Case Title: SERDA v. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: 01-29

State: wyoming

Court: Wyoming Supreme Court

Date: 2002-03-14T00:00:00Z

Document:
SERDA v. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2002 WY 3842 P.3d 466Case Number: 01-29Decided: 03/14/2002

OCTOBER TERM, A.D. 2001

 

                                                                                                
   

 

SONJIA 
SERDA, 

Appellant(Petitioner),

 

v.

 

STATE OF 
WYOMING, ex rel., WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION, 

Appellee(Respondent).

 

 

W.R.A.P. 
12.09 Certification from the District Court of Laramie County

The 
Honorable Edward L. Grant, Judge

 

Representing 
Appellant:

George 
Santini of Ross, Ross & Santini, LLC, Cheyenne, Wyoming.  Argument by 
Mr. Santini.

 Representing 
Appellee:

Gay 
Woodhouse, Attorney General; John W. Renneisen, Deputy Attorney General; Gerald 
L. Laska, Senior Assistant Attorney General; and David L. Delicath, Assistant 
Attorney General.  Argument by Mr. 
Delicath.

 

Before 
LEHMAN, C.J., and GOLDEN, HILL, KITE, and VOIGT, JJ.

 

 

HILL, 
Justice, 
delivered the opinion of the Court.  
GOLDEN, Justice, filed a specially concurring opinion, in which 
VOIGT, Justice, joined.

 

            
HILL, Justice. 

[¶1]      Appellant, Sonjia 
Serda (Serda), challenges the October 16, 2000 order of the Medical Commission 
(Commission), which denied a portion of her attorney's claim for costs and 
expenses necessarily and reasonably incurred in preparation for her hearing 
before the Commission.  Appellee, 
Wyoming Workers' Safety and Compensation Division (Division), contends that the 
Commission properly denied Serda's claim in accordance with its rules, as well 
as governing statutes.  On November 1, 
2000, Serda filed a petition for review in district court pursuant to W.R.A.P. 
12.03.  On 
December 12, 2000, the district court certified the matter to this Court for 
review under authority granted by W.R.A.P. 12.09.

 

[¶2]      We affirm.

 

 

[¶3]      Serda raises these 
issues:

 

1.  Did the Medical Commission act arbitrarily 
and capriciously in failing to follow its own rules of practice and procedure in 
denying Appellant's claim for reimbursement of medical fees expended during the 
preparation of her claim for contested case hearing?

 

2.  Did the Medical Commission err as a matter of 
law in its interpretation of §§ 27-14-405(g) and (m) and 27-14-604, W.S. 1977 
(1998 Repl.) in denying payment for the costs of a third physical impairment 
rating performed at Appellant's request during the pendency of [the] contested 
case proceedings?

 

The Division rephrases those issues somewhat:

 

I.  Did the Medical Commission correctly follow 
its own rules in declining to order the Division to pay for Appellant's third 
impairment rating?

 

II.  Did the Medical Commission comply with Wyo. 
Stat. Ann. § 27-14-405(g) & (m) in declining to order the Division to pay 
for Appellant's third impairment rating?

 

 

[¶4]      Serda's claim for 
worker's compensation benefits began in August of 1996, when she injured her 
right elbow while at work in Cheyenne.  She received worker's compensation benefits 
for that injury and, after a substantial period of conservative treatment, 
underwent surgery on January 27, 1998.  Serda continued therapy for many months after 
the surgery and was deemed by her treating physician to have reached maximum 
medical improvement on May 21, 1998.  Serda continued to experience significant 
pain and continued treatment for that problem.

 

[¶5]      Wyo. Stat. Ann. § 
27-14-405(f) (LexisNexis 2001) provides:  "An injured employee suffering an 
ascertainable loss may apply for a permanent partial impairment award as 
provided in this section."  Section 27-14-405(g) provides:  "An injured 
employee's impairment shall be rated by a licensed physician using the most 
recent edition of the American Medical Association's guide to the evaluation of 
permanent impairment."  The record does not reflect that Serda made 
an application for a permanent partial impairment award; however, on July 24, 
1998, the Division sent Serda to Gem City Bone & Joint for the purpose of 
undergoing an impairment evaluation.  The report of that evaluation is detailed, 
but it suffices for purposes of this appeal to note that the report was sent to 
the Division and set Serda's impairment rating at 0%.  Sections 
27-14-405(f) and (g) are not specific as to how the selection of the physician 
whose examination will initiate this process is made, but the Division's rules 
flesh this out.  
Chapter 5, section 3(c)(ii) provides:

            
(c)  Initial Claim for Permanent 
Partial Impairment (PPI) Benefits.

            
. . . .

(ii)  Applications for 
PPI Award.  
If the treating physician determines that the injury has resulted in a 
permanent impairment according to the American Medical 
Association's Guide to the Evaluation of Permanent Impairment or its 
successor, the treating physician shall notify the Division in writing.  The Division shall 
file the written documentation of permanent impairment, copying all 
parties.  Based 
upon the rating given by the treating physician, the worker may apply with the 
Division for the appropriate award, pursuant to W.S. §§ 27-14-405 or 406.

