Case Title: Weaver v. Cost Cutters

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1998-02-19T00:00:00Z

Document:
Weaver v. Cost Cutters1998 WY 17953 P.2d 851Case Number: 97-106, 97-68Decided: 02/19/1998Supreme Court of Wyoming

Brenda K. WEAVER, Appellant (Petitioner),

v.

COST CUTTERS, Appellee 
(Respondent).

 

Cost Cutters, Appellant (Employer/Respondent), and 
WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION, 
Appellant

(Objector/Respondent),

v.

Brenda WEAVER, Appellee 
(Employee/Petitioner).

 

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

 

Roger Fransen, HICKEY, 
MACKEY, EVANS, WALKER & STEWART, Cheyenne, for Appellant 
(Petitioner).

Steven K. Sharpe, ANTHONY, 
GOODRICH, NICHOLAS & SHARPE, LLC, Cheyenne, for Appellee 
(Respondent).

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 Appellant (Objector/Respondent).

 

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

 

MACY, Justice.

 [¶1] These cases arose out 
of the same worker's compensation administrative hearing and were consolidated 
by this Court for our review and decision. The hearing examiner denied permanent 
partial impairment benefits for Brenda Weaver (the claimant) and considered Cost 
Cutters' (the employer) request to have the final determination modified on the 
grounds of mistake or fraud. Both parties, along with the Wyoming Workers' 
Safety and Compensation Division (the division), petitioned the district court 
to review the hearing examiner's order. The district court certified these cases 
to the Wyoming Supreme Court pursuant to W.R.A.P. 
12.09(b).

 

[¶2] We affirm in part, 
reverse in part, and remand.

 

                                             ISSUES

 

[¶3] The claimant offers the 
following issues for our review:

 

          
1. Whether the decision of the Office of Administrative Hearings to deny 
permanent partial impairment benefits is supported by substantial 
evidence.

 

          
2. Whether the Office of Administrative Hearings erred when it failed to 
recognize and give effect to a rebuttable presumption that [the claimant's] 
impairment was not caused by a preexisting condition.

 

[¶4] The division and the 
employer present the following issues for our analysis:

 

          
A. Did the Hearing Examiner improperly deny modification of past benefits 
at a hearing on an outstanding permanent disability claim in which the Division 
was unrepresented?

 

          
B. Was the Hearing Examiner's decision limiting modification of benefits 
for fraud or mistake to outstanding claims contrary to 
law?

 

                                              
FACTS

 

[¶5] The claimant worked for 
Cost Cutters as a cosmetologist. She claimed that she injured her back on July 
29, 1994, when she slipped and fell at work while she was moving heavy boxes 
with a dolly. The claimant reported the accident to her manager on the day that 
the alleged fall occurred.

 

[¶6] The employer's manager 
testified that the claimant was laughing while she was telling her about the 
fall and that the claimant indicated she did not need to go to a doctor. 
According to the manager, the claimant telephoned her later that evening to tell 
her: "`I wasn't even going to go to the doctor until I thought about how sick I 
am of the company, and so I decided to go.'"

 

[¶7] The claimant filed a 
claim for worker's compensation benefits on the day after she allegedly fell. In 
the injury report, she indicated that she had previously received medical 
treatment for a similar injury. The division reviewed the claim and awarded 
medical and disability benefits. The employer consented at that time to the 
division's determination.

 

[¶8] After the claimant had 
received medical benefits for almost two years, the division issued a final 
determination, awarding permanent partial impairment benefits. The employer 
objected to the determination and requested a hearing. The employer claimed that 
the claimant's back injury did not result from the fall which allegedly had 
occurred while she was at work. The employer explained in a letter that, when 
the claimant began to work for the employer, she told the manager that she had 
recurring back problems. The employer also asserted that the claimant complained 
to co-workers and the manager about stomach and back pain which had been caused 
from her husband kicking her in the stomach. The hearing examiner scheduled a 
hearing to consider whether the claimant was entitled to receive permanent 
partial impairment benefits. The division elected not to participate in this 
hearing.

