Case Title: Matter of Workers' Compensation Claim of Jacobs

Citation: 

Docket Number: 95-237

State: wyoming

Court: Wyoming Supreme Court

Date: 1996-10-07T00:00:00Z

Document:
Matter of Workers' Compensation Claim of Jacobs1996 WY 130924 P.2d 982Case Number: 95-237, 95-229Decided: 10/07/1996Supreme Court of Wyoming
In 
the Matter of the WORKER'S COMPENSATION CLAIM OF Kirk B. JACOBS, An Employee of 
Medicine Bow Ski Area.

STATE of Wyoming, ex rel. 
WYOMING WORKERS' COMPENSATION DIVISION,

 Appellant 
(Respondent),

v.

Kirk B. JACOBS, Appellee 
(Employee-Claimant).

 In the Matter of the WORKER'S 
COMPENSATION CLAIM OF Kirk B. JACOBS, An Employee of Medicine Bow Ski Area. 

Kirk B. JACOBS, Appellant 
(Employee-Claimant),

 v.

 STATE of Wyoming, ex rel., WYOMING 
WORKERS' COMPENSATION DIVISION,

 Appellee 
(Respondent).

Appeal from District 
Court, Albany County, Arthur T. Hanscum, J.

William U. Hill, 
Attorney General; John W. Renneisen, Deputy Attorney General; Gerald W. Laska, 
Senior Assistant Attorney General; and Jennifer A. Evans, Assistant Attorney 
General, Cheyenne, for State ex rel. Wyoming Workers' Compensation 
Division.

George Santini, 
Cheyenne, for Kirk B. Jacobs.

Before 
TAYLOR, C.J., THOMAS, MACY and LEHMAN, JJ., and BRACKLEY, District 
Judge.

TAYLOR, Chief 
Justice.

[¶1]      The Wyoming 
Workers' Compensation Division appeals a hearing examiner's award of home health 
care to an injured worker. The worker cross appeals, asking that a rate of 
compensation be set for his home health care. Holding that the award of 
non-professional health care by the hearing examiner exceeds his authority in 
the absence of a mutual agreement between the employee, employer and the 
director of the Workers' Compensation Division, we 
reverse.

I. 
ISSUES

[¶2]      Appellant, State 
ex rel. Wyoming Workers' Compensation Division (Division), states the following 
issues in Case No. 95-229:

A.        Whether a 
decision of the Wyoming Workers' Compensation Division to allow or disallow home 
nursing services is subject to judicial review.

B.        Whether the 
Office of Administrative Hearings['] order awarding Claimant five hours of daily 
non-professional home nursing services is arbitrary, capricious, and unsupported 
by the record.

[¶3]      The injured 
appellee, Kirk Jacobs (Jacobs), articulates the following issues in Case No. 
95-229:

1.         
Did the Office of Administrative Hearings have authority to enter an 
award for non-professional home health care services?

2.         Is 
there substantial evidence to support the Hearing Examiner's award of five (5) 
hours per day for non-professional health care services?

[¶4]      In Case No. 
95-237, his cross appeal, Jacobs states a single issue:

Did the Hearing Officer 
[err by] not establishing an hourly rate for payment of home health care 
services provided by Appellant's wife?

[¶5]      The Division 
identifies much the same issue in Case No. 95-237:

Whether this matter 
should be remanded to the Office of Administrative Hearings for a determination 
of the hourly rate to be paid for home health care services provided by 
Claimant's wife?

II. 
FACTS

[¶6]      In September of 
1982, Jacobs suffered a work-related injury to his right little toe. In February 
of 1983, Jacobs experienced an allergic reaction to an antibiotic used to treat 
an infection which had developed in his right foot. The reaction manifested 
itself as colitis and nerve damage which left Jacobs with severe chronic pain 
and an intermittent inability to accomplish the activities of daily life without 
assistance.

[¶7]      Jacobs received a 
seventy-eight percent permanent partial disability award in 1990, and still 
requires high doses of morphine for reported pain. Approximately $400,000.00 in 
worker's compensation benefits have thus far been awarded to Jacobs, who 
continues to receive approximately $3,000.00 per month for morphine 
alone.