3 Weil's Code of Wyoming Rules, Department of Employment, 
Workers' Compensation Rules, Regulations and Fee 
Schedule, Chapter 5, Section 3.  Claims for 
Benefits, 025 220 001-13 (2001).  Serda's treating physician was B.F. Magsamen, 
M.D., of Fort Collins, Colorado, and no determination was made by him, nor did 
he submit written documentation of an impairment rating.  The record does not 
reflect that Serda made any objection to this procedure, either at this point in 
the proceedings, or later when she was actually represented by counsel.  Wyo. Stat. Ann. § 
27-14-405(m) (LexisNexis 2001) provides:

 

            
(m) If the percentage of physical impairment is disputed, the division 
shall obtain a second opinion and if the ratings conflict, shall determine the 
physical impairment award upon consideration of the initial and second 
opinion.  Any 
objection to a final determination pursuant to this subsection shall be referred 
to the medical commission for hearing by a medical hearing panel acting as 
hearing examiner pursuant to W.S. 27-14-616.

 

[¶6]      When Serda received 
notice of the 0% rating, she objected. It is clear that Wyo. Stat. Ann. § 
27-14-405(m) authorizes the Division to obtain a second opinion so as to counter 
that evaluation brought forward by the worker's treating physician, which may 
serve to obviate the need for an IME in many circumstances.  The record does not 
explain the reason for the lengthy delay, but on March 26, 1999, the Division 
sent Serda to Rehabilitation Associates of Colorado for a second impairment 
rating.  That 
report is somewhat more detailed than the first and set Serda's impairment 
rating as follows:  
"In my experience, a 5% extremity impairment would be appropriate.  If desired, 
utilizing table 30, this can be converted to a 3% whole person impairment."  The report was 
addressed to the Division and Concentra Managed Care.  Thus, contrary to 
the governing statutes and pertinent rules of the Division, both impairment 
ratings were obtained by physicians engaged by the Division for purposes of 
defense against the claim, which it initiated for Serda.  On July 22, 1999, 
the Division sent Serda a document captioned:  "FINAL DETERMINATION OF PERMANENT PARTIAL 
IMPAIRMENT BENEFITS."  
That document informed Serda that, "The Division has reviewed this rating 
along with the original rating of 0% and has determined that you are entitled to 
a 3% percent [sic] impairment."  Serda sent a letter 
to the Division, under the date of July 27, 1999, which we quote in pertinent 
part:

 

I object to the Final Determination of Permanent Partial 
Impairment Benefits of 3% because I do not think it reflects my complete 
impairment.  I 
request the opportunity to seek legal advice at no personal expense and to 
present my objections before the Medical Commission, with a date for hearing to 
be as soon as possible, considering of course all interested parties' 
schedules.

 

The record then demonstrates that:  Serda's request was 
referred to the Medical Commission by the Case Analyst on September 28, 1999; 
was further referred to the Medical Commission by the Case Analyst acting as the 
District Manager on December 27, 1999; was further referred by the Program 
Manager on December 27, 1999; and was actually referred to the Administrator of 
the Medical Commission on December 27, 1999.  On December 28, 1999, the Commission then 
received the above-described documentation.  Both the Division and the Commission are 
located in Cheyenne.  
By order dated December 29, 1999, a pre-hearing conference was set by the 
Commission for January 26, 2000.  By order dated January 26, 2000, the 
Commission appointed an attorney to represent Serda and rescheduled the 
pre-hearing conference for February 8, 2000.  In a document dated February 8, 2000, and 
entitled, "Order Setting Review Conference," the Commission reported the 
following:

 

            
THIS MATTER having come before the Office of the Medical Commission, 
(hereinafter referred to as "the Commission"), pursuant to the request for an IME [independent medical examination] 
and said request having been made by counsel for the Employee/Claimant [Serda], 
George Santini, and George having further request [sic] that we would like to have J.C. DeMers stipulate 
to an IME and said request having been made during the 2nd Pre-Hearing Conference, and counsel for the 
Objector /Defendant [Division] having not been available for said conference, 
and the Medical Commission [sic] having fully 
reviewed the case file;

 

            
IT IS HEREBY ORDERED that this matter shall be set for a review 
conference on the 28th day of February at 
10:00 a.m.  
At said review conference the parties will advise the Hearing Examiner of 
the status of the above matter;

 

            
IT IS FURTHER ORDERED that the parties may engage in further discovery 
herein until fifteen (15) days prior to the hearing date, yet to be set.

 

(Emphasis added.)

[¶7]      By order dated March 
21, 2000, which purports to be a report of the proceedings at the February 28, 
2000 review conference, the hearing was set for June 29, 2000.  No mention is made 
of Serda's request for an IME, though it seems unmistakably clear that such a 
request was made.1

 

[¶8]      With respect to an 
IME, the governing statute, Wyo. Stat. Ann. § 27-14-604 (LexisNexis 2001), 
provides:

 

(a) In any contested proceeding, the hearing examiner may 
appoint a duly qualified impartial health care provider to examine the employee 
and give testimony.  
The fee for the service shall be as ordered by the hearing examiner, with 
mileage allowance as is allowed to other witnesses to be assessed as costs and 
paid as other witness fees are paid.  The employer or employee may, at his own 
expense, also designate a qualified health care provider who may be present at 
the examination of the employee and give testimony at later hearings.

