Case Title: Talbot v. State ex rel. Workers' Safety & Comp. Div.

Citation: 

Docket Number: S-12-0016

State: wyoming

Court: Wyoming Supreme Court

Date: 2012-10-18T00:00:00Z

Document:
IN THE MATTER OF WORKER'S COMPENSATION CLAIM OF: LANCE TALBOT v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2012 WY 134Case Number: S-12-0016Decided: 10/18/2012This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so that correction may be made before final publication in the permanent volume.
OCTOBER TERM, A.D. 
2012
IN 
THE MATTER OF THE WORKER' S COMPENSATION CLAIM OF:LANCE 
TALBOT,Appellant(Petitioner),v.STATE OF WYOMING, ex 
rel., WYOMING WORKERS' SAFETY AND COMPENSATION 
DIVISION,Appellee(Respondent).
Appeal from the 
District Court of Albany County
The Honorable Jeffrey 
A. Donnell, Judge
Representing 
Appellant:
Bernard Q. Phelan, 
Phelan Law Offices, Cheyenne, Wyoming.
Representing 
Appellee:
Gregory A. Phillips, 
Wyoming Attorney General; John D. Rossetti, Deputy Attorney General; Michael J. 
Finn, Senior Assistant Attorney General; Brenda S. Yamaji, Assistant Attorney 
General.
Before KITE, C.J., 
and GOLDEN,* HILL, VOIGT, and BURKE, JJ.
*Justice Golden 
retired effective September 30, 2012.
VOIGT, 
Justice.
[¶1]      
The appellant received disability benefits due to a work-related injury.  
Those benefits were terminated as a result of the appellant’s 
incarceration.  Following his release, the appellant applied for 
reinstatement of the benefits.  Although that application was initially 
denied, benefits were awarded following a contested case hearing.  At that 
time, the appellant filed one application for retroactive benefits for the 
period during which his prior claim was contested and two additional 
applications for separate periods of prospective benefits.  The Office of 
Administrative Hearings (OAH) denied all three claims for failure to comply with 
the Wyoming Worker’s Compensation Act.  The district court affirmed the 
denial of two of those applications and the appellant now appeals those 
denials.  Because the applications did not comply with Wyo. Stat. Ann. 
§ 27-14-501(b) (LexisNexis 2011), we affirm.
ISSUE
[¶2]      
Did the hearing examiner err as a matter of law in determining that the Wyoming 
Worker’s Compensation Act requires a separate examination for each period of 
certification of Temporary Total Disability benefits?
FACTS
[¶3]      
On March 13, 2006, the appellant slipped on ice and injured his back in a 
work-related accident.  Following this injury, the appellant applied to the 
Wyoming Workers’ Safety & Compensation Division (Division) and received 
Temporary Total Disability (TTD) benefits until he became incarcerated in the 
Wyoming State Penitentiary.  Following his parole, the appellant sought to 
have his benefits reinstated.  On January 20 and 27, 2009, the appellant 
saw Dr. Cook who assessed the appellant’s injuries and certified him 
disabled.  The Division refused to pay due to a lack of evidence that the 
appellant’s pain was a result of the 2006 injury.  On September 17, 2009, 
following a contested case hearing, the OAH reversed that denial and awarded 
benefits to the appellant for the period January 27, 2009 through March 27, 
2009.
[¶4]      
Following that reversal, the appellant applied for one period of retroactive 
benefits for the period when his disability determination was contested, and two 
periods of prospective benefits.  On October 14, 2009, the appellant 
applied for benefits for the period October 15 through November 15, 2009.  
That application indicated April 2, 2009, as the date of the appellant’s last 
doctor’s examination.  On October 27, 2009, the appellant applied for 
