Case Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF : TERRY MCINTOSH v. STATE OF WYOMING ex rel. WYOMING MEDICAL COMMISSION; and WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: 06-113

State: wyoming

Court: Wyoming Supreme Court

Date: 2007-07-12T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF : TERRY MCINTOSH v. STATE OF WYOMING ex rel. WYOMING MEDICAL COMMISSION; and WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2007 WY 108162 P.3d 483Case Number: No. 06-113Decided: 07/12/2007
APRIL TERM, A.D. 2007

 
 
                                                                                                            

 
 
IN THE 
MATTER OF THE WORKER'S COMPENSATION CLAIM OF: 

 
 
TERRY 
McINTOSH,

Appellant  (Petitioner),

 

v.

 
 
STATE OFWYOMING ex rel. WYOMING MEDICAL 
COMMISSION; 

and 
WYOMING 
WORKERS' SAFETY AND COMPENSATION DIVISION,

Appellees  (Respondents). 

 
 
Appeal 
from the DistrictCourtofLaramieCounty

 
 

Representing 
Appellant:

Bill G. 
Hibbler of Bill G. Hibbler, P.C., Cheyenne, Wyoming. 

 
 

Representing 
Appellees:

Patrick 
J. Crank, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; 
Steve Czoschke, Senior Assistant Attorney General; Keith J. Dodson, Legal 
Intern.  Argument by Mr. 
Dodson.

 
 
Before 
VOIGT, C.J., and GOLDEN, HILL, KITE, BURKE, JJ.

 
 
KITE, 
J., delivers the opinion of the Court.  
GOLDEN, J., files a dissenting opinion in which VOIGT, C.J., 
joins.

 
 

KITE, 
Justice.

 
 
[¶1]      Terry McIntosh 
filed a claim for benefits with the Workers' Compensation Division (the 
Division) alleging he had suffered a back injury at work.  The Division determined his injury to be 
an aggravation of a pre-existing condition and awarded him benefits.  Several months later, the Division 
determined that Mr. McIntosh's condition was pre-existing and declined payment 
of further benefits. 

 
 
[¶2]      Mr. McIntosh 
requested a hearing and the Division referred the case to the Office of 
Administrative Hearings (OAH).  
Several days later, the OAH transferred the case to the Medical 
Commission.  After a hearing, the 
Medical Commission issued an order upholding the denial of benefits.  Mr. McIntosh appealed to the district 
court, which also upheld the denial.  
On appeal to this Court, Mr. McIntosh claims the Medical Commission's 
order was not supported by substantial evidence and the Medical Commission did 
not have authority to decide his case because: 1) the Division did not seek to 
re-open it in accordance with Wyo. Stat. Ann. § 27-14-605(a) (LexisNexis 2005); 
and 2) it was not a medically contested case.  We affirm.

 
 
 
 
ISSUES

 
 
[¶3]  Mr. McIntosh states the issues as 
follows:

 
 
            
I.          
Whether the Medical Commission order is supported by substantial 
evidence?

 
 
            
II.          
Whether the Medical Commission order is contrary to law because the 
Workers' Compensation Division failed to comply with Wyo. Stat. § 
27-14-605(a)?

 
 
            
III.         
Whether the Medical Commission order is contrary to law because it 
determined a non-medically contested issue concerning the application of Wyo. 
Stat. § 27-14-605(a)?

 
 
            
IV.        
Whether the Medical Commission panel abused its discretion in failing to 
consider the testimony of the claims analyst?

 
 
The 
Division re-phrases Mr. McIntosh's first three issues and omits his fourth issue 
from its issues statement. 

 
 
 
 
 
 
FACTS

 
 
[¶4]      On September 5, 
2003, Mr. McIntosh filled out an employee report of injury in which he stated he 
had injured his back on June 25, 2003, while replacing ceiling tiles at his job 
at the Plains Hotel in Cheyenne, Wyoming.  
On November 3, 2003, the Division issued a final determination in which 
it concluded "the material aggravation to a pre-existing back injury is 
compensable and the case is now open for the current exacerbation of your 
pre-existing injury."  Several 
months later, on April 9, 2004, the Division issued a final determination in 
which it concluded Mr. McIntosh's "current medical condition of severe spinal 
stenosis is preexisting to the work related twisting injury" and notified him it 
was discontinuing payment of benefits.   

 
 
[¶5]      Mr. McIntosh 
requested a hearing and, on May 27, 2004, the Division referred the case to the 
OAH.  On June 7, 2004, the OAH 
issued an order transferring the case to the Medical Commission.  The order stated:    

 
 
The 
Office has reviewed the file, in particular the April 9, 2004 Final 
Determination.  The Office finds 
that the issue to be resolved in this matter is medically contested as defined 
by the Wyoming Workers' Safety and Compensation Division's Rules, Regulations 
and Fee Schedules, Ch. 6 § 1(a)(i) (2004).  
This Office is therefore without jurisdiction to hear this matter and all 
proceedings before this Office should be transferred to the Medical Commission 
for resolution. 

 
 
[¶6]      The Medical 
Commission accepted the case, appointed legal counsel to represent Mr. McIntosh, 
and issued a scheduling order.  Mr. 
McIntosh and the Division filed disclosure statements and, on May 4, 2005, the 
Medical Commission convened a hearing.     On May 24, 2005, the 
Medical Commission issued findings of fact, conclusions of law and an order in 
which it concluded that Mr. McIntosh "ha[d] not met his burden of [proving] that 
his low back symptoms [were] related to the work accident."  

