Case Title: Daiss v. Division of Workers' Safety and Compensation

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1998-10-15T00:00:00Z

Document:
Daiss v. Division of Workers' Safety and Compensation1998 WY 133965 P.2d 692Case Number: 97-341Decided: 10/15/1998Supreme Court of Wyoming

Sally 
A. DAISS, Appellant (Petitioner),

v.

DIVISION OF WORKERS' SAFETY AND COMPENSATION, 
DEPARTMENT OF EMPLOYMENT, State of Wyoming, 
Appellee(Respondent).

 

Appeal from the District Court, Natronna County, W. 
Thomas Sullins, J.

 

Donald L. Painter, Casper, 
for Appellant (Petitioner).

William U. Hill, Attorney 
General; John W. Renneisen, Deputy Attorney General; Gerald W. Laska, Senior 
Assistant Attorney General; and Bernard P. Haggerty, Assistant Attorney General, 
for Appellee (Respondent).

 

Before LEHMAN, C.J., and 
THOMAS, MACY, GOLDEN & TAYLOR,* JJ.

 * Chief Justice at time of expedited 
conference

 

MACY, Justice.

 [¶1] The medical commission granted Appellee Division 
of Workers' Safety and Compensation's (the division) motion to dismiss the issue 
of whether surgery on Appellant Sally Daiss' (the employee) back was necessary 
because the medical commission lacked subject matter jurisdiction. The employee 
petitioned the district court for a review of the medical commission's order, 
and the district court certified the case to the Wyoming Supreme Court pursuant 
to W.R.A.P. 12.09(b).

 

[¶2] We affirm the medical 
commission's order.

 

                                              
ISSUE

 

[¶3] The employee presents 
one issue for our review:

 

          
1. Whether the Medical Commission had jurisdiction to rule on the 
compensability of p[ro]posed surgery.

 

                                              
FACTS

 

[¶4] The employee suffered a 
compensable, work-related, lower back injury on or about March 22, 1996. On July 
16, 1996, she visited Kenneth Pettine, M.D., an orthopedic surgeon, who 
determined that she had a torn disk. He opined that the disk was desiccated, or 
dried out, before the injury occurred and that the injury to the disk caused the 
onset of the employee's pain. Dr. Pettine recommended that the desiccated disk 
be conservatively treated but advised the employee that surgery was an elective 
option. Although Dr. Pettine had not recommended surgery, he believed that the 
employee had reached maximum medical improvement from a "nonoperative 
standpoint." The doctor indicated that surgery would be a reasonable choice and 
suggested that the employee "obtain 
administrative approval" for it.

 

[¶5] Apparently in response 
to some sort of inquiry, the division sent a letter to the employee on September 
24, 1996, stating that it would probably deny future claims that may be 
submitted for the proposed surgery. The letter stated, however, that "[t]his is 
not a final determination as no claim has been submitted for payment at this 
time." On November 14, 1996, the employee submitted a claim for surgical 
benefits to the office of administrative hearings, requesting payment of all 
reasonable and necessary expenses that would be incurred from the proposed 
surgery. The claim was not submitted on the division's form. The division 
objected to the claim, arguing that there had not been a final determination and 
the matter had not been referred to the office of administrative hearings and 
that, therefore, the office of administrative hearings did not have subject 
matter jurisdiction over the matter. The employee filed a traverse to the 
division's objection, claiming that the office of administrative hearings had 
subject matter jurisdiction pursuant to WYO. STAT. ANN. § 27-14-601 
(1997).

 

[¶6] The employee had an 
independent medical examination done on April 26, 1997. As a result of that 
examination, the division issued a final determination, finding that the 
employee was not entitled to receive benefits because she had already been 
awarded a five percent permanent physical impairment rating and her impairment 
rating remained the same. The employee objected to the final determination and 
requested a hearing, arguing that she was a surgical candidate who had not yet 
reached maximum ascertainable loss or 
maximum medical improvement and that the proposed surgery should be compensable. 
The division referred the case to the medical commission. The notice of referral 
for hearing listed three issues to be decided by the medical commission: whether 
surgery on the employee's back was necessary; whether the employee was at an 
ascertainable loss; and whether the permanent physical impairment rating was 
correct.

 

 [¶7] The division subsequently asked the 
medical commission to dismiss the issue of whether the proposed surgery was 
necessary because the commission lacked subject matter jurisdiction, given that 
the employee had failed to submit a proper claim as was prescribed in the 
division's rules, and because a claim could not be filed for services that had 
not yet been provided. The medical commission granted the division's request, 
reasoning that the employee had not filed a formal claim for the proposed 
surgery but had merely inquired into the compensability of the proposed 
procedure and that, consequently, the division had not made a final determination on this issue. The employee petitioned 
the district court for a review of this order, and the district court certified 
the case to the Wyoming Supreme Court.

 

        
                               STANDARD 
OF REVIEW

 

[¶8] When a case has been 
certified to the Wyoming Supreme Court pursuant to W.R.A.P. 12.09(b), we review 
the case by applying the appellate standards that are applicable to a reviewing 
court of the first instance. Weaver v. Cost Cutters, 953 P.2d 851, 854 (Wyo. 
1998); Fansler v. Unicover Corporation, 914 P.2d 156, 158 (Wyo. 1996). Judicial 
review of administrative decisions is limited to a determination of the matters 
specified in WYO. STAT. ANN. § 16-3-114(c) (1997). W.R.A.P. 12.09(a); Everheart 
v. S & L Industrial, 957 P.2d 847, 851 (Wyo. 1998).

