Title: In re Worker's Compensation Claim of Payne

State: wyoming

Issuer: Wyoming Supreme Court

Document:

In re Worker's Compensation Claim of Payne1999 WY 183993 P.2d 313Case Number: 98-196Decided: 12/29/1999Supreme Court of Wyoming
 
IN 
THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF VIRGIL L. PAYNE, AN EMPLOYEE OF 
FRONTIER REFINING, INC.:

VIRGIL L. PAYNE, 
Appellant (Petitioner),

v.

FRONTIER REFINING, INC., 
Appellee (Respondent).

 

Appeal from the District 
Court of Laramie County: The Honorable Edward L. Grant, 
Judge.

Daniel E. White 
of Daniel E. White, P.C., Cheyenne, WY. Argument by Mr. White, representing 
appellant.

Alexander K. 
Davison and Peter C. Nicolaysen of Patton & Davison, Cheyenne, WY. Argument 
by Mr. Nicolaysen, representing appellee.

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

LEHMAN, Chief 
Justice.

[¶1]      After undergoing 
carpel tunnel syndrome release surgery, appellant Virgil Payne (Payne) sought 
worker's compensation benefits. A hearing examiner from the Office of 
Administrative Hearings denied benefits, finding that Payne's injury report was 
untimely and that Payne failed to rebut the presumption that his claim be denied 
pursuant to Wyo. Stat. Ann. § 27-14-502(c) (Michie June 1991 Rpl.). 
Specifically, the hearing examiner found that Payne had failed to establish a 
lack of prejudice to his employer in monitoring medical treatment. Because we 
conclude that the hearing examiner's finding is not supported by the record, we 
reverse.

ISSUES

[¶2]      The injured 
worker, Virgil Payne, presents two issues for review:

1. Does W.S. § 
27-14-502(c) require a worker's compensation claimant to rebut a factual defense 
relating to the employer's ability to monitor medical treatment which was: (1) 
not raised by the pleadings; (2) not litigated in the contested case proceedings 
conducted below; and (3) raised for the first time sua sponte by the Office of 
Administrative Hearings in its order denying benefits.

2. Does W.S. § 
27-14-502(c) require the Appellant to rebut Appellee's defense that it was 
prejudiced in its ability to monitor medical treatment due to the Appellant's 
failure to comply with an accident investigation and reporting policy where: (1) 
the Appellee's human resources manager testified that the policy did not apply 
to the type of injury which had been sustained by the Appellant; and (2) all of 
the medial treatment of the Appellant's carpal tunnel syndrome occurred after 
Appellee had been formally notified of the injury.

Payne's 
employer, the appellee Frontier Refining, Inc., restates the 
issues:

1. Whether 
substantial evidence exists to support a finding that the claimant did not 
timely report the injury.

2. Whether 
substantial evidence exists to support the denial of benefits based upon the 
claimant's failure to show by clear and convincing evidence that the employer's 
ability to monitor the claimant's medical treatment was not 
prejudiced.

FACTS

[¶3]      Virgil Payne 
began working for Frontier Refinery, Inc., (Frontier) in 1969. Since 1985, he 
has worked as a pump mechanic. Sometime in between approximately 1992 and 1994, 
Payne began experiencing pain and numbness in his hands and wrists, and loss of 
sensation in his fingers.

[¶4]      On May 3, 1995, 
during a routine medical exam of old head and back injuries, Payne complained of 
pain and numbness in his hands and of some stiffness in his right elbow. Payne's 
physician determined Payne "probably has carpal tunnel," and advised Payne of 
that. However, the physician's report indicates they "elected . . . to put off 
any kind of a workup for now."

[¶5]      On November 24, 
1995, Payne again met with his physician. After performing nerve conduction 
testing, the physician confirmed the diagnosis of carpal tunnel syndrome (CTS). 
The physician's report indicates that Payne's CTS is "most likely related to 
work." Payne testified the CTS diagnosis was communicated to him on that date, 
but the physician did not tell Payne that the condition might be work related. 
On November 29, 1995, Payne's physician referred Payne to a surgeon, 
recommending Payne be given "strong consideration for surgical 
intervention."

[¶6]      On December 19, 
1995, Payne told Frontier's Human Resources Manager that he planned to undergo 
surgery for his CTS. Payne also mentioned that he might file a worker's 
compensation claim, to which the manager responded that Frontier would contest 
the claim. Pursuant to Frontier's elective surgery policy, Payne provided 
written notice to Frontier the next day, December 20, 1995, that surgery on his 
right wrist was planned. Payne completed a worker's compensation injury report 
on February 8, 1996, which was filed with the Clerk of the District Court on 
February 20, 1996.

[¶7]      On April 9, 1996, 
Payne underwent CTS release surgery on his right wrist. Payne submitted worker's 
compensation claims for the cost of surgery, medical treatment, and for 
temporary total disability. In its Final Determination, the Wyoming Worker's 
Compensation Division (Division) approved Payne's claim for benefits. Frontier 
objected, however, arguing that Payne's CTS was not work 
related.

[¶8]      The matter was 
referred to the Office of Administrative Hearings. Prior to the hearing, 
Frontier filed a case disclosure statement in which it raised the issue that 
Payne should be denied benefits because he failed to report the injury in a 
timely fashion. At the hearing, the evidence focused on two issues: (1) whether 
Payne's injury was work related, and (2) the timeliness of Payne's report of the 
injury.