 
 
[¶7]  Mr. McIntosh filed a petition for review 
in district court in which he raised a number of issues, including those 
presented on appeal.  The district 
court entered an order affirming the denial of benefits.  Mr. McIntosh appealed from the district 
court's order.  

 
 
 
 
STANDARD 
OF REVIEW

 
 
[¶8]  In an appeal from a district court's 
decision on a petition for review of administrative action, we afford no 
deference to the district court's decision and, instead, review the case as if 
it came directly from the agency.  
Bonsell v. State ex rel. Wyo. 
Workers' Safety and Comp. Div., 2006 WY 114, ¶ 7, 142 P.3d 686, 688 (Wyo. 
2006).  Judicial review of agency 
decisions is limited to those considerations specified in Wyo. Stat.  Ann. § 16-3-114(c) (LexisNexis 2005), 
which provides in pertinent part:

 
 
            
(c) To the extent necessary to make a decision and when presented, the 
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.

 
 
Additionally, 
we have said:

 
 
            
The substantial evidence test is the appropriate standard of review in 
appeals from contested case proceedings when factual findings are involved and 
both parties submit evidence.  
Substantial evidence is relevant evidence which a reasonable mind might 
accept in support of the agency's conclusions.  It is more than a scintilla of 
evidence.  Even if the factual 
findings are found to be supported by substantial evidence, the ultimate agency 
decision may still be found to be arbitrary or capricious for other 
reasons.  An appellate court does 
not examine the record only to determine if there is substantial evidence to 
support the agency's decision, but it also must examine the conflicting evidence 
to determine if the hearing examiner could have reasonably made its finding and 
order upon all of the evidence before it.  

 
 
            
We do not defer to the agency's determination on issues of law; instead, 
we will correct any error made by the agency in either interpreting or applying 
the law.  

 
 

Bonsell, ¶ 8, 
142 P.3d  at 688-89.

 
 
 
 
DISCUSSION

 
 
 
 
1.         
Sufficiency of the Evidence 

 
 
[¶9]  Mr. McIntosh asserts the Medical Commission's 
order was not supported by substantial evidence because the only competent 
medical evidence was Dr. Steven Beer's deposition testimony that in his opinion 
Mr. McIntosh's symptoms were related to his work injury.  Mr. McIntosh claims 
the Medical Commission improperly disregarded Dr. Beer's testimony and based its 
ruling on the unsupported conclusion that Mr. McIntosh was not credible.  The Division 
contends the Medical Commission's conclusion that Mr. McIntosh was not credible 
was supported by substantial evidence and the Medical Commission, as the trier 
of fact, was entitled to give the evidence, including Dr. Beer's testimony, the 
weight it thought it deserved.

 
 
[¶10]  We address first the finding that Mr. 
McIntosh was not credible.  In its four pages of findings, the Medical 
Commission found that Mr. McIntosh gave different dates as to when the injury 
occurred, June 25; June 16; June 16 or 17; June 11; early July; and July 
20.  The 
Medical Commission also found that Mr. McIntosh gave different accounts of the 
injury, including that "he has no history of injury recently"; "he could not 
recall the exact incident but reported doing lots of lifting, standing and 
twisting"; he had ongoing back pain since the beginning of July but "does not 
recall an exact incident"; he was on a ladder handing ceiling tiles down to a 
co-worker when something twisted in his back; and he was turning sideways while 
lowering ceiling tiles and felt and heard a "pop" in his low back.  The Medical 
Commission pointed out in its findings that, in contrast to the last statement 
which Mr. McIntosh made at the hearing, none of the medical records indicated he 
had reported hearing a "pop" to any doctor.  

 
 
[¶11] Additionally, the Medical Commission found that Mr. 
McIntosh gave different accounts of when he first noticed the pain, initially 
stating the pain began when he got off the ladder; then testifying that he had 
no pain until later that night; and finally, when asked about his prior 
statement that he told his supervisor within an hour or two of the injury, 
changing his testimony and saying he experienced pain immediately.  The Medical 
Commission also found that Mr. McIntosh stated in his report of injury and 
testified at the hearing that he had no back problems before the work incident 
when the medical records indicated otherwise.  The June 18, 2003, record, for example, 
stated "he has no history of injury recently, but does have an extensive history 
of back problems, including motorcycle accidents."  A July 1, 2003, 
record stated his past medical history included some motorcycle accidents, car 
accidents, neck pain, sacroiliac pain, and a past history of having seen a 
chiropractor.  
In light of the medical records, the Medical Commission found Mr. 
McIntosh's testimony that he had no prior back problems "wholly lacking in 
credibility."  
In its findings, the Medical Commission also found it significant that 
Mr. McIntosh did not file his report of injury until September 5, 2003, by which 
time, he testified, his job had been eliminated.  

 
 
[¶12]  Based upon its four pages of findings, the 
Medical Commission made the further finding that Mr. McIntosh generally was not 
credible.  In 
its conclusions of law, the Medical Commission stated:

 
 

6.       Mr. McIntosh has not met his burden of 
proof.  He has 
given multiple accounts of when the injury occurred and when his symptoms first 
appeared.  He 
never reported a "popping" sound to any doctor.  His initial reports to various physicians did 
not indicate a discrete mechanism of injury or how he was injured, and there 
were reports he had a long standing low back problem.  His radiographic 
studies show significant preexisting degenerative changes which could have 
become symptomatic through natural progression, activity outside of work or 
possibly at work.  
The timing of the injury report coincides with the loss of his job. 
Weighing all the evidence and testimony the Panel is left with the ultimate 
conclusion that Mr. McIntosh has not met his burden of proof.