 

[¶9] We do not disturb an 
agency's findings of fact unless they are clearly contrary to the overwhelming 
weight of the evidence.  Weaver, 953 P.2d  at 855; Nelson v. Sheridan Manor, 939 P.2d 252, 255 (Wyo. 1997). We do not, 
however, grant the same deference to an agency's conclusions of law. Id. We 
affirm an agency's conclusions of law if they are in accordance with law. Corman 
v. State ex rel. Wyoming Workers' Compensation Division, 909 P.2d 966, 970 (Wyo. 
1996). When an agency has not invoked and properly applied the correct rule of 
law, we correct the agency's errors. Gneiting v. State ex rel. Wyoming Workers' 
Compensation Division, 897 P.2d 1306, 
1308 (Wyo. 1995).

 

                                           
DISCUSSION

 

[¶10] The employee contends 
that the fact that she did not use the division's form in submitting her claim 
should not be of any consequence because the requirement that she submit her 
claim on a form provided by the division is "an exercise in meaninglessness." 
The division's rules require claimants to submit their claims on forms provided 
by the division. Those rules provide in pertinent part: "Claims for Benefits. A 
person seeking an award of benefits under the Act must submit a written 
application for benefits on a form provided by the division. (A report for 
injury is not a claim for benefits. W.S. 27-14-503(a))." WYOMING WORKERS' 
COMPENSATION RULES, REGULATIONS AND FEE SCHEDULES ch. 5, § 2 (1995). The Wyoming 
Worker's Compensation Act (the Act) directs the division to prepare and print 
the necessary forms to be used in all procedures under the Act and to instruct 
claimants on how to make correct claims. WYO. STAT. ANN. § 27-14-508 
(1997).

 

[¶11] In Manning v. State ex 
rel. Wyoming Worker's Compensation Division, 938 P.2d 870, 872 (Wyo. 1997), the 
employee wrote to the division, inquiring about the compensability of a proposed 
rule-out consultation. This Court held that, before the employee could be 
compensated under the Act, she had to submit a claim for benefits on the form 
provided by the division:

 

The Division's rules state that "[a] person seeking 
an award of benefits under the Act must submit a claim for 
benefits."  Wyoming Workers' 
Compensation Rules, Regulations and Fee Schedules, ch. VI, § 1 (July 1993) 
(emphasis added). A "claim" is defined as "[a]n application for benefits under 
the Act using the forms provided by the division." Id., ch. I, § 4(a). An injury 
report is not a claim for benefits. Id., ch. VI, § 1. Nor can . . . an[] inquiry 
letter to the Division be considered [a] claim[].

 

938 P.2d  at 873. We are not 
convinced that requiring claims to be submitted on forms provided by the 
division is, as the employee asserts, "an exercise in 
meaninglessness."

 

 [¶12] The other question raised in this 
case is whether medical services that have not yet been rendered are 
compensable. The employee claims that the division issued a final determination 
on her claim and that the medical commission had authority under the Act to 
determine whether her proposed surgery would be compensable. Although the 
division issued a final determination denying benefits because the percentage of 
permanent physical impairment did not change, it did not render a final 
determination on the employee's request for approval of the proposed back 
surgery. In fact, the division's September 24, 1996, letter declined to issue a 
final determination on the proposed procedure because a formal claim had not 
been submitted.

 

[¶13] The Act presumes that 
claims for expenses will be made after the medical services have been rendered: 
"Within thirty (30) days after the first of the month succeeding the month in 
which services were rendered to the injured employee, itemized bills and 
claims for medical and hospital care shall be filed with the division." WYO. 
STAT. ANN. § 27-14-501(d) (1997) (emphasis added).  Additionally, the division's rules 
contemplate that claimants will be reimbursed for the medical expenses of 
services that have already been provided. They provide in pertinent 
part:

 

          
(d) Medical Reimbursement.

 

                    
(i) If a claim is filed for reimbursement of medical expenses, the 
division will audit the receipts in accordance with its established fee 
schedule.

 

(ii) Reimbursement for medical expenses will 
only be considered if filed with the division within ninety (90) days from the 
date the services were provided.

 

WYOMING WORKERS' COMPENSATION RULES, 
REGULATIONS AND FEE SCHEDULES ch. 6, § 1(d) (1995) (emphasis 
added).

 

[¶14] In Manning, this Court 
held that the hearing examiner lacked jurisdiction to appoint an attorney and 
award attorney fees because the employee had not undergone the examination and 
had not filed a claim for benefits. 938 P.2d  at 873. An inquiry beforehand as to 
the compensability of a rule-out consultation did not justify the appointment of 
an attorney. Id. Similarly, in State ex rel. Wyoming Workers' Compensation 
Division v. Gerdes, 951 P.2d 1170, 1175 (Wyo. 1997), we held that the hearing 
examiner was limited to the issues that existed at the time of the hearing. A 
hearing examiner, therefore, may not award benefits for claims that may accrue 
after the date of the hearing. 951 P.2d  at 1175.

 

[¶15] Neither the Act, the 
division's rules, nor Wyoming case law authorizes the medical commission to 
determine the compensability of a procedure when claims for the procedure have 
not been properly submitted or the procedure has not been the subject of a final 
determination by the division. Likewise, none of the above-mentioned sources 
authorizes a contested case hearing to be held on a request for approval of a 
proposed surgery. We conclude, therefore, that the medical commission properly 
determined that it lacked subject matter jurisdiction to decide whether the 
employee's proposed back surgery would be compensable. The medical commission's order granting the division's 
motion to dismiss the issue of whether surgery on the employee's back was 
necessary is, accordingly,

 

[¶16] 
Affirmed.