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

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1996-05-31T00:00:00Z

Document:
Pittman v. State ex rel. Wyoming Workers' Compensation Div1996 WY 76917 P.2d 614Case Number: 95-216Decided: 05/31/1996Supreme Court of Wyoming
Theodore W. PITTMAN,

 Appellant 
(Employee-Claimant),

v.

STATE 
of Wyoming, ex rel. WYOMING WORKER'S COMPENSATION DIVISION, 

Appellee 
(Objector-Defendant).

Appeal 
from the District Court, Natrona County, Harry E.

Harry 
G. Bondi, Casper, for appellant.

William 
U. Hill, Attorney General, Jennifer A. Evans, Assistant Attorney General, for 
appellee.

Before 
THOMAS, MACY, TAYLOR, and LEHMAN, JJ., and RYCKMAN, District 
Judge.

LEHMAN, 
Justice.

[¶1]      Theodore W. 
Pittman (Pittman) appeals from an order of the district court affirming a denial 
of worker's compensation benefits, based upon the expiration of the one-year 
statutory filing limit prescribed by W.S. 27-14-503(a).

[¶2]      We 
affirm.

ISSUES

[¶3]      Pittman raises 
four issues:

1. 
        
Is the legal conclusion by the hearing examiner that employee-claimant is 
absolutely barred under the doctrine of res judicata on his claim for benefits 
for eye surgery legally correct and supported by substantial 
evidence?

2. 
        
Did the hearing examiner in invoking the doctrine of res judicata 
improperly place the burden of proof upon employee-claimant to establish what 
issues were actually and necessarily litigated in the October 1, 1992 contested 
case hearing?

3. 
        
Is the legal conclusion by the hearing examiner that employee-claimant is 
barred under the statute of limitations of W.S. § 27-14-503 legally correct and 
supported by substantial evidence?

4. 
        
Is the legal conclusion by the hearing examiner that employee-claimant is 
not the "real party in interest" regarding the payment for the medical expenses 
of the eye surgery legally correct and supported by substantial 
evidence?

 

The 
Worker's Compensation Division (Division) presents us with three 
issues:

A. 
       
Whether the hearing examiner's determination, that the claim for medical 
benefits arising from Claimant's 1991 cataract surgeries is barred by the 
doctrine of res judicata, is supported by substantial evidence and is in 
accordance with law.

B. 
       
Whether the hearing examiner's determination that Claimant's application 
for benefits was not made within the time limits prescribed by Wyo. Stat. 
27-14-503(a) is supported by substantial evidence and is in accordance with 
law.

C.        
Whether the hearing examiner's determination, that if medical benefits 
were to be awarded for the costs of Claimant's eye treatment, payment should be 
made to the health care providers rather than to Claimant, is in accordance with 
law.

FACTS

[¶4]      On September 26, 
1989, Pittman was working as a pipe fitter at the Dave Johnson Power Plant when 
a 800 pound valve fell, causing him to fall backwards and strike his head. 
Pittman sustained numerous injuries and was awarded medical and disability 
benefits for injuries to his neck, ribs and right leg.

[¶5]      In August 1991, 
Pittman sought treatment from an ophthalmologist for his deteriorating eyesight. 
On August 14, 1991, the ophthalmologist, Dr. Ellsworth, diagnosed Pittman with 
posterior subcapsular (PSC) cataracts in both of his eyes. Pittman underwent 
surgery for treatment of the cataracts on September 4, 1991 and December 16, 
1991. Following surgery on his right eye, Pittman suffered a retinal detachment 
of the right eye as a result of a complication of the cataract surgery. Surgery 
was performed on Pittman's right eye to repair the retinal detachment on 
February 18, 1992.

[¶6]      On October 1, 
1992, a hearing was held wherein the Division was contesting payment for medical 
costs unrelated to the cataracts. In the supplemental disclosure statement for 
this hearing, Pittman attached the medical records of Dr. Ellsworth relating to 
the cataracts although he had not previously filed any bills or claims. 
Subsequently, the Division, in its disclosure statement for this hearing, 
contended that the costs of the medical treatment for Pittman's eye problems 
were also at issue. In its Order Awarding Benefits, the hearing examiner 
concluded that the cataract operations had not been shown to be reasonably 
related to Pittman's September 26, 1989 injury, and accordingly, Pittman was not 
entitled to have the Division pay for those medical expenses. Pittman did not 
appeal this order.