 
 
[¶13]  We conclude the Medical Commission's findings 
of fact and conclusions of law were supported by substantial evidence presented 
at the hearing.  
It is clear from the findings of fact that the Medical Commission gave 
considerable weight to the fact that Mr. McIntosh's reports about his injury 
were inconsistent in many ways, including what, when and how it happened and his 
condition before and after it happened.  We cannot properly substitute our judgment 
for that of the Medical Commission nor can we conclude from the record presented 
that reasonable minds could not have reached the conclusions the Medical 
Commission reached on the basis of the evidence before it.  As the trier of 
fact, the Medical Commission was charged with determining relevancy, assigning 
probative values and weighing the evidence.  Decker v. State ex rel. Medical Comm'n, 2005 WY 160, ¶ 33, 124 P.3d 686, 697 (Wyo. 
2005).  There 
is nothing in this record or the findings and conclusions from which we can 
conclude the Medical Commission's ruling was not supported by substantial 
evidence, or that it was arbitrary and capricious.   

 
 
[¶14]  We reach a similar conclusion with respect to 
Mr. McIntosh's claim that the Medical Commission improperly disregarded Dr. 
Beer's testimony.  
The Medical Commission's findings of fact included the following:  Mr. McIntosh saw 
Dr. Beer on August 20, 2003, and related that a month ago [i.e. July 20th] he was changing ceiling tiles while working 
and developed the onset of back pain with numbness and tingling into the left 
hip and leg.  
Dr. Beer's impression was symptomatic spinal stenosis at L4-5.  He wrote a letter 
to Dr. Yost on August 20, 2003, relating that Mr. McIntosh had suffered from low 
back pain and left leg pain since a work related accident.  He wrote a letter 
to the Division on April 6, 2004, stating that Mr. McIntosh presented with an 
injury to his back that occurred while working.  Dr. Beer stated in the April letter that in 
his opinion the injury was a new injury, not a preexisting injury.  

 
 
[¶15]  In his deposition, taken on March 23, 2005, 
Dr. Beer testified that spinal stenosis can be a congenital condition or caused 
by an injury.  
He testified he believed Mr. McIntosh's stenosis was a new injury and not 
preexisting because he had no symptoms before the work accident and afterwards 
he had back and lower extremity pain.  He testified there was a direct cause and 
effect relationship.

 
 
[¶16]  Dr. Beer testified Mr. McIntosh had severe 
stenosis; if Mr. McIntosh had stenosis before the work accident, he would have 
had a lot of symptoms; and, it was difficult to believe it had been ongoing for 
any extended period.  
Dr. Beer testified he did not have copies of Mr. McIntosh's medical 
records showing a history of back problems and his opinions took into account 
what Mr. McIntosh had told him.   

 
 
[¶17]  When asked about whether Mr. McIntosh could 
have aggravated a preexisting injury, Dr. Beer testified that Mr. McIntosh did 
not have symptoms before the work injury, this was a new injury, but if he had 
prior symptoms this would be an aggravation of a preexisting condition.  Dr. Beer also 
testified an individual with Mr. McIntosh's degenerative changes could have 
aggravated that condition in many ways either at work or elsewhere and it was 
possible Mr. McIntosh had a herniated disc before June 2003 and the onset of 
symptoms had been delayed.  

 
 
[¶18]  Weighed against Dr. Beer's testimony, the 
Medical Commission had Mr. McIntosh's inconsistent reports concerning his back 
problems and a written report from John Bender, O.D., who reviewed the file and 
concluded Mr. McIntosh did not have a specific work injury that led to his 
symptoms; he had preexisting degenerative back problems that became symptomatic; 
and it was just as likely his symptoms resulted from a natural progression of 
the degenerative disc disease as any work or other activity.  

 
 
[¶19]  Based upon all of the evidence, the Medical 
Commission made the following finding pertinent to Dr. Beer:

 
 
Dr. Beer was not given an accurate history and he did not 
have the opportunity to review the prior records.  Dr. Beer's opinions are based heavily on what 
Mr. McIntosh told him which is highly dubious.

 
 
[¶20]  It is apparent the Medical Commission fully 
considered Dr. Beer's testimony and, in light of other evidence, reasonably 
concluded his opinions were based on incomplete and incorrect information.  As the trier of 
fact, the Medical Commission was entitled to give his testimony the weight it 
concluded it deserved in light of other evidence presented. Decker, ¶ 33, 124 P.3d  at 697.  
The Medical Commission's order was supported by substantial evidence. 

 
 
 
 

2.                              
Medical Commission Authority to Decide This Case      

 
 
[¶21]  In his second and third issues, Mr. McIntosh 
challenges the Medical Commission's authority to decide this case on two 
separate grounds.  
First, he claims the Medical Commission did not have the authority to 
determine whether benefits were payable after the Division awarded benefits and 
then denied benefits for the same injury.  Second, he claims the Medical Commission did 
not have authority to decide this case because it was not a "medically contested 
case."  We 
consider these claims separately.

 
 
 
 

a.      
The Medical Commission's Authority to Decide This Case 
After the Division Initially Awarded Benefits and Then Denied Benefits.

 
 
[¶22]  In support of his claim that the Medical 
Commission did not have authority to decide this contested case after the 
Division awarded and then denied benefits, Mr. McIntosh cites § 27-14-605(a) 
which provides in pertinent part:

 
 
            
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 . . . 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.  The division may, 
upon the same grounds and within the same period, apply for modification of 
medical . . . benefits to a hearing examiner or the medical commission, as 
appropriate. 