 

            
(b) If the employer and employee stipulate to an examination of the 
employee by a nonresident, qualified health care provider designated by the 
hearing examiner, and that the report of the health care provider as to his 
examination shall be admitted in evidence, the hearing examiner may order 
payment of the reasonable cost and expense of the employee's attendance upon the 
health care provider, the provider's fee for examination of the employee and his 
report thereon.  
The fees and costs shall be charged in the same manner as other costs and 
witness fees.  
The nonresident health care provider shall report in writing to the 
hearing examiner and include answers to questions asked by the hearing examiner 
relative to the employee's condition.

 

[¶9]      It should be noted 
that the statute immediately above authorizes both an IME to be paid for by the 
Division, as well as an IME to be paid for by the employee or employer.

 

[¶10]   The hearing was held on June 29, 2000, 
and by order dated August 10, 2000, the Commission established Serda's 
impairment rating at 3%.  Serda did not appeal that decision.

 

[¶11]   For the purpose of preparing for the 
contested case hearing before the Commission, Serda's attorney sent Serda to 
Victoria M. Vernon, M.D., in Cheyenne for an additional evaluation (IME).  Dr. Vernon prepared 
a lengthy report, which she characterized as an IME.  It suffices for 
purposes of this appeal to note that Dr. Vernon rated Serda's impairment at 
8%.

 

[¶12]   After the Commission issued its final 
decision setting Serda's impairment rating at 3%, Serda's attorney submitted an 
application for an award of attorney's fees, as well as for the costs and 
expenses associated with his representation.  Included in that request was a $395.00 item 
representing the fee advanced by Serda's attorney, to Dr. Vernon, for the IME 
she performed.  
Wyo. Stat. Ann. § 27-14-602(d) (LexisNexis 2001)2 provides that 
a claimant may be appointed an attorney in a contested case hearing:

 

    (d) Upon request, the hearing 
examiner may appoint an attorney to represent the employee or claimants and may 
allow the appointed attorney a reasonable fee for his services at the conclusion 
of the proceeding.  
An appointed attorney shall be paid according to the order of the hearing 
examiner either from the worker's compensation account, from amounts awarded to 
the employee or claimants or from the employer.  In any contested case where the issue is the 
compensability of an injury, a prevailing employer's attorney fees shall also be 
paid according to the order of the hearing examiner from the worker's 
compensation account, not to affect the employer's experience rating.  An award of 
attorney's fees shall be for a reasonable number of hours and shall not exceed 
the benefits at issue in the contested case hearing.  In all other cases 
if the employer or division prevails, the attorney's fees allowed an employee's 
attorney shall not affect the employer's experience rating.  Attorney fees 
allowed shall be at an hourly rate established by the director of the office of 
administrative hearings and any application for attorney's fees shall be 
supported by a verified itemization of all services provided.  No fee shall be 
awarded in any case in which the hearing examiner determines the claim or 
objection to be frivolous and without legal or factual justification.

 

[¶13]   Of course, a hearing before the 
Commission is a contested case hearing.3  With respect to 
attorney's fees and costs, the Commission's rules provide as follows:

 

(a)       Upon request, 
the presiding officer or executive secretary may appoint an attorney to 
represent an employee under W.S. § 27-14-602(d) and allow a reasonable fee upon 
entry of a final order.  All requests for attorney fees shall be in 
detail showing time spent and work performed and shall be verified.  Fees allowed by the 
presiding officer shall be at an hourly rate of sixty dollars ($60.00) per 
hour.  Appointed attorneys shall be reimbursed for costs 
necessarily and reasonably incurred.  Except for good cause shown, attorneys' 
travel time in connection with the case or to the contested case hearing shall 
not be reimbursed.

(b)       Requests for 
fees and expenses of appointed attorneys shall indicate the source of funds as 
provided by W.S. 27-14-602(c) from which the fees and expenses have been 
proposed to be ordered paid and such requests shall be properly served on all 
parties and their attorneys.

(c)        No fee 
shall be awarded in any case in which the presiding officer determines the claim 
to be frivolous and without legal or factual justification.

 

3 Weil's Code of Wyoming Rules, Department of Employment, 
Workers' Compensation Medical Commission, Rules of 
Practice and Procedure, Chapter 6, Section 5. Appointed Attorney, 025 240 001-6 (1995) (emphasis 
added).

 

[¶14]   The Division objected to the request 
for it to pay the $395.00 for Dr. Vernon's services:

 

            
1.  The Division does not contest the reasonableness of the 
charges of $395.00 apparently rendered [sic] for Dr. 
Vernon's services.

 

            
2.  The Division made clear its intention to object to payment 
for an additional impairment rating early in the proceedings and did not sit 
silent in allowing the Employee-Claimant [Serda] to incur this expense.

