Case Title: Matter of Corman

Citation: 

Docket Number: 95-43

State: wyoming

Court: Wyoming Supreme Court

Date: 1996-01-08T00:00:00Z

Document:
Matter of Corman1996 WY 4909 P.2d 966Case Number: 95-43Decided: 01/08/1996Supreme Court of Wyoming

In the Matter of the Workers' 
Compensation Claim

of 
Bradley W. CORMAN, an Employee of Consolidated Freightways. 

Bradley W. CORMAN, Appellant (Petitioner), 

v. 

STATE of Wyoming, ex rel. WYOMING 

WORKERS' COMPENSATION DIVISION, Appellee 
(Respondent).

Appeal from The District Court, Laramie County, 
Edward L. Grant, J.

Bert T. Ahlstrom, Jr. and Jennifer Ann 
Cudworth, Cheyenne, for appellant.

William U. Hill, Attorney General; John W. 
Renneisen, Deputy Attorney General; Jennifer A. Evans, Assistant Attorney 
General, Cheyenne, for appellee.

Before THOMAS, MACY, TAYLOR and LEHMAN, 
JJ., and VOIGT, D.J.

VOIGT, District Judge.

[¶1]      This case has 
been certified directly to this Court from the Office of Administrative 
Hearings. Appellant contests the hearing examiner's conclusion that Appellant 
bore the burden of proving his injury was not the result of a preexisting 
condition, and the hearing examiner's finding that he failed to meet such 
burden.

[¶2]      We 
affirm.

FACTS

[¶3]      In 1984, 
Appellant suffered a work-related injury to his neck, for which he received 
worker's compensation benefits from the State of Colorado. In 1991, seven years 
later, while working for Consolidated Freightways in Wyoming, he had another 
work-related accident. He again sought worker's compensation benefits, this time 
alleging both shoulder and neck injuries. The Division approved and paid the 
claims related to the shoulder injury, but denied those associated with the neck 
injury. Upon Appellant's timely objection to the denial, the matter was referred 
to the Office of Administrative Hearings. On December 9, 1994, the hearing 
examiner issued a Decision Letter and Order Denying Benefits. The denial was 
premised upon the hearing examiner's observation that, from the evidence, he 
could not determine whether Appellant's neck problems were caused by the Wyoming 
accident or were preexisting.

ISSUES

[¶4]      The issues before 
the Court, stated some-what differently than by the parties, are as 
follows:

1. Does Appellant's 
burden of proving a compensable injury include the burden of proving that such 
was not a preexisting condition?

2. If the answer to 
the first question is "yes," did Appellant in this case meet his burden of 
proof?

DISCUSSION

Burden of 
Proof

[¶5]      This Court has 
found in numerous instances that a worker's compensation claimant has the burden 
of proving that he has experienced a compensable injury. In re Scrogham, 52 Wyo. 
232, 252, 73 P.2d 300, 307 (1937); Gifford v. Cook-McCann Concrete, Inc., 526 P.2d 1197, 1199 (Wyo. 1974); Black Watch Farms v. Baldwin, 474 P.2d 297, 298 
(Wyo. 1970). Such proof must amount to a preponderance of the evidence. Hepp v. 
State ex rel. Workers' Comp. Div., 881 P.2d 1076, 1078 (Wyo. 1994); Alco of 
Wyoming v. Baker, 651 P.2d 266, 267 (Wyo. 1982).

[¶6]      This general rule 
has been applied in cases involving all sorts of issues: Bemis v. Texaco, Inc., 
400 P.2d 529, 531 (Wyo. 1965), reh'g denied, 401 P.2d 708 (1965) (time of 
disability and cause thereof); In re Hardison, 429 P.2d 320, 322 (Wyo. 1967) 
(time of injury, cause and relation to employment); Jennings v. C.M. & W. 
Drilling Co., 77 Wyo. 69, 73-74, 307 P.2d 122, 124 (1957) (extent of injury); 
Bearden v. State ex rel. Wyoming Workers' Comp. Div., 868 P.2d 268, 270 (Wyo. 
1994) (causal connection between injury and course of employment); Matter of Van 
Matre, 657 P.2d 815, 816 (Wyo. 1983) (course of employment); Higgins v. State ex 
rel. Wyoming Worker's Comp. Div., 739 P.2d 129, 131 (Wyo. 1987), cert. denied, 
484 U.S. 988, 108 S. Ct. 508, 98 L. Ed. 2d 507 (1987) (continuance of benefits); 
Rose v. Westates Constr. Co., 703 P.2d 1084, 1087-88 (Wyo. 1985) 
(incapacitation); Seckman v. Wyo-Ben, Inc., 783 P.2d 161, 170 (Wyo. 1989) 
(impairment of earning capacity).