[¶8]      A request from 
Jacobs that his wife be compensated for twenty-four hour daily non-professional 
home nursing services was denied by the Division. In the alternative, the 
Division offered scheduled visits from a home health aid and a registered nurse, 
as well as five day-a-week meal preparation by a home-maker and a beeper system 
allowing the nurse to be on call twenty-four hours a day. A hearing examiner for 
the Office of Administrative Hearings awarded Jacobs five hours daily 
non-professional home health care, retroactive to May 1990, and the Division 
appeals the district court's order affirming that award. On cross-appeal, Jacobs 
requests limited remand for purposes of setting an hourly pay rate for his 
wife.

III. STANDARD OF 
REVIEW

[¶9]      A court reviewing 
administrative action is mandated, by Wyo. Stat. § 16-3-114(c)(ii)(A) (1990), to 
hold unlawful and set aside agency action, findings and conclusions found to be 
arbitrary, capricious, an abuse of discretion or otherwise not in accordance 
with law. When appeal has first been taken to the district court, we afford no 
particular deference to that court's conclusions, reviewing the case as though 
it had come directly to us from the administrative agency. Wyoming Steel & 
Fab, Inc. v. Robles, 882 P.2d 873, 875 (Wyo. 1994).

IV. 
DISCUSSION

[¶10]   Jacobs bears the burden of proving, 
by a preponderance of the evidence, all essential elements of his claim. Hepp v. 
State ex rel. Wyoming Workers' Compensation Div., 881 P.2d 1076, 1078 (Wyo. 
1994) (quoting Gilstrap v. State ex rel. Wyoming Workers' Compensation Div., 875 P.2d 1272, 1273 (Wyo. 1994)). The claim, including the nature and amount of 
benefits, is governed by laws in effect at the time of the injury. State ex rel. 
Wyoming Workers' Compensation Div. v. Rivera, 796 P.2d 447, 449 n. 3 (Wyo. 1990) 
(quoting Shapiro v. State ex rel. Wyoming Workers' Compensation Div., 703 P.2d 1079, 1081-82 (Wyo. 1985)).

[¶11]   At the time of Jacobs' injury, Wyo. 
Stat. § 27-12-401 (1983) provided, in pertinent part:

(a) The expense of 
medical attention and hospital care of an injured employee shall be paid from 
the date of the compensable injury * * *.

*           *           
*           
*           
*           
*

(c) Hospital care 
includes private nursing when necessary, and in case of mutual agreement between 
the employer, the employee and the director, the court may allow home 
nursing.

[¶12]   In the absence of a "mutual 
agreement between the employer, the employee and the director [of the Division] 
* * *," there is no statutory authority upon which to predicate an award of home 
nursing services to an individual injured in late 1982. Wyo. Stat. § 
27-12-401(c). Therefore, a necessary element of Jacobs' case is demonstration of 
such a mutual agreement. Jacobs failed to prove that any mutual agreement had 
been reached, leaving the hearing examiner without authority to make the 
contested award.

[¶13]   The rule that worker's compensation 
laws should be construed liberally in favor of injured workers does not afford 
this court license to expand the benefits available beyond those prescribed by 
the state legislature. Mor, Inc. v. Haverlock, 566 P.2d 219, 222 (Wyo. 1977). We 
hold that the award of non-professional home health care to Jacobs by the 
hearing examiner exceeded the bounds of the hearing examiner's 
authority.

V. 
CONCLUSION

[¶14]   The hearing examiner's award of 
non-professional home health care benefits to Jacobs is reversed. The cross 
appeal is thereby rendered moot and is dismissed.

BRACKLEY, District Judge, files a 
dissenting opinion.

BRACKLEY, District Judge, 
dissenting.

[¶15]   I respectfully dissent. Many 
Wyoming cases now authorize home nursing. The statute requiring "mutual 
agreement between the employer, the employee and the director" before awarding 
home nursing benefits allows unilateral denial without providing this court with 
a record to review.

[¶16]   Here, the hearing officer made 
specific findings and recommended home nursing. It appears the worker has proved 
all essential elements of his claim. The Division does not argue merits, it 
merely refuses to "agree." We have no record to judge if the Division is acting 
arbitrarily or is abusing its discretion regarding this 
worker.

[¶17]   Liberally construing the law in 
favor of an injured worker should require the Division to identify facts 
distinguishing this case from those where they have agreed to home nursing 
benefits. I would affirm the award absent such a showing.