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

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1994-04-22T00:00:00Z

Document:
Sims v. State ex rel. Wyoming Workers' Compensation Div.1994 WY 44872 P.2d 555Case Number: 93-175Decided: 04/22/1994Supreme Court of Wyoming
James 
E. SIMS,

Appellant 
(Petitioner),

 

v.

 

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

Appellee 
(Respondent).

 

Appeal 
from the District Court, Natrona County,

Dan 
Spangler, J.

 

Representing 
Appellant:

Donald 
L. Painter, Casper.

Representing 
Appellee:

Joseph 
B. Meyer, Atty. Gen., John W. Renneisen, Deputy Atty. Gen., Kenneth E. Spurrier, 
Asst. Atty. Gen., and W. Thomas Sullins II, Sp. Asst. Atty. 
Gen

 

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

MACY, 
Chief Justice.

[¶1]      Appellant James 
E. Sims appeals from the district court's order affirming the hearing examiner's 
decision to deny Sims's application for temporary total disability worker's 
compensation benefits.

[¶2]      We 
affirm.

[¶3]      Sims presents the 
following issue on appeal:

1. 
Whether Employee-Claimant's earning capacity was ever restored following a 
compens[a]ble injury.

[¶4]      Sims was employed 
as a welder for Salt Creek Welding, Inc. He was carrying a load of wood while he 
was at work on November 20, 1991, when he slipped and fell on some ice. He 
injured his back as a result of this fall. Sims submitted an employee's report 
of the injury on November 26, 1991, and he applied for and received medical and 
temporary total disability benefits. In February of 1992, Sims underwent surgery 
to have a herniated disk repaired in his lower back.

[¶5]      A contract 
investigator for the Workers' Compensation Division began a visual and video 
tape investigation in October 1992 of Sims's activities. Over the course of the 
investigation, Sims was observed engaging in a number of work activities. Sims 
worked on his welding truck, welded, used a grinder, used an acetylene torch to 
cut metal, and loaded metal into the bed of his truck. In August, October, 
November, and December of 1992, Sims received $7,250 for the work he performed 
for Rocky Mountain Cementers. For a few days in late December 1992 and in 
January 1993, Sims worked as a pipe fitter's helper and earned approximately 
$870 during that time.

[¶6]      Sims applied for 
temporary total disability benefits for the month of December 1992. On December 
4, 1992, the Workers' Compensation Division issued its initial review concerning 
Sims's claim for benefits. The Workers' Compensation Division determined that 
Sims's earning power had been substantially restored and, therefore, denied his 
claim. Sims filed a motion for restoration of his temporary total disability 
benefits and submitted an application for recertification of his total 
disability. A contested case hearing was held to determine whether Sims was 
entitled to receive temporary total disability benefits. At the conclusion of 
the hearing, the hearing examiner ruled in pertinent part as 
follows:

1. 
That in order for the Office to consider a claim for temporary total disability 
there must be a properly submitted application and certification for the same, 
and there is a temporary total disability claim pending for the period [of] 
December 1, 1992 to December 31, 1992, but no application or certification 
beyond [that] time.

2. 
That the application and certification for temporary total disability benefits 
hereunder consideration cannot be allowed, because the evidence presented 
reflects that Employee-Claimant has been able to return to work and 
Employee-Claimant has failed to notify the division that he did work during the 
certified period.

3. 
That the evidence presented reflects that Employee-Claimant was not temporarily 
and totally incapacitated from performing employment at any gainful employment 
or occupation for which he was reasonably suited by experience or training for 
the certified period of time, and therefore not entitled to temporary total 
disability benefits.

4. 
That Employee-Claimant has failed to meet his burden of proof with respect to 
the temporary total disability benefits claimed, and the objection of the 
Objector-Defendant, State of Wyoming, ex rel., Wyoming Workers' Compensation 
Division, to the award of such temporary total disability benefits is 
sustained.

Sims 
appealed to the district court. The district court affirmed the hearing 
examiner's decision, and this appeal followed.

[¶7]      WYO. STAT. § 
16-3-114(c) (1990) sets out the standard to be used for judicial review of 
agency actions. "`The extent and degree of disability are questions of fact.'" 
Leonard v. McDonalds of Jackson Hole, 746 P.2d 1261, 1262 (Wyo. 1987) 
(quoting State ex rel. Worker's Compensation Division v. Lewis, 739 P.2d 1225, 1226 (Wyo. 1987)). With regard to questions of fact, we 
must:

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

. 
. . . .

