Case Title: Martinez v. State ex rel. Wyoming Workers' Compensation Div.

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1996-06-03T00:00:00Z

Document:
Martinez v. State ex rel. Wyoming Workers' Compensation Div.1996 WY 79917 P.2d 619Case Number: 95-267Decided: 06/03/1996Supreme Court of Wyoming
In the Matter of the Worker's Compensation Claim of John D. 
Martinez, an Employee of Robinson Construction Company.

John 
D. MARTINEZ,

 Appellant 
(Petitioner),

v.

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

 Appellee (Respondent).

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

Michael 
K. Kelly, Laramie, for Appellant.

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, for Appellee.

Before 
THOMAS, MACY, TAYLOR and LEHMAN, JJ., and KEITH G. KAUTZ, District 
Judge.

MACY, 
Justice.

[¶1]      Robinson 
Construction Company (the employer) petitioned to modify the worker's 
compensation benefits which had previously been paid to Appellant John Martinez 
(the employee). The employer also objected to any further payments being made to 
the employee. The hearing examiner denied the employer's requests. The district 
court reversed the hearing examiner's decision as to the employee's outstanding 
claims.

[¶2]      We affirm the 
district court's reversal. 

ISSUES

[¶3]      The employee 
presents two issues on appeal:

ISSUE 
I

Whether 
the District Court erred in assigning the burden of proof to [the employee] to 
show that [the employee's] outstanding claims were compensable?

ISSUE 
II

Whether 
or not the District Court erred as a matter of law in reversing and remanding on 
the issue of causation as to the outstanding claims as [the Workers' 
Compensation Division] was estopped from disputing compensability of the 
claims?

FACTS

[¶4]      The employee 
injured his elbow on July 21, 1993, while he was at work. In the early morning 
hours of July 26, 1993, the employee had an altercation with the police, and he 
was subsequently arrested and incarcerated. During his incarceration, the 
employee received medical attention for his injured elbow.

[¶5]      The employer 
fired the employee because the employee did not report for work while he was 
incarcerated. After the employee was released from incarceration, he consulted a 
doctor about his injury and filed an application for worker's compensation 
benefits. The employer filed an injury report, noting that the employee did not 
have any problems with his elbow until after he scuffled with the police. On 
September 7, 1993, the Wyoming Workers' Compensation Division approved the 
employee's application. The employer signed a consent and waiver notice later in 
the month, consenting to the payment of temporary total disability benefits to 
the employee for the period of July 24, 1993, through August 31, 
1993.

[¶6]      The employee 
continued to receive worker's compensation benefits until January 11, 1994, 
when, pursuant to WYO. STAT. § 27-14-605(a) (1991) (amended 1994),1 the employer objected to any 
further payments being made to the employee and requested a modification of the 
benefits which had already been paid to the employee on the grounds of mistake. 
In its petition, the employer requested that the employee be required to 
reimburse the benefits which he had already received.2

[¶7]      The Workers' 
Compensation Division joined in the employer's objection, and a contested case 
hearing was set for September of 1994. By that time, the employee had 
outstanding claims pending for temporary total disability benefits and for an 
award of permanent partial disability benefits. The hearing examiner concluded 
that the employer and the Workers' Compensation Division did not meet their 
burden of proving that the employee's benefits should be terminated on the 
grounds of mistake under § 27-14-605(a). The hearing examiner, therefore, 
awarded benefits to the employee on his outstanding claims and denied the 
employer's and the Workers' Compensation Division's request for a modification 
of the benefits which had already been paid to the employee.3

[¶8]      The Workers' 
Compensation Division filed a petition for judicial review of the hearing 
examiner's decision. The district court agreed with the hearing examiner that 
the Workers' Compensation Division and the employer had the burden of proof as 
to whether the benefits which the employee had already received were mistakenly 
paid. The district court, however, reversed the hearing examiner's decision on 
the employee's outstanding claims, reasoning that the employee had the burden of 
proving that he was entitled to receive compensation for those claims. The 
district court remanded the case to the hearing examiner for a hearing on the 
employee's outstanding claims. The employee subsequently perfected his appeal to 
this Court.

DISCUSSION

[¶9]      The employee 
contends that the district court's ruling which placed the burden on him to 
prove that he was entitled to receive benefits on his outstanding worker's 
compensation claims was erroneous.

[¶10]   When we are reviewing decisions in 
worker's compensation cases, we do not accord any deference to the district 
court's decision. Olheiser v. State ex rel. Wyoming Workers' Compensation 
Division, 886 P.2d 269, 271 (Wyo. 1994). Instead, we review the case as if it 
had come directly to this Court from the agency. Cronk v. City of Cody, 897 P.2d 476, 477 (Wyo. 1995). In this case, we are concerned with allocating the burden 
of proof. We have stated: "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." Corman v. State ex rel. Wyoming Workers' 
Compensation Division, 909 P.2d 966, 970 (Wyo. 1996). We correct an agency's 
errors when the agency has not invoked and correctly applied the correct rule of 
law. Gneiting v. State ex rel. Wyoming Workers' Compensation Division, 897 P.2d 1306, 1308 (Wyo. 1995).

[¶11]   We have repeatedly stated that a 
claimant has the burden of proving all the essential elements of his worker's 
compensation claim by a preponderance of the evidence. See, e.g., Padilla v. 
Lovern's, Inc., 883 P.2d 351, 354 (Wyo. 1994); Gilstrap v. State ex rel. Wyoming 
Workers' Compensation Division, 875 P.2d 1272, 1273 (Wyo. 1994). We have also 
recognized, however, that the party who seeks to reopen or modify a worker's 
compensation case under § 27-14-605(a) has the burden of proof. Britton v. 
Halliburton Services, 895 P.2d 45, 48 (Wyo. 1995).