 
 
Mr. McIntosh contends this provision contains the exclusive 
mechanism for reconsidering whether benefits are payable once the Division has 
awarded benefits.  
Because the Division did not follow the procedures set forth in the 
provision, and instead unilaterally denied further benefits after its initial 
determination to award them, Mr. McIntosh claims the Medical Commission's order 
must be reversed.  
As part of this argument, Mr. McIntosh also contends the burden of proof 
was improperly placed on him at the hearing.  Characterizing the proceeding as a 
modification of benefits, he argues the Division had the burden of proof.

 
 
[¶ 23]  The Division responds that § 27-14-605(a) 
does not apply because it was not seeking a modification of benefits already 
awarded to Mr. McIntosh.  Instead, the Division asserts, it was 
reviewing a new applicationMr. McIntosh's April 2004 application for temporary 
total disability (TTD) benefitsto determine whether the medical condition for 
which he was seeking future benefits was related to an alleged work injury.  The Division 
asserts this is an ongoing process with any claimant and for purposes of 
determining claims it is always entitled to consider whether a causal 
relationship exists between the claimant's work and his injury.  The Division 
contends § 27-14-605(a) only applies where a re-determination is sought as to 
past claims.  
Responding to Mr. McIntosh's argument concerning the burden of proof, the 
Division asserts that for purposes of determining entitlement to future benefits 
the claimant always has the burden of satisfactorily associating that claim with 
the asserted work-related injury.        

 
 
[¶24]  The Division issued its final determination 
on November 3, 2003.  
Pursuant to Wyo. Stat. Ann. § 27-14-609(a) (LexisNexis 2005), the 
Division was required to review the determination at least once every six 
months.  In 
April 2004, Mr. McIntosh submitted to the Division a recertification of TTD 
signed by Dr. Beer.  
Dr. Beer also sent a letter advising the Division that Mr. McIntosh's 
injury was not preexisting but was a new injury.  The recertification and review apparently 
raised questions with the Division and, upon reviewing the medical documentation 
submitted to it, the Division concluded the injury was preexisting and Mr. 
McIntosh's outstanding claims were not compensable.  

 
 
[¶25] We agree with the Division that Mr. McIntosh's case 
was not "re-opened" within the meaning of § 27-14-605(a) but proceeded as 
specifically required by Wyo. Stat. Ann. § 27-14-606 (LexisNexis 2005) which 
provides that each determination or award is a separate administrative 
decision.  
Under that provision, the claimant has the burden of proving that his 
outstanding claims resulted from a work-related injury.  The fact that the 
Division previously awarded Mr. McIntosh benefits does not guarantee him future 
benefits.  As 
we have said:

 
 
            
The Division's uncontested award of benefits is not a final adjudication 
that precludes the Division from challenging future benefits.  The statutory 
language of the Wyoming Worker's Compensation Act confers finality on the 
benefits paid to the employee through uncontested determinations, subject to the 
exceptions found in Wyo. Stat. Ann. § 27-14-605.  The statutory language, however, does not 
guarantee a claimant future benefits on the basis of a prior award nor does 
public policy favor the payment of an unjustified worker's compensation 
claim.  
Therefore, an employee/claimant must prove that he was entitled to 
receive benefits for all outstanding claims despite previous awards for the same 
injury.

 
 

Hall v. State ex rel. Wyo. Workers' Comp. 
Div., 2001 WY 136, ¶ 14, 37 P.3d 373, 377 (Wyo. 
2001).   

 
 
[¶26]  The Division's uncontested award of benefits 
to Mr. McIntosh in November did not preclude the Division from challenging the 
payment of future benefits in April.  Here, the Division did not contest the 
compensability of Mr. McIntosh's original claim or seek to retract any payments 
already made to him.  
Rather, the Division challenged his right to payment of future 
benefits.  
Therefore, § 27-14-605 is not applicable and Mr. McIntosh was required to 
prove that he was entitled to receive benefits for his unpaid claims despite the 
previous award.  
The Medical Commission had authority to decide the contested case and 
properly allocated the burden of proof.

 
 
 
 

b.     The Medical Commission's Authority to Decide This Medically 
Contested Case

 
 
[¶27]  Mr. McIntosh asserts the Medical Commission 
did not have authority to decide this case because it was not a "medically 
contested case" within the meaning of Wyo. Stat. Ann. § 27-14-616(b)(iv) 
(LexisNexis 2005).  
Rather, he claims, the case was primarily a legal one because he asked 
for a determination on legal issues involving the burden of proof and the 
applicability of § 27-14-605.  He cites French v. Amax Coal 
West, 960 P.2d 1023 (Wyo. 1998) and Jacobs v. State ex rel. 
Wyo. Med. Comm'n, 2005 WY 104, 118 P.3d 441 (Wyo. 2005) 
as support for his claim.  The Division responds that this case was 
properly transferred to and decided by the Medical Commission because it was a 
medically contested case in which the primary issue to be decided was whether 
Mr. McIntosh's back problems were work-related. 

 
 
 
 
 
 
[¶28]   Section 27-14-616(b)(iv) provides in 
relevant part:

 
 
 
 
The division shall refer medically contested cases to the commission 
for hearing by a medical hearing panel.  The decision to refer a contested case to the 
office of administrative hearings or a medical hearing panel established under 
this section shall not be subject to further administrative review.  Following referral by 
the division, the hearing examiner or medical hearing panel shall have jurisdiction to hear and 
decide all issues related to the written notice of objection filed pursuant 
to W.S. 27-14-601(k).  
* * * When hearing a medically contested case, the panel shall serve as 
the hearing examiner and shall have exclusive jurisdiction to make the final 
administrative determination of the validity and amount of compensation payable 
under this act.  

