Case Title: Padilla v. Lovern's, Inc.

Citation: 

Docket Number: 94-15

State: wyoming

Court: Wyoming Supreme Court

Date: 1994-10-19T00:00:00Z

Document:
Padilla v. Lovern's, Inc.1994 WY 111883 P.2d 351Case Number: 94-15Decided: 10/19/1994Supreme Court of Wyoming
In the Matter of the 
Worker's Compensation Claim of Daniel R. PADILLA,

Appellant 
(Employee-Claimant),

v.

LOVERN'S, 
INC.,

Appellee 
(Employer-Defendant).

 

Appeal from District 
Court, Laramie County, Nicholas G. Kalokathis, J.

 

Representing 
Appellant:

John M. Walker of Hickey 
and Evans, Cheyenne.

Representing 
Appellee:

Lee E. Christian of Lee 
E. Christian, P.C., Fort Collins, CO.

 

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

MACY, Justice.

[¶1]      Appellant Daniel 
R. Padilla appeals from the district court's order which affirmed the hearing 
examiner's denial of benefits for Padilla's back injury.

[¶2]      We 
affirm.

ISSUES

[¶3]      Padilla presents 
two issues:

A. The worker's 
compensation benefits awarded to Mr. Padilla were subject to the doctrine of 
finality and as such should not have been revoked by the office of 
administrative hearings.

B. The worker's 
compensation benefits awarded to Mr. Padilla should not have been revoked by the 
office of administrative hearings as there was no medical testimony supporting 
employer's position.

 

FACTS

[¶4]      Padilla worked as 
a house painter for Appellee Lovern's, Inc. While he was at work on April 29, 
1992, painting the trim on a house, Padilla fell from a ladder and injured his 
left foot. None of his co-workers witnessed the accident. Padilla's employer 
took him to the emergency room at a local hospital where his foot was X-rayed 
and he was diagnosed as having a "[c]ontusion of the foot." The emergency room 
report stated that Padilla's "[b]ack [was] nontender."

[¶5]      Padilla went to 
see Richard Torkelson, M.D., an orthopaedic surgeon, on May 5, 1992, complaining 
of foot pain. Dr. Torkelson examined Padilla and directed him not to return to 
work. On May 18, 1992, Dr. Torkelson released Padilla for work, and Padilla 
reported to work the next day. When Padilla arrived at work, his employer 
confronted him and told him that, during his absence from work, one of his 
co-workers had seen him loading cement blocks and bags of cement into his 
father's truck. After the confrontation, Padilla quit his job.

[¶6]      On May 21, 1992, 
Padilla filed an employee's report of the injury which indicated that he had 
injured his left leg while he was working for Lovern's. On that same day, he 
returned to see Dr. Torkelson and reported that he had tenderness in his sciatic 
notch area. Dr. Torkelson referred Padilla to Stephen Martin, M.D., a physician 
and surgeon who limited his practice to neurological surgery. Dr. Martin 
diagnosed Padilla as probably having a "herniated lumbar disk" in his lower 
back. On July 15, 1992, Dr. Martin performed surgery on Padilla's back and 
removed the disk.

[¶7]      Padilla did not 
file an amendment to his employee's report of the injury to indicate that he had 
received a back injury. See WYO. STAT. § 27-14-504 (1991). The Workers' 
Compensation Division began making medical payments on May 28, 1992, to 
Padilla's doctors. On June 2, 1992, Padilla completed an application for 
temporary total disability benefits which referred only to his "injury" and did 
not specifically refer to a back injury. On the same day, the Workers' 
Compensation Division sent a consent and waiver notice form to Lovern's which 
referred only to "the April 29 . . . injury . . . of your employee." Lovern's 
sent a letter dated June 15, 1992, to the Workers' Compensation Division which 
indicated that Lovern's disapproved of disability payments being paid to 
Padilla. In the letter, Lovern's referred only to Padilla's foot 
injury.

[¶8]      The Workers' 
Compensation Division issued an initial review dated June 30, 1992, which did 
not mention Padilla's back injury, and a determination of the disputed claim 
dated July 30, 1992, which concluded that Padilla was entitled to receive 
benefits. The determination of the disputed claim referred only to Padilla's 
"injury."

[¶9]      Lovern's did not 
learn until August or September of 1992 that Padilla had received a back injury. 
On September 14, 1992, the Workers' Compensation Division sent a notice of 
claims reimbursement to Lovern's. The notice informed Lovern's that it would be 
billed for all payments which had been made to Padilla because Lovern's did not 
have an active worker's compensation account on the date that Padilla was 
injured. In a letter to the Workers' Compensation Division dated September 23, 
1992, Lovern's requested a hearing on the compensability of Padilla's injuries 
because, in part, "based upon the review of the file available at this time, the 
employer . . . challenges any subsequent medical treatment in so far as the 
medical problems appear to be unrelated to the minor injury initially 
claimed."