 

[¶9] The employer submitted 
a second letter to the division, requesting that the final determination be 
modified on the grounds of mistake or fraud because the claimant suffered from a 
preexisting condition. The employer sought to have the claimant reimburse the 
division for the benefits which had been disbursed to her. The division issued a 
second final determination in which it denied all future benefits, stating that 
it made a mistake when it found that the injury was work related. The claimant 
objected to this determination and asked for a hearing to consider the 
modification of benefits issue. Although the claimant specifically requested 
that this issue be considered during the hearing which had already been 
scheduled to consider permanent partial impairment benefits, the hearing 
examiner scheduled a separate hearing for the modification issue. The division 
planned to participate in the modification hearing.

 

[¶10] At the hearing on the 
permanent partial impairment benefits issue, the employer and the claimant were 
present. Evidence introduced by the employer to support the contention that the 
claimant had ongoing back problems prior to her alleged fall at work included 
testimony from the manager and a co-worker. The manager testified that, during 
the job interview, the claimant explained that she had a recurring back problem 
and would need time off to visit the chiropractor. The manager also stated that, 
before the claimant allegedly fell, she had missed several days of work because 
of back and leg problems.

 

[¶11] The parties presented 
conflicting testimony about what occurred on the day before the claimant fell. 
The claimant's co-worker and the manager testified that the claimant told them 
her husband had kicked her in the stomach during a domestic dispute. They stated 
that the claimant appeared to be in a significant amount of pain. The claimant 
testified that her husband did not kick her in the stomach but, rather, that he 
kicked the screen door and the screen door hit her in the stomach. She stated 
that, after the door hit her, she was crying and her stomach was hurting but 
that she did not call the doctor. She also testified that she did not have pain 
in her back as a result of being hit by the screen door.

 

[¶12] The employer offered 
the testimony of Roy Kanter, a neurologist who had reviewed the medical records 
and prepared a report on the claimant's condition. The doctor testified that he 
had reason to believe the claimant had back problems before she allegedly fell 
at work. He also testified that a hard kick to the stomach could have caused the 
claimant's back problems but that he could not reasonably determine whether it 
was the fall or the kick which actually caused the back problems she had 
experienced since July of 1994.

 

[¶13] During this hearing, 
the hearing examiner addressed the modification of benefits issue even though 
the division was not present.  She 
denied permanent partial impairment benefits but concluded that the employer's 
request for a modification of the benefits which had already been paid to the 
claimant should not be granted. The claimant petitioned the district court to 
review the administrative action. The employer and the division petitioned the 
district court to review the portion of the decision which dealt with the 
modification of benefits issue. The district court certified these cases to this 
Court pursuant to W.R.A.P. 12.09(b).

 

                                       
STANDARD OF REVIEW

 

[¶14] When we are reviewing 
cases which have been certified to us pursuant to W.R.A.P. 12.09(b), we apply 
the appellate standards which are applicable to a reviewing court of the first 
instance. Fansler v. Unicover Corporation, 914 P.2d 156, 158 (Wyo. 1996).  W.R.A.P. 12.09(a) limits judicial review 
of administrative decisions to a determination of the matters which are 
specified in WYO. STAT. § 16-3-114(c) (1997). Section 16-3-114(c) provides in 
pertinent part:

 

(c) . . . [T]he reviewing court shall decide all 
relevant questions of law, interpret constitutional and statutory provisions, 
and determine the meaning or applicability of the terms of an agency action. In 
making the following determinations, the court shall review the whole record or 
those parts of it cited by a party and due account shall be taken of the rule of 
prejudicial error. The reviewing court shall:

 

          
. . .

 

(ii) Hold unlawful and set aside agency action, 
findings and conclusions found to be:

 

(A) Arbitrary, capricious, an abuse of discretion or 
otherwise not in accordance with law;

 

          
. . . 

 

(E) Unsupported by substantial evidence in a case 
reviewed on the record of an agency hearing provided by 
statute.