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

Section 
16-3-114(c)(ii)(E).

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

Romero 
v. Davy McKee Corporation, 
854 P.2d 59, 61 (Wyo. 1993) (citing Farman v. State ex rel. Wyoming Workers' 
Compensation Division, 841 P.2d 99, 102 (Wyo. 1992)).

Bearden 
v. State ex rel. Wyoming Workers' Compensation Division, 
868 P.2d 268, 269 (Wyo. 1994). 

[¶8]      Temporary total 
disability benefits are available to injured workers pursuant to WYO. STAT. § 
27-14-404(a) (Supp. 1993):

(a) 
If after a compensable injury is sustained and as a result of the injury the 
employee is subject to temporary total disability as defined under W.S. 
27-14-102(a)(xviii), the injured employee is entitled to receive a temporary 
total disability award for the period of temporary total disability as provided 
by W.S. 27-14-403(c).

WYO. 
STAT. § 27-14-404(c) (Supp. 1993) establishes the point when the employee's 
right to receive temporary total disability benefits 
terminates:

(c) 
Payment under subsection (a) of this section shall cease 
if:

(i) 
Recovery is complete to the extent that the earning power of the employee at a 
gainful occupation for which he is reasonably suited by experience or training 
is substantially restored; or

(ii) 
The employee has an ascertainable loss and qualifies for benefits under W.S. 
27-14-405[1] or 27-14-406.[2]

WYO. 
STAT. § 27-14-102(a)(xviii) (Supp. 1993) defines temporary total disability as 
being

that 
period of time an employee is temporarily and totally incapacitated from 
performing employment at any gainful employment or occupation for which he is 
reasonably suited by experience or training. The period of temporary total 
disability terminates at the time the employee completely recovers or qualifies 
for benefits under W.S. 27-14-405 or 27-14-406[.]

[¶9]      "`[I]n a worker's 
compensation case, the claimant has the burden of proof on the essential 
elements of the claim by a preponderance of the evidence.'" Bagshaw v. Circle 
H Oilfield Service, 753 P.2d 1044, 1045 (Wyo. 1988) (quoting Leonard, 
746 P.2d at 1263). Consistent with this general rule, the employee has the 
burden "to show that he is entitled to a continuance of [temporary total 
disability] benefits." Higgins v. State ex rel. Wyoming Worker's Compensation 
Division, 739 P.2d 129, 131 (Wyo.), cert. denied, 484 U.S. 988, 108 S. Ct. 508, 98 L. Ed. 2d 507 (1987).

[¶10]   In State ex rel. Wyoming 
Workers' Compensation Division v. Ohnstad, 802 P.2d 865 (Wyo. 1990), this 
Court discussed the nature of temporary total disability 
benefits:

The 
purpose of awarding temporary total disability benefits is to provide income for 
an injured employee while he or she recovers. The [statutory] provisions dealing 
with temporary total disability benefits, when read together, indicate that the 
legislature intended for workers who are temporarily injured to be compensated 
until their earning power is substantially restored.

802 P.2d  at 867 (citation omitted). In arguing that his earning power had not been 
substantially restored, Sims relies upon Ohnstad and Pacific Power and Light 
v. Parsons, 692 P.2d 226 (Wyo. 1984).

[¶11]   In Parsons, an injured 
employee worked for six weeks in his own sod and landscaping business and 
received some earnings "during the period of time he claimed temporary total 
disability." 692 P.2d  at 227. In ruling that substantial evidence supported the 
award of temporary total disability benefits, this Court quoted the Utah Supreme 
Court as follows:

"`[T]otal 
disability' does not mean a state of abject helplessness or that the injured 
employee must be unable to do any work at all. The fact that an injured employee 
may be able to do some kinds of tasks to earn occasional wages does not 
necessarily preclude a finding of total disability to perform the work or follow 
the occupation in which he was injured."