[¶7]      Pittman finally 
submitted claims for payment of the treatment of his cataracts on June 2, 1993. 
The Division denied the benefits, and the matter was set for a contested 
hearing. On October 20, 1994, the hearing examiner issued an Order Denying 
Benefits based on the following: 1) the claim for benefits for the treatment of 
the cataracts had been previously adjudicated in the October 1992 hearing, and 
thus was barred by the doctrine of res judicata; 2) the one-year statutory 
filing limit began to run when the condition was diagnosed in August 1991, and 
thus the claims were barred by the W.S. 27-14-503(a) statute of limitations; and 
3) Pittman's private insurance carrier had paid the costs of Pittman's eye 
surgeries, and thus Pittman was not the real party in interest. Pittman filed a 
petition for review in the district court. The district court affirmed the Order 
Denying Benefits, concluding that Pittman's claims were outside the W.S. 
27-14-503(a) statute of limitations for applying for benefits. Finding this to 
be dispositive of the case, the district court declined to address the other 
issues. Pittman timely appeals that determination.

STANDARD 
OF REVIEW

[¶8]      We will reverse a 
determination that a claimant is not entitled to worker's compensation benefits 
only if it is arbitrary, capricious, an abuse of discretion, not in accordance 
with law, or is unsupported by substantial evidence. W.S. 16-3-114(c)(ii)(A) and 
(E) (1990); Stuckey v. State ex rel. Worker's Compensation Div., 890 P.2d 1097, 
1099 (Wyo. 1995); Worker's Compensation Claim of Taylor v. State ex rel. 
Worker's Compensation Div., 890 P.2d 559, 560-61 (Wyo. 1995); Bohren v. State ex 
rel. Worker's Compensation Div., 883 P.2d 355, 357-58 (Wyo. 1994). We review 
factual issues and agency factual findings using the substantial evidence 
standard:

Our 
task is to examine the entire record to determine whether substantial evidence 
supported the hearing examiner's findings. We will not substitute our judgment 
for that of the hearing examiner when substantial evidence supports his 
decision. Substantial evidence is relevant evidence which a reasonable mind 
might accept in support of the agency's conclusions.

Matter 
of Worker's Compensation Claim of Fisher, 914 P.2d 1224, 1226 (Wyo. 1996) 
(quoting Latimer v. Rissler & McMurry Co., 902 P.2d 706, 708-09 (Wyo. 
1995)); see also City of Casper v. Haines, 886 P.2d 585, 587 (Wyo. 1994); 
Stuckey, 890 P.2d  at 1099; and Aanenson v. State ex rel. Worker's Compensation 
Div., 842 P.2d 1077, 1079 (Wyo. 1992). The party appealing an administrative 
determination has the burden of proving the agency's ruling was unsupported by 
substantial evidence. Jaqua v. State ex rel. Workers' Compensation Div., 873 P.2d 1219, 1221 (Wyo. 1994).

[¶9]      Agency 
conclusions of law are not afforded the same deference as agency factual 
findings. If the conclusion is in accordance with law, it is affirmed; if it is 
not, it is to be corrected. Haines, 886 P.2d  at 587; Aanenson, 842 P.2d  at 1079. 
As to our review of mixed questions of law and fact, our standard has been 
stated this way:

When 
an agency's determinations contain elements of law and fact, we will not treat 
them as findings of fact. We extend deference only to agency findings of "basic 
fact." When reviewing a finding of "ultimate fact," we divide the factual and 
legal aspects of the finding to determine whether the correct rule of law has 
been properly applied to the facts. If the correct rule of law has not been 
properly applied, we do not defer to the agency's finding but correct the 
agency's error in either stating or applying the law.

Aanenson, 
at 1079-80 (quoting Union Pacific R.R. Co. v. State Bd. of Equalization, 802 P.2d 856, 860-61 (Wyo. 1990)); see also Haines, 886 P.2d  at 
587.

DISCUSSION

[¶10]   A claimant has the burden of 
proving each essential element of his claim by a preponderance of the evidence. 
Gilstrap v. State ex rel. Workers' Compensation Div., 875 P.2d 1272, 1273 (Wyo. 
1994). A corollary to this rule is that the claimant has the burden of following 
procedures and rules contained within the Worker's Compensation Act before he is 
entitled to worker's compensation benefits.

(a) 
A payment for benefits involving an injury which is the result of a single brief 
occurrence rather than occurring over a substantial period of time shall not be 
made unless in addition to the proper and timely filing of the reports of the 
accident, an application or claim for benefits is filed * * * within one (1) 
year after discovery of the injury by the employee. The report of accident 
is not a claim for benefits.