 

            
3.  The Division has previously asserted and continues to 
assert that under W.S. § 27-14-405(g) and (m), it is clear that the legislature 
intended for the Division to pay for one permanent physical impairment rating 
and to provide a second rating only if requested by the Employee-Claimant.  The Division fully 
met its financial obligation to the Employee-Claimant by providing two ratings 
by qualified licensed physicians.  If the legislature intended that the 
Employee-Claimant be entitled to a third rating at Division expense, then it 
would have said so.  
Inclusion of one is exclusion of others.  This statute is not intended to create a 
fishing expedition at Division expense.  An employee is only entitled to two ratings 
at Division expense.

 

[¶15]   Serda responded to that objection, 
disagreeing with the Division's contentions and pointing out that, as provided 
by the statute, both evaluations were performed by physicians selected by the 
Division, they disagreed with one another, that medical testimony was at the 
heart of the issue to be decided, and that "obtaining an opinion of a physician 
of her [Serda's] own choosing was reasonable in light of the issues to be 
addressed and the complexity of the claimant's underlying medical 
condition."  Of 
course, as we noted above, the statute and governing rules contemplate that the 
employee will obtain an impairment rating from the employee's treating physician 
and if the Division does not agree with that rating, then it will obtain another 
impairment rating from a physician of its choosing.4

 

[¶16]   The Commission held a hearing to 
consider the Division's objection and Serda's response.  In the course of 
that hearing, both Serda and the Division directed the Commission's attention to 
Wyo. Stat. Ann. § 27-14-401(f) (LexisNexis 2001), which provides:

 

(f) Subject to subsection (h) of this section, an employer 
or the division may designate health care providers to provide nonemergency 
medical attention to his employees or to claimants under this act.  Except as provided 
in subsection (h) of this section, the employee may for any reason, select any 
other health care provider.  If the employee 
selects a health care provider other than the one (1) selected by the employer 
or the division, the employer or division may require a second opinion from a 
health care provider of their choice.  The second opinion may include an independent 
medical evaluation, a functional capacity exam or a review of the diagnosis, 
prognosis, treatment and fees of the employee's health care provider.  The independent 
medical evaluation, a functional capacity exam or the review by the employer's 
health care provider shall be paid for by the employer and the evaluation, a 
functional capacity exam or review by the division's health care provider shall 
be paid from the worker's compensation account.

 

(Emphasis added.)

[¶17]   Serda's counsel indicated that the 
Division had not properly applied that provision to Serda's circumstance (and 
that counsel would, in the future,5 urge his clients to avail themselves of that 
provision).  
The Division contended that it was not applicable under the circumstances 
of this case.  
Serda also pointed out that there had been a considerable lapse of time 
between the first evaluation and the second and more than a year between the 
time of the second evaluation and that performed by Dr. Vernon just before the 
hearing.  At 
the conclusion of the hearing, the Commission issued an order denying 
reimbursement for the disputed $395.00 cost of Dr. Vernon's IME.  That order 
contained these findings:

 

            
1.  The primary issue before the 
Medical Commission in the above-entitled matter was the level of Permanent 
Physical Impairment that had been sustained by the Employee/Claimant 
[Serda].

 

            
2.  A Physical Impairment Rating had been provided by Michael 
Kaplan, M.D., of Gem City Bone and Joint, in July of 1998, that rendered a 
Physical Impairment Rating of 0%.

 

            
3.  Ms. Serda, the Employee/Claimant, disagreed with the 
evaluation of Dr. Kaplan and requested a second opinion on the issue of Physical 
Impairment and was evaluated by Bruce Lockwood, M.D., of Ft. Collins, Colorado, 
in March of 1999.  
This Physical Impairment Rating determined that Ms. Serda had a 3% 
Impairment.

 

            
4.  A third Physical Impairment Rating conducted by Victoria 
Vernon, M.D., of Cheyenne, Wyoming, in May of 2000, was conducted apparently at 
the request of the Employee/Claimant.  The Wyoming Workers' 
Safety and Compensation Division objected to the payment of costs associated 
with Dr. Vernon's Impairment Rating in the amount of $395.00, alleging that the 
Division had already paid for and provided two Physical Impairment Ratings and 
there is no authority or statutory provision that authorizes the payment of a 
third Physical Impairment Rating.

 

            
5.  The subject of Physical Impairment Ratings is discussed by 
W.S. § 27-14-405 (g), (m) and specifically provides for a first and a second 
opinion Physical Impairment Rating to be provided by the Wyoming Workers' Safety 
and Compensation Division.  The language of the statute does not provide for a third 
rating.

 

            
6.  The Employee/Claimant did not seek an additional Physical 
Impairment Rating under the provisions of W.S. §27-14-604, which states, in 
pertinent part:

 

(a)  "In any contested proceeding, the [h]earing 
[e]xaminer may appoint a duly qualified impartial [h]ealth [c]are [p]rovider to 
examine the [e]mployee and give testimony"

 

            
This procedure provides a method for an additional Physical Impairment 
Rating or Independent Examination, over and above what had previously been 
provided by the Wyoming Workers' Safety and Compensation Division.

 

            
7.  The Employee/Claimant has failed to provide sufficient 
authority to convince the Hearing Examiner that costs for said Physical 
Impairment Rating should be reimbursed through the Wyoming Workers' Safety and 
Compensation fund, pursuant to the request for Attorney's Fees and Costs.