benefits for November 15 through December 15, 2009, with March 27, 2009, as the 
last date of an examination.  Finally, on October 27, 2009, the appellant 
also applied for retroactive benefits for March 27 through “present,” citing 
March 27, 2009, as the date of the last doctor’s examination.  All three 
claims were initially denied.  
[¶5]      
The OAH found that the appellant’s claims failed to satisfy the procedural 
requirements for an application for TTD benefits.  Particularly, the claims 
did not comply with Wyo. Stat. Ann. §§ 27-14-404(d)(i) and 27-14-501(b) (LexisNexis 2011).  The 
applicable portion of subsection (d)(i) reads as follows:
(d)    
. . . Benefits under subsection (a) of this section shall not be paid 
if:
(i)      
An employee or his personal representative fails to file a claim for benefits 
within thirty (30) days after the first day immediately succeeding the first 
thirty (30) days of any certified period of temporary total 
disability[.]
Wyo. Stat. Ann. § 
27-14-404(d)(i).  Regarding the application for retroactive benefits for 
the certified period beginning March 27, the OAH found that there was no 
evidence that the TTD certification had been filed within sixty days of March 
27.  The OAH found that the appellant had not been examined for at least 
six months prior to the October 15, 2009, certification and, therefore, the 
application was properly denied by the Division.
[¶6]      
The OAH also found that the appellant’s two applications for prospective 
benefits did not meet the procedural requirements of Wyo. Stat. Ann. § 
27-14-501(b), which provides, in relevant part, as follows:
(b)    
Any health care provider attending an employee injured while engaged in any 
employment covered under this act and certifying temporary total disability 
under W.S. 27-14-404 shall examine the employee before certification and 
shall without charge file a written report with the division.  Prior to 
each period of subsequent recertification of temporary total disability, the 
health care provider shall reexamine the employee and file without charge a 
written report with the division.
The OAH found that, 
because the appellant had not been examined from either March 27 or April 2, 
2009 through December 6, 2009, the appellant had not been examined “prior to 
each period of subsequent recertification” as required by the statute and, 
therefore, denied the appellant’s claims for benefits for the periods October 15 
through November 15, and November 15 through December 15.
[¶7]      
The appellant appealed the OAH’s denial of benefits to the district court.  
The district court reversed the denial of benefits for the period October 15 
through November 15, and affirmed the denial of the other two applications for 
benefits.  Regarding the application for benefits for November 15 through 
December 15, the district court stated that:
[E]ach certification 
or recertification for TTD benefits must be preceded by a separate medical 
examination.  Wyo. Stat. Ann. § 27-14-501(b) ([LexisNexis] 2011).  The 
evidence from the contested case hearing established that Dr. Cook did not 
examine [the appellant] between April 2, 2009 and December 6, 2009.  While 
the Court finds that [the appellant’s] April 2, 2009 examination suffices for 
his October 15, 2009 application for TTD benefits, it does not suffice for more 
than one application.
[¶8]      
The district court also affirmed the denial of the appellant’s application for 
retroactive benefits for the period March 27 through “present,” albeit on 
different grounds than those given by the OAH.  The district court pointed 