[¶7]      The core element 
of a worker's burden of proof is to show a compensable injury. That term is 
defined in detail in WYO. STAT. § 27-14-102(a)(xi). At issue in the instant case 
is not the definition itself, but the specific exception for preexisting 
conditions. The statute read in pertinent part as follows at the time of the 
1991 incident:

(xi) "Injury" means 
any harmful change in the human organism other than normal aging and includes 
damage to or loss of any artificial replacement and death, arising out of and 
in the course of employment. . . . "Injury" does not 
include:

. . 
. .

(F) Any injury 
or condition preexisting at the time of employment with the employer against 
whom a claim is made.

WYO. STAT. § 27-14-102(a)(xi) (1991) 
(emphasis added).

[¶8]      In his decision 
letter, the hearing examiner reviewed the concept of burden of proof in the 
specific context of worker's compensation cases, and then reached the following 
conclusion, which is the animus for this appeal:

This Office 
concludes that the Division does not have the burden to prove that Corman's neck 
condition preexisted his August 31, 1991, accident. Rather, Corman's recognized 
burden to prove that his present neck condition arose out of the work effort 
with CF necessarily includes, under the circumstances of this case, the burden 
to establish that the condition did not preexist the August 31, 1991, accident. 
As previously indicated, the evidence presented fails to persuade this Office as 
to the actual timing of the occurrence of the C5-6 herniation. For this reason, 
Corman's claims must fail.

[¶9]      Appellant finds 
this to be error. He contends that, by setting off preexisting conditions as an 
exception to the definition of injury in the statute, the legislature intended 
to create the equivalent of an affirmative defense or bar, the burden of proving 
which would fall on the employer or the Division. He finds support for this 
proposition at 82 AM.JUR.2D, Worker's Compensation, § 566, and the cases cited 
therein. Further, he relies on the recognized concept that worker's compensation 
laws are to be liberally construed in favor of the injured worker. See In re 
Hardison, 429 P.2d  at 322.

[¶10]   While Appellant's arguments have a 
general validity, they cannot be applied in this case to provide him relief. The 
first problem is his assumption that the existence of a preexisting condition 
creates an affirmative defense or bar. An "affirmative defense," according to 
Black's Law Dictionary, is:

In pleading, matter 
asserted by defendant which, assuming the complaint to be true, constitutes a 
defense to it. A response to a plaintiff's claim which attacks the plaintiff's 
legal right to bring an action, as opposed to attacking the truth of 
claim. . . .

BLACK'S LAW DICTIONARY 60 (6th ed. 1990) 
(emphasis in original).

[¶11]   The same publication defines "bar" 
as:

In pleading, a 
special plea, constituting a sufficient answer to an action at law; so called 
because it barred, i.e., prevented, the plaintiff from further 
prosecuting it with effect, and, if established by proof, defeated and destroyed 
the action altogether. Called a special "plea in bar." It may be further 
described as a plea or peremptory exception of a defendant to destroy the 
plaintiff's action. Under Fed. Rules Civ.Proc., pleas in bar are abolished in 
favor of affirmative pleading of defenses in answer.

BLACK'S LAW DICTIONARY, 148 (6th ed. 1990) 
(emphasis in original).

[¶12]   In other words, an affirmative 
defense or bar is a legal defense to a claim, as opposed to a factual dispute as 
to an essential element of the claim. The claimant bears the burden of proof as 
to the latter, while the contestant bears the burden of proof as to the former. 
This dichotomy is preserved in WYO.R.CIV.P. 8 and 12, which allow "matter[s] 
constituting an avoidance" to be heard as questions of law, on motion prior to 
any trial on the merits.

[¶13]   When viewed in this light, the 
issue of the existence of a preexisting condition is indistinguishable from the 
central factual issue - did the injury "arise out of and occur in the course of 
employment?" If the injury resulted from a preexisting condition, rather than 
from the work-related accident, no compensable injury occurred. Consequently, 
when there is a conflict in the evidence as to this question, the claimant must 
prove by a preponderance of the evidence that the injury was work-related and 
not preexisting.

