Case Title: CAROL JOHNSON v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: S-10-0098

State: wyoming

Court: Wyoming Supreme Court

Date: 2010-12-17T00:00:00Z

Document:
CAROL JOHNSON v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2010 WY 166Case Number: No. S-10-0098Decided: 12/17/2010NOTICE: This 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 correction may be made before final publication in the permanent volume.
OCTOBER 
TERM, A.D. 2010

 
 

CAROL 
JOHNSON,Appellant (Petitioner),v.STATE OF WYOMING, ex rel., 
WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION,Appellee 
(Respondent).

 
 
Appeal 
from the District Court of Campbell County

 
 

Representing 
Appellant:

Kenneth 
DeCock of Plains Law Offices, LLP, Gillette, Wyoming.

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James Michael Causey, Senior Assistant Attorney General; and Kelly 
Roseberry, Assistant Attorney General.

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

 
 

HILL, 
Justice.

 
 
[¶1]      Carol Johnson 
challenges a Medical Commission decision denying her preauthorization for 
shoulder surgery, after the Wyoming Workers' Safety & Compensation Division 
(Division) granted her benefits for both shoulders.  We affirm.

 
 
ISSUE

 
 
[¶2]      Johnson has only 
one issue before this Court:

 
 
                        
Did the Medical Commission have jurisdiction to address the issue of the 
compensability of the original injury after the employer and the Division agreed 
the injury was compensable and the Division paid benefits toward the 
injury?

 
 
FACTS

 
 
[¶3]      For over ten 
years, Carol Johnson has been employed as a custodian by Campbell County School 
District Number One.  Her duties 
included vacuuming, mopping, and lifting.  
In 2006, Johnson began experiencing pain in her right shoulder.  She used her left arm to compensate for 
the pain, and as a result, began experiencing pain in her left shoulder as 
well.

 
 
[¶4]      In May of 2008, 
Johnson filed an injury report asserting that her bilateral shoulder pain was 
caused by her employment.  The 
Division issued a "Final Determination" opening a case and granting benefits for 
both shoulders.  In July of 2008, 
the Division authorized surgery for Johnson's right shoulder, and Johnson 
underwent surgery the following month.  
In October of 2008, Johnson requested preauthorization for surgery on her 
left shoulder, but the Division denied Johnson's request.  She objected, and the matter was 
referred to the Medical Commission.

 
 
[¶5]      In July of 2009, 
the Medical Commission conducted a contested case hearing, where Johnson argued 
that the proposed surgery was related to her work injury.  She contended that the Division should 
be estopped from asserting that she did not suffer a work injury.  The Medical Commission denied benefits, 
and the district court affirmed that decision.  This appeal 
followed.

 
 
STANDARD 
OF REVIEW

 

 
[¶6]      The applicable 
standard of review is that set out in Dale v. S & S Builders, LLC, 2008 WY 84, ¶¶ 22-25, 188 P.3d 554, 561 (Wyo. 
2008):

 
 
[T]he 
substantial evidence standard will be applied any time we review an evidentiary 
ruling.  When the burdened party 
prevailed before the agency, we will determine if substantial evidence exists to 
support the finding for that party by considering whether there is relevant 
evidence in the entire record which a reasonable mind might accept in support of 
the agency's conclusions.  If the 
hearing examiner determines that the burdened party failed to meet his burden of 
proof, we will decide whether there is substantial evidence to support the 
agency's decision to reject the evidence offered by the burdened party by 
considering whether that conclusion was contrary to the overwhelming weight of 
the evidence in the record as a whole.  
See, Wyo. Consumer Group v. Public 
Serv. Comm'n of Wyo., 882 P.2d 858, 860-61 (Wyo.1994); Spiegel, 549 P.2d  at 1178 (discussing 
the definition of substantial evidence as "contrary to the overwhelming weight 
of the evidence").  If, in the 
course of its decision making process, the agency disregards certain evidence 
and explains its reasons for doing so based upon determinations of credibility 
or other factors contained in the record, its decision will be sustainable under 
the substantial evidence test.  
Importantly, our review of any particular decision turns not on whether 
we agree with the outcome, but on whether the agency could reasonably conclude 
as it did, based on all the evidence before it.

 
 
            
The arbitrary and capricious standard remains a " safety net' to 
catch agency action which prejudices a party's substantial rights or which may 
be contrary to the other W.A.P.A. review standards yet is not easily categorized 
or fit to any one particular standard."  
Newman, ¶ 23, 49 P.3d  at 
172.  Although we explained the 
"safety net" application of the arbitrary and capricious standard in Newman, we will refine it slightly here 
to more carefully delineate that it is not meant to apply to true evidentiary 
questions.  Instead, the arbitrary 
and capricious standard will apply if the hearing examiner refused to admit 
testimony or documentary exhibits that were clearly admissible or failed to 
provide appropriate findings of fact or conclusions of law.  This listing is demonstrative and not 
intended as an inclusive catalog of all possible circumstances.  Id.

 
 
            
There will be times when the arbitrary and capricious standard appears to 
overlap with some of the other standards.  
For example, a decision against the great weight of the evidence might 
properly be called arbitrary or capricious in everyday language.  However, the words "arbitrary" and 
"capricious" must be understood in context as terms of art under the 
administrative review statute and should not be employed in areas where the more 
specifically defined standards provide sufficient relief.

 
 
            
In summary, while we believe Newman was analytically correct and 
supported by relevant authorities, application of the different standards of 
review to evidentiary matters proved confusing and led to arguably inconsistent 
decisions.  Thus, we take this 
opportunity to diverge somewhat from Newman in order to simplify the process 
of determining the proper standard of review for both litigants and courts.  In the future, we will apply the 
substantial evidence standard anytime we are reviewing an evidentiary 
issue.