 

(Emphasis added.)

 

 

[¶18]   In a case involving an issue virtually 
identical to the one facing us here, we articulated this standard:

 

Judicial review of an agency action is directed by W.S. 
16-3-114, under which 16-3-114(a) allows any person aggrieved or adversely 
affected in fact by the actions or inactions of an agency to obtain judicial 
review by the district court.  "This court is governed by the same rules of 
review as was the district court."  Atchison v. Career 
Service Council of State of Wyoming, 664 P.2d 18, 20 (Wyo.), cert. denied 464 U.S. 982, 104 S. Ct. 424, 78 L. Ed. 2d 359 (1983).  See also Banda v. State ex rel. Wyoming Workers' 
Compensation Div., 789 P.2d 124 (Wyo.1990).  While this court typically remands an 
administrative decision back to the agency when that decision relies upon 
findings of fact, Cook v. Zoning Bd. of Adjustment for 
the City of Laramie, 776 P.2d 181 (Wyo.1989);  FMC v. Lane, 773 P.2d 163 (Wyo.1989), remand is not mandatory when the question before the 
district court or this court is a question of law or a mixed question of fact 
and law.  Natrona County School Dist. No. 1 v. McKnight, 764 P.2d 1039, 1049 (Wyo.1988).  The rationale underlying remand when findings 
of fact by an agency are involved is our reliance on the expertise of an 
agency.  "[W]e 
have indicated we defer to the experience and expertise of the agency in its weighing of the evidence 
and will disturb its decisions only where it is clearly contrary to the 
overwhelming weight of the evidence on record."  Southwest Wyoming 
Rehabilitation Center v. Employment Sec. Com'n of Wyoming, 781 P.2d 918, 921 
(Wyo.1989) (emphasis added) (accord Cody Gas Co. v. 
Public Service Com'n of Wyoming, 748 P.2d 1144, 1146 (Wyo.1988)).

 

            
In the case of a question of law, it is the courts and not the agencies 
which display the dominant expertise since courts, as a matter of course, deal 
with questions of law and legislative intent.  If an agency determination is not in 
accordance with law, this court corrects the determination to assure accordance 
with law.  See Employment Sec. Com'n of Wyoming v. Western Gas 
Processors, Ltd., 786 P.2d 866 (Wyo.1990).  Unreasonableness of a compensatory legal fee 
assessment is addressed by the court as a matter of law if the underlying facts 
are not in dispute.  
The scope of review of the standard that is used for calculating the 
attorney fee is plenary with the appellate court.  Bell v. United 
Princeton Properties, Inc., 884 F.2d 713 (3rd Cir.1989).

 

            
This court in Hohnholt v. Basin Elec. Power 
Co-op, 784 P.2d 233 (Wyo.1989) addressed the specific standard for review in 
worker's compensation cases within the new organizational structure provided by 
the hearing examiner provision of W.S. 27-14-602.  The Hohnholt test 
is substantial evidence for support of the findings and conclusions when 
evidentiary issues exist.  

 

"We examine the entire record to determine if there is 
substantial evidence to support an agency's findings.  If the agency's 
decision is supported by substantial evidence, we cannot properly substitute our 
judgment for that of the agency, and must uphold the findings on appeal.  Substantial 
evidence is relevant evidence which a reasonable mind might accept in support of 
the conclusions of the agency.  It is more than a scintilla of 
evidence."  
(citation omitted)  Trout v. Wyoming Oil 
& Gas Conservation Comm'n, 721 P.2d 1047, 1050 (Wyo.1986).

 

            
Id. at 234.   The standard is similarly applied in 
the federal courts for the administrative agency appeal as one of substantial 
evidence for factual review.  Mangus v. Director, 
Office of Workers' Compensation Programs, U.S. Dept. of Labor, 882 F.2d 1527 
(10th Cir.1989).  
A plenary review of questions of law and substantial evidence for 
questions of fact are the general standard of review for worker's compensation 
attorney fee contest actions.  Matter of Death of 
Smithour, 778 P.2d 302 (Colo.App.1989); Weyerhaeuser 
Co. v. Fillmore, 98 Or.App. 567, 779 P.2d 1102 (1989).

 

            
The standard to be applied for assessment of the reasonableness of 
attorney fees is a question of law;  reasonableness within the legal standard may 
be discretionary or constitute a factual determination.  Weyerhaeuser, 779 P.2d 1102.   An 
insufficient record to support the decision made may justify the dismissal of 
the appeal, Johnson v. Statewide Collections, Inc., 
778 P.2d 93 (Wyo.1989), or may merit remand for further hearing by the 
administrative agency.  In this case, the hearing examiner provided 
no factual or legal basis to justify the fee reduction.

 

State ex rel. Wyoming Workers' Compensation Division v. 
Brown, 805 P.2d 830, 833-34 (Wyo. 1991).