[¶14]   This specific issue has never been 
directly addressed by this Court. Results of similar cases in the past, however, 
have been consistent with this ruling. In 1991, we reversed a district court 
affirmance of a hearing examiner's denial of a worker's compensation claim. The 
worker had alleged a work-related back injury. The hearing examiner and district 
court agreed that the injury was one that had occurred over a substantial period 
of time, that WYO. STAT. § 27-14-603 controlled, and that the worker had failed 
to meet that statute's requirement for "competent medical authority" in support 
of his claim. Dougherty v. J.W. Williams, Inc., 820 P.2d 553 (Wyo. 1991). On 
appeal, this Court reversed the hearing examiner's finding that Dougherty 
"failed to prove his condition arose out of and in the course of his employment 
and was not a recurrence of a preexisting condition." Dougherty, 820 P.2d  at 
555-56. The reversal was based on the hearing examiner's misapplication of the 
statute, and upon this Court's determination that there was insufficient 
evidence in the record to support the finding. The hearing examiner's apparent 
allocation to the worker of the burden of proof as to the preexisting condition 
was not criticized. For similar decisions regarding alleged back injuries and 
alleged preexisting conditions, all of which are affirmances of claim denials, 
and all of which are consistent with Dougherty, see Padilla v. Lovern's, Inc., 
883 P.2d 351 (Wyo. 1994); Hepp v. State ex rel. Workers' Comp. Div., 881 P.2d 1076 (Wyo. 1994); and Jaqua v. State ex rel. Workers' Comp. Div., 873 P.2d 1219 
(Wyo. 1994).

[¶15]   In seeming conflict with this 
reasoning, this Court has previously held that the issue of an employee's 
culpable negligence in causing his own injuries must be raised as an affirmative 
defense, with the employer bearing the burden of proof on such issue. Hotelling 
v. Fargo-Western Oil Co., 33 Wyo. 240, 246, 248, 238 P. 542, 544 (1925). 
Culpable negligence, like preexisting condition, is one of the exceptions to 
compensable injury found in WYO. STAT. § 27-14-102(a)(xi). A close reading of 
Hotelling, however, reveals a decision precisely in line with our holding today. 
In Hotelling, the Court presupposed an "injury sustained in extrahazardous 
employment as defined by the statute." In other words, the employee had already 
presented a prima facie factual case of compensability. It then became the 
employer's burden to prove his legal avoidance theory - his affirmative defense 
- culpable negligence. That is the same logic applied today in retaining the 
employee's duty to prove a compensable injury.

[¶16]   Allocation of the burden of proof 
is a matter of law. Conclusions of law of an administrative agency are affirmed 
if they are found to be in accordance with law. Matter of Cordova, 882 P.2d 880, 
882 (Wyo. 1994); Aanenson v. State ex rel. Worker's Comp. Div., 842 P.2d 1077, 
1079 (Wyo. 1992). In the instant case, the hearing examiner correctly applied 
the burden of proof. It is up to Appellant to prove, by a preponderance of the 
evidence, that his neck injury was a compensable, work-related injury, and not 
the result of a preexisting condition.

Substantial 
Evidence

[¶17]   Whether an injury occurred in the 
course of employment is a question of fact. Padilla, 883 P.2d  at 354. The 
standard of review for agency findings of fact is quite different from the 
standard of review for agency conclusions of law. Aanenson, 842 P.2d  at 1079. 
WYO.R.APP.P. 12.09(a) directs that judicial review of administrative agency 
decisions is guided by WYO. STAT. § 16-3-114(c)(ii) (1990), which provides in 
relevant part that the reviewing court shall set aside agency action found to be 
arbitrary, capricious, an abuse of discretion, or unsupported by substantial 
evidence. Appellant contends that, if he did have the burden of proof, the 
hearing examiner should have found, based on the evidence, that his neck 
problems resulted from a compensable work-related accident, and not from his 
preexisting condition. Such findings of fact are tested under a well-established 
process:

Our standard for 
reviewing findings of fact made in an administrative worker's compensation 
hearing is well settled. If, after examining the entire record, we find 
substantial evidence to support the agency's finding, we will not substitute our 
own judgment for that of the agency. Instead, we will uphold the agency's 
finding. Substantial evidence is relevant evidence which a reasonable person 
might accept as supporting the agency finding. In addition, we examine only the 
evidence which favors the prevailing party, allowing every favorable inference, 
while omitting consideration of any conflicting evidence.

Wyoming Steel & Fab Inc. v. Robles, 882 P.2d 873, 876 (Wyo. 1994), quoting Sinclair Trucking v. Bailey, 848 P.2d 1349, 
1351 (Wyo. 1993) (citations omitted); Latimer v. Rissler & McMurry Co., 902 P.2d 706, 708-09 (Wyo. 1995).