 
 
[¶29]  Looking at the plain and ordinary meaning of 
the language as is our practice when interpreting statutes, SLB v. JEO (In re 
ANO), 2006 WY 74, ¶ 8, 136 P.3d 797, 800 (Wyo. 
2006), it is clear the Division is required to refer medically contested cases 
to the Medical Commission for hearing and the Division's decision in that regard 
is not subject to challenge at the administrative level.  It is also clear 
that once the Division has referred a case, the Medical Commission has 
jurisdiction to decide all issues related to those identified in the hearing 
request.  Thus, 
upon the Division's determination that a contested case is medically contested, 
it must refer it to the Medical Commission and, upon referral, the Medical 
Commission has jurisdiction to decide the issues presented.

 
 
[¶30]  In Mr. McIntosh's case, the Division did not 
refer the case to the Medical Commission.  Rather, the Division referred the case to the 
OAH which then transferred it to the Medical Commission.  Section 
27-14-616(e) provides in pertinent part:  

 
 
            
Upon agreement of all parties to a case, the hearing examiner in a 
contested case under this chapter may transfer a medically contested case to a 
medical hearing panel . . . .  

 
 
The record in Mr. McIntosh's case does not reflect whether 
the OAH obtained the parties' agreement before transferring the case to the 
Medical Commission.  
However, we are not willing to assume from a silent record that the OAH 
failed to seek or obtain the parties' agreement particularly where, as here, 
neither party objected to the transfer nor have they claimed on appeal that the 
OAH failed to obtain their agreement.  When a statute allows a case to be 
transferred upon the parties' agreement, the OAH transfers the case, and neither 
party objects, it is reasonable to conclude the parties agreed with the 
transfer.  

 
 
[¶31]  Thus, Mr. McIntosh's case was transferred to 
the Medical Commission as a "medically contested case." The following 
administrative rule governs this situation:

 
 

(i)                 
For purposes of referring contested cases to the Workers' 
Compensation Medical Commission for hearing, * * * the phrase "medically 
contested cases" shall include those cases in which the primary issue is:

 
 

(A)              
a claimant's percentage of physical impairment;

 
 

(B)              
whether a claimant is permanently totally disabled;

 
 

(C)             
whether a claimant who has been receiving TTD benefits 
remains eligible for those benefits under W.S. § 27-14-404(c); or,

 
 

(D)             
any other issue, the resolution of which is primarily 
dependent upon the evaluation of conflicting evidence as to medical diagnosis, 
medical prognosis, or the reasonableness and appropriateness of medical care. 

 
 
Rules, Regulations and Fee Schedules of the Wyoming Workers' Safety and 
Compensation Division, Chapter 6, § 1 (a)(i)(D) (2004).  Giving this 
language its plain and ordinary meaning, it is clear the medically contested 
cases the Division is required to refer to the Medical Commission "shall 
include" cases in which the primary issue is one of those enumerated in 
subsections (A) through (D).  

 

[¶32]  The ordinary meaning of the word "include" 
is:  to take in 
or comprise as part of a whole or group.  Webster's Third New International Dictionary 
1143 (2002).  
Thus, cases in which the primary issue is one of those enumerated in (A) 
through (D) are "part of the group of" medically contested cases the Division is 
required to refer to the Medical Commission.  Importantly, the rule does not state that the 
phrase "medically contested cases" shall "only include" or "exclusively include" 
cases involving issues (A) through (D).  Giving effect to the plain meaning of the 
rule and the legislature's intent in § 27-14-616, it is reasonable to conclude 
that cases where the primary issue is one of those identified in the rule are 
part of the group of medically contested cases the Division is required to 
refer.    

 
 
[¶33]  This Court has said, "A medically contested 
case', as defined by the Division, is one in which the primary issue requires 
the application of a medical judgment to complex medical facts or conflicting 
diagnoses."  French, 960 P.2d  at 
1030; Jacobs, ¶ 
10, 118 P.3d  at 445.   Consistent with the language and intent 
of the statute and the rule, this definition allows for referral to the Medical 
Commission when cases primarily involve medically contested issues, including 
but not limited to those identified in subsections (A) through (D) of the 
rule.  

 
 
[¶34]  After the OAH referred this case to the 
Medical Commission, Mr. McIntosh identified the primary issue for determination 
as follows:

 
 
            
It is the contention of the Claimant that he suffered a compensable 
work-related injury in the form of aggravating his existing condition.

 
 
The Division identified the "primary medical issue" as 
causation.  To 
resolve the issue, the claimant's medical condition before and after the alleged 
work injury had to be evaluated. 

 
 
[¶35]  The evidence presented to the Medical 
Commission at the hearing included medical records showing the claimant had a 
prior history of back problems and a recent work injury.  The evidence also 
included Dr. Beer's testimony that:  he was not aware of a prior history of back 
problems and believed this was a new injury caused by a work incident; records 
showing prior back problems would indicate Mr. McIntosh had suffered a material 
aggravation of a pre-existing injury; although tests suggested degeneration, the 
problems in his opinion became symptomatic when the disk herniated; and in his 
opinion, to a reasonable degree of medical probability, any prior back-related 
complaints became more severe as a result of the work injury, causing Mr. 
McIntosh to seek treatment.  The evidence also included Dr. Bender's 
report stating that in his opinion there was no causal connection between Mr. 
McIntosh's work and his back problems and the back problems were more likely a 
result of degenerative changes.  