 

 

[¶19]   As a preface to our discussion, we find 
the following material from our decision in In re 
Pohl, 980 P.2d 816, 818, 820-21 (Wyo. 1999) particularly worthy of note:

 

Pohl suffered a work-related back injury on July 22, 1992, 
when she reached for a clipboard and experienced pain on the left side of her 
lower back.  
She reported the incident to her employer but continued working.  On September 30, 
1992, Pohl experienced an increase in her lower back pain, which included pain 
radiating into her left buttock.  A few days later, Pohl went to an emergency 
room, where she was diagnosed with an acute lumbar strain and a herniated lumbar 
disc with radiculopathy (disease of the spinal nerve roots).

 

            
Pohl originally followed a non-surgical course of treatment, but she 
continued to suffer pain.  Another examination in February of 1993 
confirmed disc degeneration and inflammation between lumbar vertebrae 4 and 5. 
In June of 1993, Pohl underwent spinal fusion surgery.  After this surgery 
and recuperation, Pohl accepted a 20 percent permanent partial impairment 
award.

 

            
Pohl moved to Oregon in 1995 and continued to receive therapy and 
treatment.  In 
June of 1995, Pohl requested an impairment rating from her Oregon 
physician.  
Although the physician told Pohl that "Oregon physicians don't do 
[impairment] ratings," the physician supplied a rating.  Without including 
any explanation of how the rating was calculated, Pohl's physician concluded 
that Pohl's whole body impairment rating had increased to 32 percent.  Relying on the 32 
percent rating, Pohl petitioned the Division for an award for an increase in 
permanent partial disability pursuant to Wyo. Stat.  Ann. § 27-14-605(a) 
(Michie Rpl. June 1991) [footnote omitted].  The Division disputed the 32 percent rating 
and arranged for an independent medical evaluation (IME) with a second Oregon 
physician.  
After examination and testing, the IME examiner concluded that Pohl's 
impairment rating was 35 percent.

 

            
Before rendering a final determination, the Division employed a 
physician, Dr. Anne MacGuire, to conduct a review of Pohl's claim.  After reviewing 
Pohl's history and both impairment ratings, Dr. MacGuire concluded that both 
impairment ratings were invalid under the AMA Guide to the Evaluation of 
Permanent Impairment, Fourth Edition (AMA Guide).  The Division denied Pohl's claim for an 
increase in her impairment rating, stating that the "Medical Adjudicator for the 
Division has reviewed the Impairment Rating and has indicated that you have no 
additional impairment, therefore, additional Permanent Partial Disability 
benefits will not be awarded."   Pohl filed a timely request for a 
hearing, and the Division referred the case to the Workers' Compensation Medical 
Commission (Medical Commission).

 

            
. . . .

 

Pohl complains that the Division did not comply with the 
Worker's Compensation Act when it evaluated her claim for an increase in 
incapacity under Wyo. Stat.  Ann. § 27-14-605(a) (Michie Rpl. June 
1991).  She 
contends that the Division acted contrary to Wyo. Stat.  Ann. § 27-14-405(m) 
(Michie 1997) (formerly -405(e) (Rpl. June 1991)) when it employed a physician 
to perform a "paper review" of Pohl's conflicting impairment ratings and later 
relied on the physician's review in denying benefits.  We reject these 
contentions.

 

Section 27-14-405(m) provides

If the percentage of physical impairment is disputed, the 
division shall obtain a second opinion and if the ratings conflict, shall 
determine the physical impairment award upon consideration of the initial and 
second opinion.  
Any objection to the final determination pursuant to this subsection 
shall be referred to the medical commission for hearing by a medical hearing 
panel acting as hearing examiner pursuant to W.S. 27-14-616.

 

            
In Pohl's case, the Division disputed the percentage of physical 
impairment and arranged for an IME.  After the IME was completed, the Division 
employed a case review physician, Dr. MacGuire, to assist in "determin[ing] the 
physical impairment award upon consideration of the initial and second 
opinion."   
Clearly, the Division was within its authority in engaging a medical 
professional, Dr. MacGuire, to assist in evaluating the case before it.  See Wyo. Stat.  Ann. § 27-14-801(d) 
(Michie Rpl. June 1991).  Moreover, when Pohl's Oregon physician 
indicated in a report that "Oregon physicians don't do ratings," closer 
consideration of the ratings from both Oregon physicians was warranted.  After reviewing the 
impairment ratings, Dr. MacGuire concluded that both ratings were invalid due to 
inaccurate applications of the AMA Guide.

 

            
In her brief, Pohl concedes that it is appropriate for the Division to 
reject evidence which is invalid or erroneous.  Nevertheless, she maintains that the Division 
erred by disregarding the ratings from the Oregon physicians.  We disagree.  With the accuracy 
of the impairment ratings challenged, the Division properly denied Pohl's claim 
and left its resolution to the expertise of the Medical Commission.  We conclude that 
the Division's [sic] acted in accordance with Wyo. 
Stat. Ann. § 27-14-405(m) when it employed Dr. MacGuire to evaluate Pohl's 
impairment ratings.

 

[¶20]   The Pohl 
case tends to suggest that the Division may obtain an IME at its expense when it 
deems it necessary; whereas, the worker may not have any right to counter such 
an IME except at the worker's own expense.  The case of Sweets v. 
State of Wyoming, ex rel. Wyoming Workers' Safety and Compensation Division, 
2002 WY 37, ___ P.3d ____, (Wyo. 2002) (No. 01-29, published March 12, 2002) 
contains another similar example where the Division obtained two IME's prior to 
a hearing.