[¶10]   Lovern's petitioned for a hearing 
on the determination of the disputed claim or, in the alternative, to reopen the 
case for fraud pursuant to WYO. STAT. § 27-14-605(a) (1991).1 The Office of Administrative 
Hearings held a hearing in March 1993 and, after the hearing, issued an order 
which denied benefits for Padilla's back injury. In the decision letter attached 
to the order, the hearing examiner stated:

Critical to this Office's 
decision herein is the distinction which needs to be drawn between [Padilla's] 
left leg injury and the alleged back injury. As will be more fully addressed 
later, this Office concludes that finality attached to claims and awards made on 
account of the left leg injury, but not to claims and awards made on account of 
the alleged back injury. Thus, [Padilla] maintains the burden of proving that 
his alleged back injury arose out of his April 29, 1992, work-related accident. 
. . . This Office concludes that Padilla has failed to meet this 
burden.

. . . .

. . . [F]inality has 
never attached to any of the claims and awards made in connection with Padilla's 
alleged low back injury as sufficient and proper notice was not provided 
Lovern's. It was not until sometime in August, 1992, that Lovern's first 
received any notice of an alleged back injury - notice provided long after 
Padilla first sought back treatment and filed an accident report on May 21, 
1992, and weeks after Padilla underwent back surgery on July 15, 1992. . . 
.

Under the totality of the 
evidence presented, this Office is not persuaded that Padilla's back condition 
arose out of his April 29, 1992, accident with Lovern's. In addition to the 
numerous inconsistencies in his actions following April 29, 1992, Padilla lacks 
any credibility in testifying before this Office. This Office observed Padilla 
continually recant various assertions made under oath only when upon 
cross-examination he was confronted with certain evidence. In essence, Padilla 
appears to be an individual either not capable of or unwilling to testify 
truthfully.

. . . .

The medical testimony 
herein is based upon a questionable history and as such is not persuasive. 
Accordingly, when viewed together with the remaining evidence, this Office 
concludes that Padilla has failed to meet his burden of proving that his alleged 
back injury arose out of his April 29, 1992, accident with Lovern's. For these 
reasons, Padilla's claims relating to the alleged back injury must 
fail.

(Citations 
omitted.)

[¶11]   Padilla filed a petition for 
judicial review in the district court, and the district court affirmed the 
hearing examiner's decision. Padilla appealed to this Court.

FINALITY

[¶12]   Padilla contends that Lovern's 
should not have been allowed to have a hearing on the case because Lovern's 
failed to object in a timely manner to the Workers' Compensation Division's 
determination of the disputed claim. Lovern's argues that it was not given 
notice or an opportunity to be heard and, therefore, the Workers' Compensation 
Division's determination was not final and that, since finality had not attached 
to the Workers' Compensation Division's award for Padilla's back injury, the 
hearing examiner did not err by conducting a hearing. Lovern's asserts in the 
alternative that, if finality did attach, the hearing examiner should have 
reopened the case on the basis that Padilla's back injury claim was 
fraudulent.

WYO. STAT. § 
27-14-606 (1991) states:

Each determination or 
award within the meaning of [the Wyoming Worker's Compensation Act] is an 
administrative determination of the rights of the employer, the employee and the 
disposition of money within the worker's compensation account as to all matters 
involved. No determination shall be final without notice and opportunity 
for hearing as required by this act.

(Emphasis 
added.)

[¶13]   In construing a statute, we must 
determine whether the statute is clear or ambiguous. "[A] statute is unambiguous 
if its wording is such that reasonable persons are able to agree as to its 
meaning with consistency and predictability." Allied-Signal, Inc. v. Wyoming 
State Board of Equalization, 813 P.2d 214, 220 (Wyo. 1991). "[A] statute is 
ambiguous only if it is found to be vague or uncertain and subject to varying 
interpretations." 813 P.2d  at 219-20. "[W]hether an ambiguity exists in a 
statute is a matter of law to be determined by the court." 813 P.2d  at 220. If 
the language of a statute is clear and unambiguous, we apply the plain and 
ordinary meaning of the words and do not resort to the rules of statutory 
construction. Parker Land and Cattle Company v. Wyoming Game and Fish 
Commission, 845 P.2d 1040, 1043 (Wyo. 1993).

[¶14]   We hold that the language of § 
27-14-606 is plain and unambiguous, and we conclude that, pursuant to § 
27-14-606, no determination can be final unless the employer receives notice and 
an opportunity for a hearing.

[¶15]   Lovern's did not receive any notice 
that Padilla had suffered a back injury until after Padilla had undergone back 
surgery and after the Workers' Compensation Division had issued its 
determination of the disputed claim. The portion of the determination which was 
made in connection with Padilla's back injury was, therefore, not final. The 
hearing examiner properly held a hearing on Padilla's back injury claim. 
See § 27-14-606.