 

We will not adjust an 
agency's findings of fact unless they are clearly contrary to the overwhelming 
weight of the evidence.  Nelson v. 
Sheridan Manor, 939 P.2d 252, 255 (Wyo. 1997). We will not, however, grant the 
same deference to an agency's conclusions of law. Id. We affirm an agency's 
conclusions of law when 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 correctly 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

 

A. Burden of 
Proof

 

[¶15] The claimant contends 
that she met her burden of proving her injury arose out of and in the course of 
her employment. A worker's compensation claimant has the burden of proving every 
essential element of her claim by a preponderance of the evidence.  Cabral v. Caspar Building Systems, Inc., 
920 P.2d 268, 269 (Wyo. 1996). In meeting this burden, she must show that her 
injury arose out of and in the course of her employment while she was at work. 
WYO. STAT. § 27-14-102(a)(xi) (1997). Whether the claimant's injury occurred in 
the course of her employment is a question of fact. Cabral, 920 P.2d  at 
269.

 

[¶16] The hearing examiner's 
order denying permanent partial impairment benefits provided in pertinent 
part:

 

5. A review of the evidence in this case leaves this 
Office to conclude that Claimant has not met her burden of proving that her 
current injuries were the result of the July 29, 1994, slip and fall at Cost 
Cutters.

 

6. The only evidence presented on the issue of 
permanent partial impairment was a letter from Dr. Eric Young to the Workers' 
Compensation Division rating the Claimant's impairment at 23%. The letter states 
that Claimant is a person with surgically treated disk lesions with residual 
symptoms. There was no evidence presented that the 1994 slip and fall created 
the residual problems suffered by Claimant. . . . With Claimant's long history 
of preexisting neck, back, hip and left groin pain radiating into the leg and 
causing numbness, this Office is not persuaded that the Claimant's symptoms she 
had been suffering before the fall are not identical to the symptoms she now 
suffers.

 

          
. . . .

 

8. The Employer also submitted written and 
testimonial evidence from Dr. Kanter, a neurologist who completed a record 
review in this case. In accordance with his written report, Dr. Kanter testified 
that he could not state with a reasonable degree of medical certainty that 
Claimant's impairment was caused by the reported fall at work. He based his 
opinion on the lengthy history Claimant had with problems to her neck and back 
prior to the fall as well as the hard blow to the abdomen suffered by Claimant 
two days prior to the fall. Because of Claimant's significant history for the 
same or similar problems, she has failed to prove that her permanent rating was 
caused by her work-related accident. .

          
. .

 

The hearing examiner was in 
the best position to assess the credibility of the doctor's testimony and weigh 
the evidence presented at the trial and in the record. Goddard v. Colonel 
Bozeman's Restaurant, 914 P.2d 1233, 1237 (Wyo. 1996). We will not substitute 
our judgment for that of the hearing examiner with regard to factual disputes. 
Id.

 

[¶17] The claimant had not 
only the burden of proving that she suffered a permanent partial impairment but 
also the burden of proving that a causal relationship existed between the 
permanent partial impairment and a work-related injury. Tenorio v. State ex rel. 
Wyoming Workers' Compensation Division, 931 P.2d 234, 238 (Wyo. 1997). She 
failed to present expert medical testimony to establish that her permanent 
partial impairment arose from a fall that occurred at work. The employer, on the 
other hand, presented significant evidence to establish the possibility that the 
claimant's permanent partial impairment was the result of prior injuries to her 
back, leg, and neck or was caused by a kick to the stomach. We agree that the 
claimant failed to meet her burden of proof and hold that the hearing examiner 
properly denied permanent partial impairment benefits.

 

B. Presumption That No 
Preexisting Condition Exists

 

[¶18] The claimant asserts 
that, when the employer and the division approved the initial worker's 
compensation claim, they established that the injury was compensable. She claims 
that the compensable injury created a presumption that the permanent partial 
impairment was not due to a preexisting condition and that the burden of proof, 
therefore, shifted to the employer. She further maintains that the employer 
failed to meet this burden.

 

WYO. STAT. § 27-14-606 (1997) 
provides:

 

Each determination or award within the meaning of 
this act is an administrative determination of the rights of the employer, the 
employee and the disposition of money within the worker's compensation account 
as to all matters involved. No determination shall be final without notice and 
opportunity for hearing as required by this act.