 

 

[¶21]   We agree with the Division's contention 
that Wyo. Stat. Ann. § 27-14-405(m) authorizes two 
impairment ratings.  
We find it unnecessary under the circumstances of this case to 
definitively answer the Division's contention that that same statute, ergo, prohibits a third (or subsequent) evaluation.

 

[¶22]   Although Serda sought approval from the 
Commission to obtain an IME, that request was not approved prior to Serda having 
incurred the expense of the IME.  Approval of that expenditure either before 
the hearing or after the hearing was within the authority of the 
Commission.  
However, we are unable to conclude that denying Serda reimbursement for 
that expense was arbitrary, capricious, an abuse of discretion, or contrary to 
applicable law, and the Commission's order is affirmed.

  
Golden, J., 
concurring, in which Voigt, J. joins.

 

[¶23]       While I concur in the result, I write separately because I 
differ with the majority opinion regarding the statutes at issue and their 
application.  I 
also disagree with the factual context applied by the majority opinion.  An independent 
medical examination as contemplated under § 27-14-604 never occurred in this 
case, thus making § 604 inapplicable to these facts.

 

[¶24]       The Division argues that § 27-14-405 limits the 
responsibility of the Division under these circumstances to two physical 
examinations, leading the majority opinion to discuss several sections of 
Article 4 of the Wyoming Worker's Compensation Act.  The Division is 
confusing the applicable statutes.  Section 405 only applies to the initial 
determination of an impairment rating.  The circumstances at issue in this case arise 
within the context of a contested case hearing.  Section 405 simply has no application to 
proceedings in a contested case.

 

[¶25]       Specifically, this appeal concerns the payment for a 
physician's services that were rendered as part of a contested case 
hearing.  
Article 6 of the Wyoming Worker's Compensation Act governs the procedures 
for a contested case hearing.  In determining who should bear the specific 
expense at issue in this appeal, two separate statutory sections are 
pertinent.  The 
first section is § 27-14-602(d) and accompanying rule.6  This section 
provides generally for the appointment of an attorney and provides for the 
payment of the fees of an appointed attorney under certain circumstances.  The accompanying 
rule allows for the payment of certain costs as well.

 

[¶26]       The second statutory section pertinent to this appeal is § 
27-14-604 that reads:

 

§ 27-14-604. Examination by impartial health care provider; 
costs; report by nonresident provider.

 

(a) In any 
contested proceeding, the hearing examiner may appoint a duly qualified 
impartial health care provider to examine the employee and give testimony.  The fee for the 
service shall be as ordered by the hearing examiner, with mileage allowance as 
is allowed to other witnesses to be assessed as costs and paid as other witness 
fees are paid.  
The employer or employee may, at his own expense, also designate a 
qualified health care provider who may be present at the examination of the 
employee and give testimony at later hearings.

 

(b) If the 
employer and employee stipulate to an examination of the employee by a 
nonresident, qualified health care provider designated by the hearing examiner, 
and that the report of the health care provider as to his examination shall be 
admitted in evidence, the hearing examiner may order payment of the reasonable 
cost and expense of the employee's attendance upon the health care provider, the 
provider's fee for examination of the employee and his report thereon.  The fees and costs 
shall be charged in the same manner as other costs and witness fees.  The nonresident 
health care provider shall report in writing to the hearing examiner and include 
answers to questions asked by the hearing examiner relative to the employee's 
condition.

 

Wyo. Stat. Ann. § 27-14-604 (LexisNexis 2001).

 

[¶27]       Section 604 governs the procedure for an independent 
medical examination.  
It very specifically provides for the mechanism by which an independent 
medical examination for purposes of the contested case hearing can be obtained 
and how such examination should be conducted.  The procedure is under the control of the 
hearing officer.  
It is the hearing officer who appoints "an impartial health care 
provider."  The 
section states that the expenses for the examination are to be as ordered by the 
hearing examiner and "paid as other witness fees are paid."  Most importantly 
for the instant appeal, it states that, should the parties want a physician of 
their personal choosing present at the independent medical examination, they may 
do so at their own expense.

 

[¶28]       It seems Serda was aware of this provision.  It is mentioned in 
the "Order Setting Review Conference," set out in the majority opinion, that 
Serda, through her attorney, wanted to reach an agreement with the attorney for 
the Division for an IME, presumably pursuant to § 604.  This comment in the 
Order only reflects discussions between the parties.  The record does not 
reflect that any request or motion for an IME was ever made or ruled on by the 
hearing examiner.  
Instead, Serda consulted a physician of her own choosing and underwent a 
private physical examination.  