[¶12]   In reaching its conclusion that the 
employee had the burden of proving that he was entitled to receive benefits on 
his outstanding claims, the district court relied on WYO. STAT. § 27-14-606 
(1991). That section states:

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.

[¶13]   Section 27-14-606. We considered 
this statute in Herring v. Welltech, Inc., 660 P.2d 361 (Wyo. 1983),4 and stated that, under the language 
of the statute, "the employer must be advised of each award of compensation or 
allowance of any expense claim and [be] given the opportunity to object." 660 P.2d  at 366. See also Padilla, 883 P.2d  at 354. The Herring Court concluded that 
each award or claim is a separate matter for administrative determination and 
held:

It 
follows that the employer is entitled to dispute any award or claim on the basis 
that it is unreasonable or improper, and certainly can raise the question as to 
whether the award or claim is causally related to the industrial accident which 
occurred or whether it may be attributable to some other event.

660 P.2d  at 366. From the clear language of § 27-14-606 and this Court's decisions 
which have interpreted the statute, it is obvious that the normal process for an 
employer's objection applied to the employee's outstanding claims. It follows, 
then, that the employee bore the usual burden of proving that he was entitled to 
receive benefits for his outstanding claims. To place the burden of proof on the 
employer to dispute an employee's right to receive benefits on any further 
claims after the employee's first claim has been approved would effectively 
nullify the provisions of § 27-14-606. 

[¶14]   The employee likens his case to 
State ex rel. Wyoming Workers' Compensation Division v. Jerding, 868 P.2d 244 
(Wyo. 1994). In that case, the Workers' Compensation Division petitioned under § 
27-14-605(a) to reopen the claimant's case, seeking to terminate the claimant's 
right to receive any further benefits because it made a mistake in concluding 
that the claimant's injury was compensable. 868 P.2d  at 246. The Court 
ostensibly placed the burden of proving that a mistake had been made and that 
the claimant was not entitled to receive any future benefits upon the Workers' 
Compensation Division. 868 P.2d  at 250.

[¶15]   An important distinction exists, 
however, between the case at bar and the Jerding case which prevents Jerding 
from controlling our decision in this case. In Jerding, the Workers' 
Compensation Division was seeking to revisit its initial determination that the 
claimant's injury was compensable. 868 P.2d  at 246. In the portion of this case 
which pertains to the employee's outstanding claims, the Workers' Compensation 
Division was not contesting the compensability of the initial injury. Instead, 
it was arguing that the employee's outstanding claims should not be paid because 
his current disability was caused by his altercation with the police. The 
Workers' Compensation Division aptly stated its position in its 
brief:

It 
is therefore important to distinguish what the [Workers' Compensation] Division 
disputes with regard to [the employee's] claims and what it does not dispute. 
The [Workers' Compensation] Division does not deny that [the employee] suffered 
a work-related injury on July 21, 1993 - it does not now seek a determination 
that when [the employee] injured his elbow on July 21, 1993, he was not acting 
within the course and scope of his employment. What the [Workers' Compensation] 
Division questions now is the percentage, if any, of [the employee's] current 
disability which can be attributed to the July 21, 1993 work injury. This 
question is appropriate in light of the medical testimony that all or some 
percentage of [the employee's] current disability may be attributable to the 
July 26, 1993 altercation, unrelated to [the employee's] employment.

[¶16]   The employee also asserts that the 
Workers' Compensation Division should have been estopped from disputing the 
compensability of his claims. The employee relies on a statement in Herring as 
being support for his argument:

Once 
the accident is acknowledged to have occurred in the course of employment and 
not to have been due to the culpable negligence of the employee, the employer is 
estopped from taking a contrary position at a later date and after some claims 
have been paid. . ..

660 P.2d  at 366.

[¶17]   It is true in the case at bar that 
the employer and the Workers' Compensation Division did not contest the 
compensability of the initial injury. In fact, the employer signed the consent 
and waiver form, consenting to the first payment of temporary total disability 
benefits to the employee. We agree that the employer and the Workers' 
Compensation Division were estopped from contesting the compensability of the 
initial injury except under the provisions of § 27-14-605(a). However, as we 
explained earlier in this opinion, the same analysis does not apply to the 
employee's outstanding claims. Since each new claim or award involved a separate 
administrative determination under § 27-14-606, the employer and the Workers' 
Compensation Division were entitled to contest the employee's outstanding claims 
by arguing that the employee's altercation with the police caused his current 
disability.

CONCLUSION

[¶18]   We hold that the employee had the 
burden of proving that he was entitled to receive worker's compensation benefits 
for his outstanding claims and that the Workers' Compensation Division and the 
employer were not estopped from objecting to the employee's outstanding claims. 
The district court's decision is, therefore,

[¶19]   Affirmed.

FOOTNOTES

1 
Section 27-14-605(a) provided:

(a) 
If a determination is made in favor of or on behalf of an employee for any 
benefits under this act, an application may be made to the division by any party 
within four (4) years from the date of the last payment for additional medical 
and disability benefits or for a modification of the amount of benefits on the 
ground of increase or decrease of incapacity due solely to the injury, or upon 
grounds of mistake or fraud.

2 
In State ex rel. Wyoming Workers' Compensation Division v. Jerding, 868 P.2d 244, 249 (Wyo. 1994), this Court construed § 27-14-605(a) as providing authority 
for extinguishing Worker's compensation awards even though the statutory 
language did not expressly provide that remedy.

3 
The parties did not raise any issues on appeal with regard to the benefits which 
had already been paid to the employee.

4 
When Herring was decided, the statute was numbered § 27-12-607.