out that Wyo. Stat. Ann. § 27-14-404(d)(i), which requires that a claim be 
made within sixty days of the start of the certified period of TTD, does not 
apply to claims, such as the appellant’s, which accrue during contested case 
proceedings where the application is for continuing benefits.  Instead, the 
district court affirmed the denial on the basis of a different statutory 
requirement: “Prior to each period of subsequent recertification of temporary 
total disability, the health care provider shall reexamine the employee and file 
without charge a written report with the division.”  Wyo. Stat. Ann. § 
27-14-501(b).  The district court found that there was no evidence that the 
appellant had been examined prior to March 27, the first day of the application 
period.  Although the appellant had been examined on January 20 and 27, 
those examinations were relevant to the application for benefits for January 27 
through March 27.  The district court found that the appellant’s next 
examination was not until April 2, six days after the start of the period for 
which benefits were requested.
[¶9]      
The appellant now appeals the district court’s decision affirming the denial of 
both his application for retroactive benefits for March 27 to “present” and his 
application for prospective benefits for November 15 to December 15.
STANDARD OF 
REVIEW
[¶10]   No 
deference shall be given to an appeal of a district court’s review of an 
administrative agency’s decision and “we review the case as if it had come 
directly to us from the administrative agency.”  Dale v. S & S Builders, LLC, 2008 WY 84, ¶ 8, 188 P.3d 554, 557 (Wyo. 2008) 
(quoting Newman v. State ex rel. Wyo. Workers’ Safety & Comp. 
Div., 2002 WY 91, ¶ 7, 49 P.3d 163, 166 (Wyo. 
2002)).
[¶11]   “We 
will affirm an agency’s legal conclusion only if it is in accordance with the 
law.”  Dale, 2008 WY 
84, ¶ 26, 188 P.3d  at 562 (quoting Diamond B Servs., Inc. v. Rohde, 
2005 WY 130, ¶ 12, 120 P.3d 1031, 1038 (Wyo. 
2005)).
DISCUSSION
[¶12]   A 
health care provider must examine an applicant for TTD benefits before 
certifying the applicant disabled.  Wyo. Stat. Ann. § 27-14-501(b).  
The applicant then must file his claim within sixty days of the first day of the 
certified period of TTD.  Wyo. Stat. Ann. § 27-14-404(d)(i).  The OAH 
affirmed the denial of the appellant’s application for retroactive benefits on 
the basis of this latter statute.  This Court, however, has limited the 
application of Wyo. Stat. Ann. § 27-14-404(d) in situations where benefits 
have been terminated and become subject to a contested case hearing.  
“[T]he procedures mandated in Wyo. Stat. Ann. § 27-14-404(d) do not apply to 
claims which accrue during contested case proceedings.”  State ex rel. 
Wyo. Workers’ Comp. Div. v. Gerdes, 951 P.2d 1170, 1174 (Wyo. 
1997).  
[¶13]   In 
Gerdes, the claimant objected to the Division’s termination of her 
benefits after it received a letter from the claimant’s doctor stating that she 
had reached maximum medical improvement.  Id. at 1172.  After a 
hearing, the OAH sided with the claimant and awarded retroactive benefits.  
Id. at 1172-73  The Division appealed, arguing in part that the 
retroactive award was inappropriate because the claimant did not file a claim 
pursuant to Wyo. Stat. Ann. § 27-14-404(d).  Id. at 1173.  In 
the instant case, however, the appellant did file a claim as required by the 
statute.  That claim, although initially denied, was later awarded after a 
contested case hearing.  Following the award, the appellant filed 
additional claims (including those in dispute here), one of which was for the 
retroactive period during which the earlier claim was contested.  