[¶18]   Arbitrary and capricious action of 
an administrative agency is action that is wilful and unreasonable, without 
consideration and in disregard of the facts and circumstances. Marathon Oil Co. 
v. Pan Am. Petroleum Corp., 473 P.2d 575, 577 (Wyo. 1970). In response to an 
allegation that an agency acted arbitrarily or capriciously because there was 
not substantial evidence in the record to support the agency decision, the 
reviewing court also examines the conflicting evidence to determine if the 
agency could reasonably have made its findings and order upon all the evidence 
before it. Board of Trustees of School District No. 4 v. Colwell, 611 P.2d 427, 
429 (Wyo. 1980). This assessment of the administrative agency action to evaluate 
whether it is arbitrary, capricious or characterized by an abuse of discretion 
calls for an examination of whether the decision was based on a consideration of 
relevant factors and whether it is rational. Knight v. Environmental Quality 
Council, 805 P.2d 268, 273 (Wyo. 1991); Tri-State Generation & Transmission 
Ass'n v. Environmental Quality Council, 590 P.2d 1324, 1327 (Wyo. 1979). In the 
instant case, Appellant points out no abuse of discretion by the hearing 
examiner, and he identifies no conduct that could be considered to be arbitrary 
or capricious. He simply contends that the evidence does not support the 
finding.

[¶19]   Appellant's reliance in his 
evidentiary argument on the mandate for liberal construction of worker's 
compensation statutes in favor of workers is misplaced. It is true that the 
"general provisions are to be liberally construed in favor of the workman." In 
re Hardison, 429 P.2d  at 322; Seckman, 783 P.2d  at 165. However, this rule does 
not relate to the evidence offered, and it should not relieve a claimant of his 
burden to clearly prove each of the elements of his claim. In re Hardison, 429 P.2d  at 322; Olson v. Federal Am. Partners, 567 P.2d 710, 714 (Wyo. 1977). 
Neither does this rule of liberality allow the trier of fact to "fill in the 
gaps" in the claimant's evidence by invoking inferences favorable to him. 
Nickerson v. State ex rel. Worker's Comp. Div., 740 P.2d 399, 400 (Wyo. 1987). 
Courts are, in fact, to exercise restraint and adhere strictly to the literal 
terms of the statute when addressing limitations directly mandated by the 
legislature. Seckman, 783 P.2d  at 165. In particular, the courts are not free 
under the guise of liberal construction to extend worker's compensation benefits 
to injuries that do not reasonably fall within the statute. In re Hardison, 429 P.2d  at 322; Matter of Van Matre, 657 P.2d  at 818; Deloges v. State ex rel. 
Worker's Comp. Div., 750 P.2d 1329, 1331 (Wyo. 1988). The legislature clearly 
intended that preexisting conditions are not compensable under the 
statute.

[¶20]   In the instant case, the hearing 
examiner found against Appellant because conflicts in the testimony made it 
impossible for him to decide the primary question: what caused the neck 
injuries? Expert medical testimony was presented by both sides. In such case, it 
is not for this Court to reevaluate the evidence and to make an independent 
determination as to the cause of the injury. Neither do we assess witness 
credibility. Latimer, 902 P.2d  at 711; Hepp, 881 P.2d  at 1079; Creek v. Town of 
Hulett, 657 P.2d 353, 357 (Wyo. 1983). Rather, this Court simply searches the 
record to determine if substantial evidence was presented supporting the hearing 
examiner's decision. Such a review of the present record discloses expert 
medical testimony, notes in several doctors' records, magnetic resonance imaging 
studies, and rehabilitation reports that support the proposition that the neck 
injury was preexisting, or may have been preexisting. We defer to the hearing 
examiner's findings as to these factual matters. Bohren v. State ex rel. 
Worker's Comp. Div., 883 P.2d 355, 357 (Wyo. 1994); Claim of Mitchell, 876 P.2d 984, 987 (Wyo. 1994).

[¶21]   Inconsistencies in the evidence 
that prevent the finder of fact from determining whether the injury is 
compensable mean that the claimant has failed to meet his burden of proof. 
Latimer, 902 P.2d  at 711; Farman v. State ex rel. Wyoming Worker's Comp. Div., 
841 P.2d 99, 103 (Wyo. 1992). A claimant cannot prevail if factors necessary to 
prove his claim are left to conjecture. Alco, 651 P.2d  at 
268.

[¶22]   It is the burden of the party who 
appeals from an administrative determination to show a lack of substantial 
evidence supporting that determination. Hepp, 881 P.2d  at 1078; Jaqua, 873 P.2d  
at 1221. Here, there has been no showing that the hearing examiner was arbitrary 
or capricious, or that he abused his discretion, or that substantial evidence 
did not exist to support his findings.

CONCLUSION

[¶23]   The claimant in a worker's 
compensation case has the burden of proving all the essential elements of his 
claim. Questions as to the existence of a preexisting condition or injury, as 
contemplated by WYO. STAT. § 27-14-102(a)(xi)(F), are indistinguishable from 
questions of whether an injury arose out of and in the course of employment. As 
such, they are questions of fact for which the claimant bears the burden of 
proof. Substantial evidence in the record of the case now before this Court 
exists to support the finding of the hearing examiner that Appellant failed to 
prove that his neck injuries were compensable under the worker's compensation 
statutes.

[¶24]   The order of the hearing examiner 
is affirmed.