 
 
[¶36]  Thus, conflicting medical testimony requiring 
the application of medical judgment to complex medical facts was presented at 
the hearing on the primary medical issue of whether Mr. McIntosh's back problems 
resulted from normal degeneration or became symptomatic as a result of a work 
injury.  While 
the decision reached by the Medical Commission may also have involved 
non-medical issues, the primary issue presented for determination at the hearing 
was whether a work-related injury caused the back problemsa "medically 
contested issue."  

 
 
[¶37]  This case is not like French or Jacobs, in which 
the Court reversed Medical Commission rulings on the ground that the cases were 
not medically contested and remanded them for referral to the OAH.  In French, the primary 
issue the Medical Commission decided was the applicability of a rule of law 
mentioned, but not adopted, in Long v. Big Horn Const. Co., 295 P.2d 750 (Wyo. 
1956).1  

 
 
By the time of the hearing, the legal issues of the case 
had clearly taken precedence over the medical issues.  All parties agreed 
that the legal issues, yet to be expressly decided in Wyoming case law, controlled the 
outcome of the case.

 
 

French, 960 P.2d  at 1028.  The Medical Commission concluded that 
determination of the only medical issuea definitive diagnosis showing whether 
the loss of consciousness that led to the work injury was caused by the 
claimant's preexisting conditionwas unnecessary to deciding the case.  Because the 
determinative issue was purely legal, we held the Medical Commission lacked 
subject matter jurisdiction and its order was void.

 
 
[¶38]  In Jacobs, the Medical Commission determined that collateral estoppel 
and res judicata 
prohibited the claim for benefits.  We held the Medical Commission did not have 
authority to consider those legal issues and remanded the case for referral to 
the OAH.  We 
said:  "When 
the Medical Commission determined in this instance that there were no medically 
contested issues before it * * * the Medical Commission was obligated to return 
the case to the Division for referral to the [OAH]."  Jacobs, ¶ 10, 118 P.3d  at 444-445.  Thus, French and Jacobs are distinguishable because, unlike the issues 
decided by the Medical Commission in those cases, the primary issue in Mr. 
McIntosh's case was whether his injury was causally related to his work, a 
determination requiring the application of medical judgment to complex medical 
facts.       

 
 
[¶39] As was true in Mr. McIntosh's case, the Medical 
Commission is frequently asked to determine whether an injury was causally 
related to a claimant's employment.  See, e.g., Sanchez v. State ex rel. Wyo. Workers' Safety and Comp. 
Div., 2006 WY 64, 134 P.3d 1255 (Wyo. 2006); 
Spletzer v. State ex 
rel. Wyo. Workers' Safety and Comp. Div., 2005 WY 90, 116 P.3d 1103 (Wyo. 2005); 
Padilla v. State ex 
rel. Wyo. Workers' Safety and Comp. Div., 2004 WY 10, 84 P.3d 960 (Wyo. 
2004).  The 
fact that the Medical Commission may, in the course of deciding that medical 
issue, also be asked to consider non-medical issues does not deprive it of 
authority to decide the case.  The legislature expressly provided for this 
eventuality by stating, "the medical hearing panel shall have jurisdiction to 
hear and decide all issues related to the written notice of objection."  § 
27-14-616(b)(iv).   Thus, the fact that Mr. McIntosh also 
raised legal issues during the hearing did not deprive the Medical Commission of 
its authority to decide the case.  So long as the primary issue for 
determination was the medically contested issue of whether Mr. McIntosh's back 
problems were caused by a work-related injury, the Medical Commission had 
authority to decide the case.  

 
 
 
 

3.                  
Failure to Consider Testimony

 
 
[¶40]  Mr. McIntosh's final claim is that the 
Medical Commission erred in failing to consider the testimony of the Division's 
claims analyst, Tanya Wheeler.  Mr. McIntosh claims that Ms. Wheeler's 
testimony was relevant to explain why the Division denied him benefits in April 
when it had awarded him benefits for the same injury several months 
earlier.  
Through her testimony, he sought to prove the Division had no basis for 
discontinuing his benefits.  

 
 
[¶41]  In its order, the Medical Commission 
summarized Ms. Wheeler's hearing testimony as follows:  

 
 
She was the third claims analyst to handle this file and 
took over the file in March of 2004.  Shortly after getting the file she reviewed 
the file with other Division employees and based on the medical evidence, a 
decision was made to issue a final determination to terminate benefits.  This termination 
was apparently based on a pre-existing condition or that Mr. McIntosh had 
returned to his base line condition.

 
 
The Medical Commission concluded Ms. Wheeler's testimony 
was "irrelevant to this proceeding [because] once the issue is referred, it is 
the responsibility of the Panel to decide medical issues, and why or how the 
issue came to the Medical Commission is not relevant."  

 
 
[¶42] Rulings on the admission of evidence are within the 
sound discretion of the agency as the trier of fact.  Aspen Ridge Law 
Offices, P.C. v. Wyo. Dep't of Employment, 2006 WY 129, ¶ 13, 143 P.3d 911, 917 (Wyo. 
2006).  We will 
only set aside an evidentiary determination if the agency abused its 
discretion.  
Id.  In Mr. McIntosh's 
case, the Medical Commission allowed Ms. Wheeler to testify; therefore, his 
claim does not involve the exclusion of testimony.  Rather, he claims 
the Medical Commission erred in concluding her testimony was irrelevant and 
declining to consider it.  