 

[¶29]       The order of the commission under review states that the 
medical examination at issue "was conducted apparently at the request of the 
Employee/Claimant" and that "[t]he Employee/Claimant did not seek an additional 
Impairment Rating under the provisions of W.S. §27-14-604."  There is nothing in 
the record to dispute these findings.  In fact, in her "Response to Objection to 
Application for Award of Attorney Fees and Payment of Expenses," Serda, through 
her attorney, admitted that the medical examination was done at her request by 
"a physician of her own choosing."  Thus, the examination was a private 
examination that in no way complied with the IME procedure contemplated by § 
604.7  

 

[¶30]       The factual issue before the court, then, involves the 
responsibility for payment of a private medical examination.  The problem with 
allowing payment for a private medical examination under the guise of costs is 
that the statutes reflect a scheme whereby a party requesting a private medical 
examination should be responsible for the payment therefor.  The only time the 
hearing officer is specifically provided with authority to direct payment of a 
medical examination is if the examination is an independent examination under § 
604.  In order 
to determine legislative intent, statutes must be read in pari materia, In re WJH, 2001 WY 54, ¶16, 24 P.3d 1147, ¶16 (Wyo. 
2001) ("in ascertaining the meaning of a given law, we consider and construe in 
harmony all statutes relating to the same subject or having the same general 
purpose"), and specific statutes control over general statutes on the same 
subject.  Thunderbasin Land, Livestock & Inv. Co. v. County of 
Laramie County, 5 P.3d 774, 782 (Wyo. 2000) ("The specific statute controls 
over the general when they address the same subject.")  

 

[¶31]       Here, there is a very specific statute dealing with the 
issue of directing payment for medical examinations for contested case 
hearings.  It 
states that the hearing officer has discretion to direct payment for an 
independent medical examination conducted by an impartial health care provider 
appointed by the hearing officer, but that the parties should bear the expenses 
of any private physicians they wish to employ.  An administrative rule relating to attorney 
costs generally cannot override this specific statutory language.  

 

[¶32]       The facts are simply that, in the context of a contested 
case hearing, Serda employed a private physician to conduct a private physical 
examination.  
There is no statutory provision allowing for anyone other than Serda to 
pay for the expenses associated therewith.  The order of the Commission is rightly 
affirmed.

 

FOOTNOTES

   
1There is nothing in the governing statute or 
pertinent rules to suggest that a "formal motion" is required to obtain an IME, 
though that would be better practice.  Here, the record is clear that the Commission 
was asked to exercise its statutory prerogatives in this regard.  It is equally clear 
that the record contains no indication that the request was approved or 
disapproved by the Commission.

  2We include here Wyo. Stat. Ann. § 27-14-608 
(LexisNexis 2001), which prohibits an attorney from receiving an additional fee 
from a claimant.  
We also note that the statute refers only to "fee" and does not 
specifically mention costs or expenses:

 

(a) If the hearing examiner under W.S. 27-14-602(d) 
or the district court or supreme court under W.S. 27-14-615 set a fee for any 
person for representing a claimant under this act excluding a health care 
provider, the person shall not receive any additional fee from the claimant.

(b) Any person violating this section is guilty of a 
misdemeanor and upon conviction shall be fined not more than seven hundred fifty 
dollars ($750.00), imprisonment in the county jail for a term not to exceed six 
(6) months, or both.

 

   
3Wyo. Stat. Ann. § 27-14-616(b)(iv) (LexisNexis 2001) 
provides that one of the duties of the Commission is:

 

            
(iv) To furnish three (3) members of the commission to serve as a medical 
hearing panel to hear cases referred for hearing.  The division shall refer medically contested 
cases to the commission for hearing by a medical hearing panel.  The decision to 
refer a contested case to the office of administrative hearings or a medical 
hearing panel established under this section shall not be subject to further 
administrative review.  Following referral by the division, the 
hearing examiner or medical hearing panel shall have jurisdiction to hear and 
decide all issues related to the written notice of objection filed pursuant to 
W.S. 27-14-601(k).  
Different medical hearing panels with different membership may be 
selected to hear different cases, but a panel may hear more than one (1) 
case.  
Individual medical hearing panels shall be selected by the executive 
secretary under the supervision and guidance of the chairman of the medical 
commission.  At 
least one (1) member of each panel shall be a physician.  One (1) member 
shall be designated by the executive secretary to serve as chairman of the 
panel.  When 
hearing a medically contested case, the panel shall serve as the hearing 
examiner and shall have exclusive jurisdiction to make the final administrative 
determination of the validity and amount of compensation payable under this 
act.  For cases 
referred to the medical commission as small claims hearings under W.S. 
27-14-602(b), the medical hearing panel may consist of one (1) physician who 
shall serve as the hearing examiner and shall have exclusive jurisdiction to 
make the final administrative determination of the validity and amount of 
compensation payable under this act.

 

   
4Presumably, if the employee has been treated by a 
physician designated/approved by the Division, then the Division may be less 
likely to challenge the impairment rating.  See Wyo. Stat. 
Ann. § 27-14-401(f) (LexisNexis 2001).

    5Serda 
was not represented by counsel at the time the Division directed her to the 
first two evaluations.  Because there was not a contested case in 
existence, she was not entitled to the appointment of an attorney.

6See paragraphs twelve and 
thirteen of the majority opinion for the text of the statute and the rule.

7The fact that Serda and 
her examining physician chose to refer to the medical examination as an IME is 
irrelevant to the question of whether the examination complied with the dictates 
of § 604, which it clearly did not.