[¶14]   The 
distinction between Gerdes and this case is that in the former, the 
contested case resulted in an award of retroactive benefits for a period during 
which the appellant did not comply with Wyo. Stat. Ann. § 27-14-404(d).  
Here, on the other hand, the appellant, following a contested case hearing 
resulting in a reversal of a denial of benefits, applied for retroactive 
benefits for the period during which his TTD status was contested.  The 
appellant did not meet the sixty-day filing deadline found in Wyo. Stat. Ann. § 
27-14-404(d) because he awaited the outcome of the contested case proceedings 
before applying.  Despite this distinction, the rationale given by this 
Court in Gerdes for limiting Wyo. Stat. Ann. § 27-14-404(d) is applicable 
here as well.  In that case, this Court focused on the fact that the 
purpose of the statute is diminished when a final determination terminating 
benefits has been issued.  “[T]he purpose of the procedural requirements 
of Wyo. Stat. Ann. § 27-14-404(d) does not appertain to the period 
following a final determination that benefits be terminated.  After a final 
determination, no number of filings or certifications will reinstate the 
benefits or allow the claim to be heard on its merits.”  Gerdes, 951 P.2d  at 1174.  Although the Division correctly points out that 
Gerdes requires the claimant to show at the hearing that he is entitled 
to continuing benefits, that requirement applies to the benefits at issue in the 
contested case hearing.  Here, the appellant applied for retroactive 
benefits in a separate application following the outcome of the contested case 
hearing.  For these reasons, we will not affirm the denial of the 
appellant’s application for retroactive benefits for failure to comply with Wyo. 
Stat. Ann. 27-14-404(d)(i).  This statute, however, is not the only one 
with which an application for TTD benefits is expected to comply.
[¶15]   On 
appeal, the appellant argues that the Wyoming Worker’s Compensation Act does not 
require separate examinations for each application for TTD and that such an 
interpretation would result in repetitive examinations.  The language of 
the relevant statute is as follows:
(b)   Any 
health care provider attending an employee injured while engaged in any 
employment covered under this act and certifying temporary total disability 
under W.S. 27-14-404 shall examine the employee before 
certification and shall without charge file a written report with the 
division.  Prior to each period of subsequent recertification 
of temporary total disability, the health care provider shall 
reexamine the employee and file without charge a written report 
with the division. . . .  Any health care provider certifying or 
recertifying temporary total disability without an examination of the employee 
shall be reported to the state licensing board for the respective health care 
provider.
Wyo. Stat. Ann. § 
27-14-501(b) (emphasis added).  In analyzing the language of the statute, 
“[o]ur paramount consideration is the legislature’s intent as reflected in the 
plain and ordinary meaning of the words used in the statute.”  Spreeman 
v. State, 2012 WY 88, ¶ 10, 
278 P.3d 1159, 1162 (Wyo. 2012) 
(quoting Parks v. State, 2011 
WY 19, ¶ 11, 247 P.3d 857, 
859 (Wyo. 2011)).  The statute’s inclusion of the word 
“each” in the statement “[p]rior to each period of 
subsequent recertification . . . the health care provider shall reexamine the 
employee” necessarily requires a separate examination.  The legislature 
purposely chose to require reexamination prior to each period of 
subsequent recertification.  The inclusion of “each” serves 
to emphasize that there must be an examination every time an applicant reapplies 
for benefits.  This would seem logical as the legislature would want to 
ensure that an applicant for ongoing TTD benefits still needs those 
benefits.  Contrary to the appellant’s argument, the language of the 
statute does require a separate examination for each certification.
[¶16]   The 
appellant’s applications for TTD benefits were properly denied by the OAH 
because Wyo. Stat. Ann. § 27-14-501(b) requires a separate reexamination for 
each recertification period.  Although the district court addressed three 
separate applications for benefits, only two of those applications are at issue 
in the instant case because the district court reversed the OAH’s denial of 
benefits for one of those applications, finding that the applications were in 
compliance with Wyo. Stat. Ann. § 27-14-501(b), contrary to the findings of the 
OAH, because a health care provider reexamined the appellant on April 2, 
2009.  Although it is not clear from the record whether this visit occurred 
on April 2 or March 27, it does seem clear that this was the only time the 
appellant was examined prior to the three separate periods of 
recertification.  As discussed above, Wyo. Stat. Ann. § 27-14-501(b) 
requires a separate reexamination for each period of subsequent 
recertification.  Because this examination was the basis for the 
appellant’s receipt of benefits for the period October 15 through November 15, 
it cannot also serve as the requisite examination for any later period of 
recertification.  A health care provider did not reexamine the appellant, 
as required by Wyo. Stat. Ann. § 27-14-501(b), prior to each of the 
recertification periods at issue in this appeal and therefore we will affirm the 
denial of TTD benefits for both applications.
CONCLUSION
[¶17]   The 
Wyoming Worker’s Compensation Act requires a separate physical examination prior 
to each certified period of disability.  Because a health care provider did 
not perform a separate examination for each of the appellant’s applications for 
TTD benefits, we will affirm the district court’s decision to deny benefits to 
the appellant.