 
 
[¶43]  We find no error in the Medical Commission's 
decision not to consider Ms. Wheeler's testimony.  The Medical Commission correctly concluded 
that when a case is referred for a contested hearing, it becomes its 
responsibility to independently determine the issues presented.  In Mr. McIntosh's 
case, the primary issue presented was whether his injury was causally related to 
his work.  The 
Medical Commission allowed Ms. Wheeler to testify, determined her testimony was 
not relevant to its determination of the issue and then appropriately made its 
own independent determination concerning causation without considering the 
Division's reasons for its decision.

 
 
 
 
CONCLUSION

 
 
[¶44]  The Medical Commission's order was supported 
by substantial evidence and was not arbitrary and capricious.  The Medical 
Commission had authority to decide this medically contested case. Section 
27-14-605 did not apply to these proceedings.  The Medical Commission did not err in 
declining to consider the Division's reasons for discontinuing benefits and 
making its own independent decision concerning causation based upon Mr. 
McIntosh's testimony and the medical evidence presented at the hearing.  

 
 
[¶45]  The District Court's order affirming the 
Medical Commission's order is affirmed.

 
 
            

 
 
 
 
 
 
  

GOLDEN, J., dissenting, in which VOIGT, C.J., 
joins.

 
 
[¶46]   I respectfully dissent because I do not 
believe the Medical Commission had jurisdiction to decide this case.  The case contains 
no medically contested issues and, in any event, was not properly referred to 
the Medical Commission.  The Medical Commission therefore had no 
jurisdiction to decide this case, and this appeal should be dismissed.

 
 
[¶47]   From a medical perspective, I see no 
disputed complex medical facts.  Indeed, one need only review the majority 
opinion's discussion on the sufficiency of the evidence to appreciate that the 
only evidentiary issue in this case was Mr. McIntosh's credibility.  Simply because the 
Medical Commission judged Mr. McIntosh's credibility primarily by the history he 
gave to the various physicians he consulted about his back pain does not make 
this hearing medically contested.  The Medical Commission's ultimate denial of 
benefits did not depend on any medical information in the medical records, but 
rather on the factual history given by Mr. McIntosh contained in those 
records.

 
 
[¶48]   The majority opinion, in paragraph 36, 
gives great significance to Dr. Bender's paper review in determining that the 
hearing involved "conflicting medical testimony requiring application of medical 
judgment to complex medical facts."  I fail to discern any conflicting medical 
testimony.  It 
was uncontested that Mr. McIntosh's spine showed signs of degenerative 
changes.  The 
contradiction in the evidence presented by Dr. Beer and Dr. Bender was one of 
general fact.  

 
 
[¶49]   Dr. Bender, in his paper review, 
focused on inconsistencies in Mr. McIntosh's reporting of the mechanics and 
immediate severity of the back injury to various doctors visited in the 
aftermath of his alleged work injury.  These inconsistencies led Dr. Bender to 
question Mr. McIntosh's credibility.  For instance, at one point Dr. Bender opines 
that he has "deep concern about the change in [Mr. McIntosh's] report of the 
mechanism of injury between the time he saw Dr. Yost and the time that he filled 
out his Employee Report of Injury Form on 09/18/03."2  Relying on the 
inconsistencies, and in particular Mr. McIntosh's early reports that he did not 
remember an exact incident leading to the back pain, Dr. Bender expressed 
skepticism as to whether Mr. McIntosh's herniated disc could be related to any 
specific work activity.  Ultimately, all Dr. Bender concluded from his 
paper review was that "it is just as likely that [Mr. McIntosh] developed 
symptoms simply as a result of the natural progression of his [underlying 
degenerative condition] as it is his work activities which by his own 
description were not in and of themselves likely to cause any of the 
abnormalities noted on his MRI scan."  

 
 
[¶50]   This conclusion in no way contradicted 
the testimony of Dr. Beer.  Dr. Beer acknowledged the degenerative 
changes to Mr. McIntosh's spine and that his current symptoms could be caused by 
any number of factors.  Dr. Beer testified, however, that the reason 
he attributed the injury to the work-related incident was because he believed 
Mr. McIntosh's version of the events leading to the injury, including Mr. 
McIntosh's statement that he had no prior back injury and no history of back 
pain prior to the work incident.  This testimony was discounted by the Medical 
Commission not on any medical basis.  It was discounted based on a finding that Mr. 
McIntosh had given Dr. Beer an inaccurate history.  This finding, in 
turn, is based of course on the Medical Commission's disbelief of Mr. 
McIntosh.  
There simply were no medically contested issues, leaving the Medical 
Commission with no jurisdiction to decide the case.  

 

[¶51]   Procedurally, there is an even bigger 
problem.  Prior 
to the hearing, Mr. McIntosh questioned the burden of proof.  Which party bears 
the burden of proof is strictly a question of law.  Dan's Supermarket v. 
Pate, 2001 WY 104, ¶ 8, 33 P.3d 1121, 1124 (Wyo. 
2001).  As this 
Court has made clear, the Medical Commission does not possess the expertise to 
answer questions of law.  Jacobs v. State ex rel., Wyoming Medical Comm'n, 2005 WY 104, ¶ 12, 118 P.3d 441, 445 (Wyo. 
2005); French v. 
Amax Coal West, 960 P.2d 1023, 1030 (1998).  The error in the Medical Commission's attempt 
to answer this question of law was magnified in this case because the Medical 
Commission did not address the question except in its final order.  There is an obvious 
due process problem with having a claimant enter a hearing without knowing 
whether he bears the burden of proof.  Answering the legal question was a 
prerequisite to holding the hearing and could have been answered only by the 
OAH.  Because 
of the magnitude of this legal question, even had there been medically contested 
issues in this case, I suggest that this legal question was primary, placing 
jurisdiction with the OAH and not the Medical Commission.