 
 
We 
review an agency's conclusions of law de novo, and we will affirm such legal 
conclusions only if they are in accordance with law.  Dale, ¶ 26, 188 P.3d  at 
561-62.

 
 
DISCUSSION

 
 
[¶7]      Johnson's 
sole issue on appeal is that the Medical Commission lacked jurisdiction to 
determine the compensability of her injury, and that since the employer and the 
Division agreed that she suffered a compensable injury, the Medical Commission 
should not have "re-determined" compensability.    Johnson asserts that the 
Medical Commission should have only answered this question: whether the proposed 
shoulder surgery was reasonably related to the work injury.  In response, the Division argues that 
the issue before the Medical Commission was not whether the injury was 
compensable, but rather whether or not Johnson's proposed surgery should be paid 
for.  The Division argues that 
Johnson is required to prove each claim that arises, and that she was not 
guaranteed any future benefits on the basis of any prior 
award.

 
 
[¶8]      Wyo. Stat. Ann. § 
27-14-606 (LexisNexis 2009) states:

 
 
§ 27-14-606.  Determination 
and awards are administrative determination as to all parties; notice and 
hearing requirements.

 
 
            
Each determination or award within the meaning of this 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.

 
 
[¶9]      In analyzing this 
statute, we have said:

 
 
[T]he 
employee [bears] the usual burden of proving that he [is] entitled to receive 
benefits for his outstanding claims.  
To place the burden of proof on the employer to dispute an employee's 
right to receive benefits on any further claims after the employee's first claim 
has been approved would effectively nullify the provisions of 
§27-14-606.

 
 

In 
re Worker's Comp. Claim of David v. State ex rel. Wyo. Workers' Safety and Comp. 
Div., 2007 WY 22, ¶ 9, 151 P.3d 280, 286 (Wyo. 2007) 
(emphasis in original).  
Furthermore,

 
 
[s]ince 
each new claim or award involves a separate administrative determination under 
§27-14-606, the claimant is required to prove that he or she is entitled to 
receive benefits for all outstanding claims even if he or she has received 
previous awards for the same injury.

 
 

Id., ¶ 9, 151 P.3d  at 287 (citing Martinez v. State ex rel. Wyo. Workers' 
Comp. Div., 917 P.2d 619, 621-622 (Wyo. 
1996)).

 
 
[¶10]   Tenorio v. State ex rel. Wyo. Workers' Comp. Div., 931 P.2d 234, 239 (Wyo. 1997), echoed the foregoing sentiment.  There, the Division contested future 
payment of benefits, but did not contest the compensability of the claimant's 
original claim, nor did it seek to retract any payments previously made to the 
claimant.  The claimant argued that 
the Division was precluded by the operation of collateral estoppel from 
challenging the causation of her then current claim, an argument which this 
Court rejected.

 
 
[¶11]   As in David, Martinez, and Tenorio, supra, each of Johnson's claims are 
independent of each other, regardless of whether her case remains open with the 
Division.  In Johnson's case, the 
Medical Commission found as follows:

 
 

9.            
Johnson 
has not met her burden of proof under W.S. §27-14-603(a).  She has not established (i) a direct 
causal connection between the condition or circumstances under which the work is 
performed and the injury; (ii) that the injury can be seen to have followed as a 
natural incident of the work as a result of the employment; (iii) the injury can 
fairly be traced to the employment as a proximate cause; (iv) the injury does 
not come from a hazard to which she would have been equally exposed outside of 
the employment; and (v) the injury is incidental to the character of the 
business and not independent of the relation of employer and employee.  The proof offered by Johnson falls far 
short of the required standard.

 
 
There 
are material non-employment causative factors which contribute to her left 
shoulder problems and claimed need for surgery including the wear and tear that 
can occur living and working for 69 years, natural degeneration, ongoing 
shoulder problems that go back to 1989 which pre-date her employment with the 
Employer, and a long history of smoking.  
Even Dr. Murphy acknowledges these as contributing factors.  Likewise, Dr. Ruttle believes her 
shoulder problem is related to age, smoking, and is unrelated to her work.  Drs. Whipp and Rangitsch denied the 
preauthorization in part, as no connection was shown between Johnson's 
employment and the proposed surgery.

 
 
10.       The Panel 
finds that Johnson has not met her burden of proof that the proposed shoulder 
surgery is related to her employment.  
Therefore, the benefits in issue must be denied.

 
 
[¶12]   Receiving a prior award of benefits 
for her right shoulder did not guarantee Johnson future benefits for her left 
shoulder.  Whenever there is an 
application for new benefits, the Division may require the claimant to 
illustrate that the injury was work-related.  Contrary to Johnson's argument that the 
Medical Commission lacked jurisdiction over the question of whether Johnson 
sustained a work-related injury, we conclude that the actual determination made 
by the Medical Commission was whether or not her shoulder surgery should be 
covered.  Because Johnson did not 
show her left shoulder surgery was related to her employment, her claim was 
properly denied.  As we stated in Tenorio, "[T]he legislature did not 
intend the Division's uncontested award of benefits to rise to the level of a 
final adjudication' necessary to apply the doctrine of issue preclusion to 
outstanding claims for worker's compensation benefits."  Id., 931 P.2d  at 
239.

 
 
CONCLUSION

 
 
[¶13]   We conclude that the Medical 
Commission had jurisdiction to address the issue of the compensability of Ms. 
Johnson's original injury.  
Affirmed.