Both Eau Galle Cheese and its worker's compensation insurer, Reliance National Insurance Company, disputed the claim. At some point during these proceedings, the Wisconsin Insurance Security Fund assumed liability for Reliance when that company became insolvent and entered liquidation proceedings.

¶ 6. At a hearing on the matter, Eau Galle Cheese presented testimony from Dr. Stephen Barron. Dr. Barron gave extensive testimony explaining why he believed that it was not possible to identify Kallstrom's work at the cheese factory as the cause of his injury. The Commission also had before it the opinions of various treating physicians, including Dr. T. Sunil Thomas's opinion that Kallstrom's employment had caused the degenerative back condition. The Commission found that Kallstrom had sustained a compensable occupational back injury. Among other relief, the Commission ordered "the employer and its insurance carrier" to reimburse Kallstrom's health insurance carrier, Benefit Plan Administrators, the sum of $27,155.36.

¶ 7. Eau Galle Cheese and the Fund challenged the Commission's decision in circuit court. The circuit court issued an order affirming the Commission's order. The circuit court's order also clarified that the "Fund is not liable for Medical reimbursement" to Kallstrom's health care insurer. Although both parties discuss this issue in their respective briefs, the end result is that all parties agree the Fund is not liable.

Discussion

I. Occupational Disease Injury

¶ 8. The Commission found that Kallstrom suffered a compensable occupational disease injury as a *212 result of repetitive strenuous job activity over an extended period of time. The Commission adopted Dr. T. Sunil Thomas's opinion that Kallstrom's back had " 'wor[n] out' after years of labor intensive work" at the Eau Galle Cheese Factory. In effect, the Commission concluded that, although there was no evidence that Kallstrom's back injury was the result of identifiable traumatic work-related injuries, his back injury was nonetheless compensable because Kallstrom's work at the cheese factory was a material contributory factor causing that injury.

¶ 9. The parties dispute whether a back injury caused by job activity, but not caused by one or more identifiable traumatic events, is a compensable occupational "disease" injury within the meaning of Wis. Stat. § 102.03(1)(e). 3 Eau Galle Cheese argues that such an injury is not covered by § 102.03(l)(e) because it does not fit any existing definition of "occupational back disease" found in the case law. More specifically, Eau Galle Cheese argues that such an injury is not compensable under either Lewellyn v. DILHR, 38 Wis. 2d 43, 155 N.W.2d 678 (1968), or Shelby Mutual Insurance Co. v. DILHR, 109 Wis. 2d 655, 327 N.W.2d 178 (Ct. App. 1982). The Commission responds that Kallstrom's injury is a compensable injury caused by a "disease" within the meaning of § 102.03(1)(e) because that in *213 jury comports with our discussion of a compensable occupational back disease in Shelby Mutual. We agree with the Commission and first discuss Shelby Mutual, 4

¶ 10. Worker's compensation cases involve two types of compensable injuries: those caused by accidents, and those caused by occupational diseases. See Zabkowicz v. Industrial Comm'n, 264 Wis. 317, 319, 58 N.W.2d 677 (1953).

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Bluebook (online)
2005 WI App 242, 707 N.W.2d 293, 288 Wis. 2d 206, 2005 Wisc. App. LEXIS 921, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wisconsin-insurance-security-fund-v-labor-industry-review-commission-wisctapp-2005.