 

Under this Court's 
interpretation of § 27-14-606 in prior cases, the claimant was required to prove 
that she was entitled to receive benefits for all outstanding or new claims 
despite previous awards which may have been made for the same injury. Tenorio, 
931 P.2d  at 239; Martinez v. State ex rel. Wyoming Workers' Compensation 
Division, 917 P.2d 619, 621 (Wyo. 1996). We held that each award or claim was a 
separate matter for determination and that an employer could dispute any award 
or claim on the basis that it was unreasonable or improper. Martinez, 917 P.2d  
at 621. Specifically, an employer could question whether a claim was causally 
related to a compensable injury or it was attributed to some other event. 
Id.

 

[¶19] Initially, neither the 
employer nor the division contested the compensability of the claimant's injury. 
The permanent partial impairment award, however, was a new and separate matter. 
Id. The hearing examiner properly separated the past claims from the future 
claims. The employer was entitled to dispute the permanent partial impairment 
award on the basis that the impairment was causally related to a preexisting 
condition and not related to an injury that arose out of and in the course of 
the claimant's employment. Id.

 

[¶20] As we stated earlier 
in our discussion, the claimant had the burden of proving the essential elements 
of her claim by a preponderance of the evidence including the cause of her 
permanent partial impairment. Cabral, 920 P.2d  at 269. We have already decided 
that the claimant failed to carry this burden and that the hearing examiner 
properly denied the benefits.

 

C. Modification of 
Benefits

 

[¶21] The employer and the 
division contend that the hearing examiner should not have addressed the 
modification of benefits issue at the permanent partial impairment benefits 
hearing because the division was not present and had not been given notice that 
this issue would be considered at that hearing.

 

[¶22] The division may 
appear before a hearing examiner and defend against any claim and "shall in all 
respects have the same rights of defense as the employer." WYO. STAT. § 
27-14-607 (1997). The Wyoming Administrative Procedure Act provides in pertinent 
part:

 

(a) In any contested case, all parties shall be 
afforded an opportunity for hearing after reasonable notice served personally or 
by mail. . . .

 

          
(b) The notice shall include a statement of:

 

          
. . .

 

(iv) A short and plain statement of the matters 
asserted. If the agency or other party is unable to state the matters in detail 
at the time the notice is served, the initial notice may be limited to a 
statement of the issues involved, and thereafter upon application a more 
definite and detailed statement shall be furnished.

 

WYO. STAT. § 16-3-107 
(1997).

 

[¶23] The hearing examiner 
scheduled two hearings to consider the claimant's benefits. She scheduled the 
first hearing to consider whether or not the claimant was entitled to receive 
permanent partial impairment benefits. She scheduled the second hearing to 
consider the employer's request to have the final determination modified on the 
grounds of mistake or fraud and the claimant reimburse the division for the 
benefits which had been disbursed to her. The division elected not to 
participate in the first hearing but planned to participate in the second 
hearing.

 

[¶24] The hearing examiner 
failed to notify the division that she was going to address the modification of 
benefits issue during the permanent partial impairment benefits hearing. During 
the first hearing, she agreed to hear both issues and to enter an order on them 
despite the fact that she had scheduled a separate hearing to consider the 
modification issue. Without giving the division an opportunity to be heard, the 
hearing examiner decided that the division did not make a mistake and that fraud 
was not involved in this case. She concluded that a basis did not exist for 
modifying the awards already paid to the claimant.

 

[¶25] At the permanent 
partial impairment benefits hearing, the claimant had the burden of proof. 
Cabral, 920 P.2d  at 269. The division would have had the burden at the second 
hearing of proving that a mistake or fraud existed because it sought to modify a 
worker's compensation claim. Martinez, 917 P.2d  at 621. Since the burden of 
proof was on the division with regard to the modification issue, the hearing 
examiner should not have considered that issue during the first hearing without 
affording the division the opportunity to be present to meet its 
burden.

 

[¶26] Because the division's 
absence from the hearing foreclosed any opportunity to meet its burden of proof 
and to support its position, the portion of the hearing examiner's decision 
which addressed the modification issue was not in accordance with the law.  Section 16-3-114(c)(ii)(A). We remand 
the case for a hearing to give the division an opportunity to be 
heard.

 

                                           
CONCLUSION

 

[¶27] We affirm the hearing 
examiner's decision to deny permanent partial impairment benefits and reverse 
that portion of the hearing examiner's decision which addressed the modification 
issue. We remand the case for further proceedings in accordance with this 
opinion.