W.S. 
27-14-503(a) (1991) (emphasis added).

[¶11]   Thus, we begin with the question of 
when Pittman discovered that he had a compensable 
injury.

[W]hen 
determining the time a particular injury became compensable, it should be asked: 
When would a reasonable person, under the circumstances, have understood the 
full extent and nature of the injury and that the injury was related to his or 
her employment? The statute of limitations starts running when that date is 
fixed.

Haines, 
886 P.2d  at 588 (quoting Aanenson, 842 P.2d at 1082); Olheiser v. State ex rel. 
Worker's Compensation Div., 866 P.2d 768, 772 (Wyo. 1994). We have consistently 
held that when a correct diagnosis and prognosis of present or likely future 
disability is communicated to the claimant, the injury is discovered, it is 
compensable, and the statute of limitations begins to run. Haines, 886 P.2d  at 
589.

[¶12]   Regarding the discovery of a 
compensable injury and causal relationship between the injury and employment, a 
claimant is required to use due diligence in pursuing his claim. Olheiser, 866 P.2d  at 773. Due diligence is defined as: 

Such 
a measure of prudence, activity, or assiduity, as is properly to be expected 
from, and ordinarily exercised by, a reasonable and prudent [person] under the 
particular circumstances; not measured by any absolute standard, but depending 
on the relative facts of the special case.

Black's 
Law Dictionary (6th ed. 1990); Olheiser, at 773. Due diligence is implied in the 
phrase "a reasonable person under the circumstances." Id. Accordingly, if a 
person fails to exercise due diligence in the pursuit of his claim, then he has 
failed to act as a reasonable person under the circumstances and his claim will 
be barred if the one-year time limit has expired. Id.

[¶13]   Here, the hearing examiner found 
and concluded:

Findings 
of Fact

1. 
        
Theodore W. Pittman (the "Claimant") was injured in a work-related 
incident on September 26, 1989, while employed by North American Energy Services 
Company. The Claimant suffered multiple injuries as a result of the work-related 
incident and underwent several surgeries.

2. 
        
In addition to other physical problems, the Claimant has also suffered 
from cataracts in both eyes. The cataracts were originally diagnosed by Randal 
N. Ellsworth, M.D., in August, 1991.

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Conclusions 
of Law

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4. 
        
The Claimant is also barred from receiving workers' compensation benefits 
for the cataract operations under the statute of limitations set forth in WYO. 
STAT. § 27-14-503. This statute of limitations requires an injured worker to, 
among other things, file an application within one (1) year after discovery of 
the injury.

5. 
        
The statute of limitations begins to run when the injured worker's injury 
becomes "compensable." An injury becomes compensable when the injured employee 
is made aware of the extent of the injury through a correct medical diagnosis. 
Baldwin v. Scullion, 50 Wyo. 508, 62 P.2d 531 (Wyo. 1936).

6. 
        
The Claimant's injury became compensable when it was diagnosed by Dr. 
Ellsworth in August, 1991, as posterior subcapsular cataracts. Therefore, the 
Claimant was required to seek benefits no later than August 30, 1992, which he 
failed to do.

[¶14]   Substantial evidence exists in the 
record to support the hearing examiner's conclusion that W.S. 27-14-503(a) 
barred Pittman's claim for cataract treatments. Pittman was injured in a 
work-related incident on September 26, 1989, and was aware that multiple 
injuries had resulted from this injury, including trauma to his head. In August 
1991, Dr. Ellsworth, an ophthalmologist, diagnosed Pittman with PSC cataracts in 
both eyes. Dr. Ellsworth informed Pittman that he would need corrective surgery. 
Thus, in August 1991, a correct diagnosis and prognosis concerning his cataracts 
was communicated to Pittman by competent, medical authority; therefore, the 
injury was discovered and it became compensable. Dr. Ellsworth testified that 
upon his communication of the diagnosis and prognosis, Pittman did not inquire 
whether the cataracts could have been caused by the 1989 incident. Pittman 
himself testified that he does not remember exactly when he determined that they 
might be causally related to his 1989 work-related injury. In any event, Pittman 
did not file his claim for benefits until June 1993, sixteen months after his 
last eye surgery.

CONCLUSION

[¶15]   We find that Pittman failed to 
exercise due diligence in discovering whether the cataracts were causally 
related to his September 26, 1989 work-related injury. The cataracts became a 
compensable injury upon diagnosis in August 1991. Failure to file a claim within 
the one-year statutory limit, W.S. 27-14-503(a), precludes the award of worker's 
compensation benefits.

[¶16]   Affirmed.