[¶16]   Our holding that Lovern's was 
entitled to receive notice and a hearing to dispute Padilla's back injury claim 
is dispositive; therefore, we do not need to address Lovern's alternative 
argument that it was entitled to have the hearing examiner reopen the case on 
the basis that Padilla's back injury claim was fraudulent.

BURDEN OF 
PROOF

[¶17]   Padilla asserts that his benefits 
award should not have been revoked because Lovern's did not present any direct 
testimony whatsoever which indicated that Padilla's back injury was not related 
to his fall from the ladder while he was at work.

[¶18]   "The claimant has the burden of 
proving each essential element of [his] claim by a preponderance of the 
evidence." Gilstrap v. State ex rel. Wyoming Workers' Compensation 
Division, 875 P.2d 1272, 1273 (Wyo. 1994) (citing Leonard v. McDonalds of 
Jackson Hole, 746 P.2d 1261, 1263 (Wyo. 1987)). "The party who appeals from 
an administrative determination has the burden of proving the lack of 
substantial evidence to sustain the ruling of the agency." Jaqua v. State ex 
rel. Wyoming Workers' Compensation Division, 873 P.2d 1219, 1221 (Wyo. 
1994). Whether an employee's injury occurred in the course of his employment is 
a question of fact. Bagshaw v. Circle H Oilfield Service, 753 P.2d 1044, 1045 (Wyo. 1988). We review factual issues by applying the substantial evidence 
standard. WYO. STAT. § 16-3-114(c)(ii)(E) (1990).

"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), quoted in Hepp v. State ex rel. Wyoming Workers' Compensation 
Division, 881 P.2d 1076, 1077-78 (Wyo. 1994).

[¶19]   Dr. Martin testified that Padilla's 
back injury was the result of his fall from the ladder while he was at work. Dr. 
Martin also stated that the patient history which he received from Padilla was 
the sole basis for his conclusion. Dr. Martin further stated that having an 
accurate patient history was critical in making a diagnosis and in prescribing a 
treatment.

[¶20]   Padilla gave, at best, incomplete 
information to both Dr. Torkelson and Dr. Martin about his prior back injuries. 
Padilla did not tell Dr. Torkelson that he had experienced any prior back 
injuries. He reported to Dr. Martin that he had experienced one prior back 
injury in 1982 and that his back had completely healed after that injury. 
Padilla had, however, suffered back injuries in 1979, 1981, and 1985, each of 
which occurred while Padilla was working for a different employer. After the 
1985 injury, Padilla was in traction in the hospital for thirteen days, he was 
disabled from work for approximately two years, and he received a settlement of 
$27,500 from his employer.

[¶21]   One of Padilla's co-workers 
testified that he had seen Padilla loading cement blocks and a bag of cement 
into his father's truck after he had allegedly injured his back. Dr. Martin 
stated that, if Padilla had lifted cement blocks and bags of cement after he had 
supposedly injured his back, he would suspect "maximization of his 
symptomatology, malingering, faking." Dr. Torkelson stated that Padilla's back 
injury could have been caused either by a fall or by lifting.

[¶22]   Padilla's testimony conflicted with 
the other evidence. He testified that he was being honest when he reported his 
medical history to his doctors. He denied that he had worked for his father 
after the accident, and he claimed that his back injury was caused by the fall 
from the ladder while he was working for Lovern's.

[¶23]   The hearing examiner stated that 
Padilla's medical evidence was "based upon a questionable history and as such 
[was] not persuasive" and that Padilla "lack[ed] any credibility in testifying 
before this Office." He concluded that Padilla had failed to meet his burden of 
proving that his back injury arose out of the April 29, 1992, 
accident.

[¶24]   We have held that the finder of 
fact is not bound by the medical evidence and that he is entitled to consider 
relevant factors other than the medical evidence. Forni v. Pathfinder 
Mines, 834 P.2d 688, 693 (Wyo. 1992); Cannon v. FMC Corporation, 718 P.2d 879, 882 (Wyo. 1986). The fact finder is in the best position to judge both 
the claimant's credibility and the weight to be given to the medical evidence. 
Romero v. Davy McKee Corporation, 854 P.2d 59, 63 (Wyo. 
1993).

[¶25]   The hearing examiner's conclusion 
that Padilla failed to meet his burden of proof was supported by substantial 
evidence.

CONCLUSION

[¶26]   The district court did not err when 
it affirmed the hearing examiner's decision to deny Padilla's request for 
worker's compensation benefits for his back injury.

[¶27]   Affirmed.

Footnotes

1 Amended by 1994 WYO. 
SESS. LAWS ch. 86, § 2 effective July 1, 1994.