 
 
[¶52]   Finally, I am concerned about the 
process by which the case was referred to the Medical Commission.  The Division 
statutorily is charged with referring the case either to the Medical Commission 
or the OAH in the first instance.  Should the Division refer a case to the 
Medical Commission, the Medical Commission must then evaluate the case on a 
continuing basis to ensure the issue(s) involved is primarily a medically 
contested issue(s).  
If at any time it appears that the primary issue(s) is not medically 
contested, the Medical Commission must return the case to the Division.  See generally Birkle v. State ex rel. 
Wyoming Workers' Safety and Comp. Div., 2007 WY 9, 150 P.3d 187 (Wyo. 2007); 
Jacobs; French.

 
 
[¶53]   The majority opinion, in paragraph 39, 
asserts that upon a referral from the Division to the Medical Commission, the 
Medical Commission has jurisdiction to decide all issues related to those 
identified in the hearing request.  Unless the statements to this effect are 
intended to directly overrule this Court's decisions in Birkle; Jacobs; French; and Russell v. State ex 
rel. Wyoming Workers' Safety and Comp. Div., 944 P.2d 1151 (Wyo. 1997), 
they are far too broad.  Although administrative review is not 
available to the parties to challenge the Division's referral, that does not 
remove the statutory restraints on the Medical Commission's subject matter 
jurisdiction.  
French, 
960 P.2d  at 1029 (referral by Division does not override statutory 
jurisdictional limitations.)  Because the majority does not express an 
intent to overrule established case law, and because the majority opinion 
concedes that the Medical Commission's subject matter jurisdiction is limited to 
medically contested cases in other portions of the opinion, I construe the 
majority opinion's statements to have simply omitted certain jurisdictional 
exceptions.

 
 
[¶54]   Should the Division initially refer the 
case to the OAH, the OAH has the option of seeking the advice of the Medical 
Commission or even transferring the case directly to the Medical 
Commission.  By 
statute, however, the OAH cannot refer out an issue or the entire case without 
consent of all parties.  Wyo. Stat. Ann. § 27-14-616(e) 
(LexisNexis 2005).

 
 
[¶55]   In this case, the Division initially 
referred the case to the OAH, which almost immediately, and with no further 
information, referred the case to the Medical Commission.  The referral 
contravened the statute in several respects.  First, obviously the OAH ignored the 
Division's determination as to the appropriate initial referral, effectively 
cutting the Division out of this step of the referral process.  Second, the OAH 
referred the case to the Medical Commission because it determined it had no 
jurisdiction over "medically contested" cases.  This is an odd determination since the 
pertinent statute and case law affirmatively state that the OAH has such 
jurisdiction.  
French, 
960 P.2d  at 1029.  
See 
generally Russell.

 
 
[¶56]   Finally, the record contains no 
indication that, prior to the referral, the parties were contacted or consented 
to the same.  I 
believe this renders the referral void.  Section 27-14-616(e) serves a serious 
purpose.  The 
parties, especially at the early stages of a proceeding, know their case better 
than the OAH.  
Their input on the issues to be decided, and which tribunal is best 
situated to decide them, can be critical.  

 
 
[¶57]   I disagree with the majority opinion 
that record silence equals consent.  The agreement of all parties is a statutory 
prerequisite to referral by the OAH.  As such, the parties' consent should be 
reflected in the record.  At the very least the referral order should 
state that the OAH has received the consent of the parties to the referral.  This is necessary 
for the Medical Commission to determine whether it can accept the referral 
because, without the consent of the parties, the OAH exceeds its statutory 
authority in referring the case.  I believe that is exactly what happened in 
this case  the OAH exceeded its statutory authority rendering its referral of 
the case to the Medical Commission void.

 
 
[¶58]   The doctors who comprise the Medical 
Commission are paid by the State for their medical expertise.  It is a waste of 
the doctors' time and medical expertise, as well as state money, for them to be 
called upon to determine questions of non-medical fact.  I believe the 
statute means exactly what it says - and what this Court has consistently 
construed it to mean  that a case should only go before the Medical Commission 
if it is a medically contested case.  Birkle; Jacobs; French.  In this case, the nature of Mr. McIntosh's 
injury was not determinative of whether or not the injury was work-related.  The medical 
expertise of the panel was not required and should never have been invoked.

 
 
[¶59]   The Medical Commission is a welcome 
addition to the Workers' Compensation hearing process, but it is simply that  
an addition.  
It is not a substitute for the OAH.  It has always been the function of the OAH to 
determine questions of fact and law and the OAH should not be allowed to 
abrogate its duty with such seeming total indifference to legislative 
intent.  

 
 
 
 
 
 

FOOTNOTES

1The rule of law mentioned 
in Long was that 
employment induced by false or fraudulent representations not going to the 
contents of the contract is voidable and not void, meaning benefits will be 
allowed unless a causal connection exists between the injury and the 
misrepresentation.  French, 960 P.2d  at 1026, fn. 2.  

2Dr. Yost was the one of 
the first doctors seen by Mr. McIntosh for the back pain at issue.  The visit referred 
to by Dr. Bender was on July 1, 2003, approximately two weeks after the reported 
work incident, but after Mr. McIntosh had already visited two other 
physicians.