692 P.2d  at 228 (quoting Entwistle Company v. Wilkins, 626 P.2d 495, 498 
(Utah 1981)). This Court continued by holding: "Some occasional work and 
attempts to get work, during the healing period, do not justify denying 
temporary total benefits. Also, if a claimant is unable to perform remunerative 
work with reasonable consistency, without pain and discomfort, temporary 
disability is deemed total." 692 P.2d  at 229. The Court found that the following 
evidence was sufficient to support the award: (1) the employee's physician had 
not released him for regular duty; (2) the employee's work was for a short 
period of time; and (3) the employee was physically limited in performing the 
work. Id.

[¶12]   In Ohnstad, an employee was 
earning approximately $1,200 per month when he was injured. Subsequent to the 
injury, he took a job which paid less than $600 per month. Comparing the 
employee's pre- and post-injury earnings, this Court held that substantial 
evidence supported the conclusion that his earning power had not been 
substantially restored. 802 P.2d  at 868.

[¶13]   The evidence in this case is very 
different from that presented in Parsons and Ohnstad. While 
occasional work by an injured employee may not jeopardize the employee's right 
to receive total temporary disability benefits, the law requires that benefits 
cease when "[r]ecovery is complete to the extent that the earning power of the 
employee at a gainful occupation for which he is reasonably suited by experience 
or training is substantially restored." Section 
27-14-404(c)(i).

[¶14]   Substantial evidence supported the 
hearing examiner's conclusion that Sims's earning power had been substantially 
restored. Sims did not meet his burden of proving that he was temporarily and 
totally disabled. Sims worked in his own welding business during the period of 
time he claimed temporary total disability benefits.3 He received approximately $8,120 in 
a little over four months. While this amount was less than his pre-injury 
earnings of $2,600 per month, the disparity between his pre- and post-injury 
earnings was not nearly as great as that presented in Ohnstad.4

[¶15]   This Court has recognized that 
"actual earnings is not the only method for comparing an individual's pre- and 
post-injury earning power." Ohnstad, 802 P.2d  at 868 n. 3. See also 
Parsons, 692 P.2d at 228-29; and 1C ARTHUR LARSON, THE LAW OF WORKMEN'S 
COMPENSATION § 57.21(a) (1993). Unlike the situation presented in 
Parsons, Sims's work activities were not occasional. He worked over a 
considerable period of time during the summer and fall of 1992 and the winter of 
1992-1993. 692 P.2d  at 228-29. Sims acknowledged that he was conducting his own 
welding business and that he had distributed business cards in order to solicit 
business during this period.

[¶16]   The video tape evidence, as 
described at the hearing by the contract investigator, indicated that Sims's 
ability to carry out the duties of a welder was not obviously restricted or 
limited. Although Sims testified that he was still experiencing pain and that he 
had not yet been released for work by his physician, he had no apparent 
difficulty moving or engaging in the various work activities associated with the 
welding profession.

[¶17]   The hearing examiner's conclusion 
that Sims's earning power had been substantially restored was supported by 
substantial evidence.

[¶18]   Affirmed.

Footnotes

1 WYO. STAT. § 27-14-405 (1991) pertains to permanent partial disability 
benefits.

2 WYO. STAT. § 27-14-406 (1991) provides for the payment of permanent 
total disability benefits.

3 When he applied for temporary total disability benefits, Sims signed a 
form which contained the following sworn statement: "I do solemnly swear that my 
disability status remains unchanged, that I have not returned to work, and do 
hereby make application and claim for temporary total disability for the 
certified period of time. In the event I am able to return to work prior to the 
end of the certified period of time, I will notify the Division immediately." 
Sims signed the application form despite the fact that he had worked, and he did 
not inform the Workers' Compensation Division that he had returned to work. 
While we do not base our decision in this case on the fact that he did not 
candidly report his work activities to the Workers' Compensation Division, we 
recognize that misrepresentations made by employees in order to receive worker's 
compensation benefits are improper. WYO. STAT. § 27-14-510 (Supp. 
1993).

4 
Sims contends that his expenses for the work he performed for Rocky Mountain 
Cementers, including payment to his stepson for helping him complete the job, 
were greater than his earnings. The profitability of his work was irrelevant to 
the issue of whether his earning power had been substantially restored. As we 
stated in Parsons: "Whether this unsuccessful venture was because of appellee's 
disability, inexperience, management or otherwise, we do not know. It is 
immaterial to the determination of this case." 692 P.2d  at 229 n. 1.