[¶9]      The hearing 
examiner denied benefits, finding Payne's report of the injury was untimely and 
Payne failed to rebut the presumption that his claim be denied pursuant to Wyo. 
Stat. Ann. § 27-14-502(c). Specifically, the hearing examiner found "[t]here 
does not exist in this case clear and convincing evidence that there was a lack 
of prejudice to Frontier in monitoring Claimant's medical treatment." Because 
the hearing examiner decided the case on the injury report issue, it did not 
reach the issue of whether Payne had established his CTS was work related or 
whether Payne had established the requirements for an injury occurring over a 
substantial period of time. Wyo. Stat. Ann. § 
27-14-603(a).

[¶10]   Payne petitioned for review with 
the district court, which affirmed the hearing examiner's denial of benefits. 
This timely appeal follows.

STANDARD OF 
REVIEW

[¶11]   The dispositive issue in this case 
is whether Payne rebutted the presumption that his claim be denied as a result 
of a tardy injury report. Wyo. Stat. Ann. § 27-14-502(c). The presumption of 
claim denial may be rebutted if the claimant establishes by clear and convincing 
evidence a lack of prejudice to the employer or the Division in investigating 
the accident and in monitoring medical treatment. Neither the employer nor the 
Division are required to show prejudice. Matter of Zielinske, 959 P.2d 706, 710 
(Wyo. 1998). Instead, the claimant has the burden to establish a lack of 
prejudice as a result of the untimely injury report. Id. This determination is a 
question of fact. Id. at 709 (citing Curnow v. State ex rel. Workers' 
Compensation Div., 899 P.2d 875, 878 (Wyo. 1995)).

[¶12]   When, as in this case, a hearing 
examiner decides that a party charged with the burden of proof has failed to 
meet that burden, the case is reviewed under the "[a]rbitrary, capricious, an 
abuse of discretion or otherwise not in accordance with law" standard of Wyo. 
Stat. Ann. § 16-3-114(c) (ii) (A) (Lexis 1999). Bando v. Clure Bros. Furniture, 
980 P.2d 323, 331 (Wyo. 1999); Nissen v. Cheyenne Frontier Days, 983 P.2d 722, 
724 (Wyo. 1999); Pederson v. State ex rel. Workers' Compensation Div., 939 P.2d 740, 742 (Wyo. 1997); Bohren v. State ex rel. Worker's Compensation Div., 883 P.2d 355, 357-58 (Wyo. 1994). The hearing examiner, as the trier of fact, is 
charged with weighing the evidence and determining the credibility of witnesses. 
Bando v. Clure Bros. Furniture, 980 P.2d  at 331 (citing Pederson, 939 P.2d at 
742). A hearing examiner's findings of fact are accorded deference, and the 
hearing examiner's decision will not be overturned unless it is clearly contrary 
to the overwhelming weight of the evidence. Id. Demonstrating evidentiary 
contradictions in the record does not establish the ruling was irrational, but 
we do examine conflicting evidence to determine if the agency reasonably could 
have made its finding and order based upon all of the evidence before it. 
Id.

DISCUSSION

[¶13]   An employee's claim for worker's 
compensation benefits is governed by the law in effect when the injury occurred. 
Clark v. State ex rel. Workers' Safety and Compensation Div., 968 P.2d 436, 438 
(Wyo. 1998); State ex rel. Workers' Compensation Division v. Jacobs, 924 P.2d 982, 984 (Wyo. 1996). Wyo. Stat. Ann. § 27-14-502, which was amended in 1996, 
controls the employee's duty to file an injury report. Because Payne was injured 
prior to the effective date of the 1996 amendment, the earlier version of the 
statute, Wyo. Stat. Ann. § 27-14-502 (Michie June 1991 Rpl.), applies to his 
claim. That statute provides in relevant part:

(a) As soon as 
is practical but not later than seventy-two (72) hours after the general nature 
of the injury became apparent, an injured employee shall report the occurrence 
and general nature of the accident to the employer and within ten (10) days 
after the injury became apparent, file the report in the office of the clerk of 
court of the county in which the accident occurred. . . .

. . 
.

(c) Failure of 
the injured employee . . . to report the accident to the employer and to file 
the report with the clerk of court in accordance with subsection (a) of this 
section is a presumption that the claim shall be denied. The presumption may be 
rebutted if the employee establishes by clear and convincing evidence a lack of 
prejudice to the employer or division in investigating the accident and in 
monitoring medical treatment.

[¶14]   It is clear the reporting 
requirements of Wyo. Stat. Ann. § 27-14-502 apply to Payne's claim. In 
accordance with Wyo. Stat. Ann. § 27-14-603(a) (Lexis 1999), Payne sought to 
establish an injury that occurred over a substantial period of time. Although 
the injury report statute (Wyo. Stat. Ann. § 27-14-502) does not include a 
provision for injuries which occur over a period of time as does the statute of 
limitations (Wyo. Stat. Ann. § 27-14-503(b)), we have held that "even in the 
case of an injury which occurs over a period of time, the reporting requirements 
of Wyo. Stat. § 27-14-502 are as important as the filing requirements of Wyo. 
Stat. § 27-14-503, perhaps more so." Neal v. Caballo Rojo, Inc., 899 P.2d 56, 61 
(Wyo. 1995). 

[¶15]   Before discussing prejudice in 
monitoring Payne's injury, there are two other matters necessary to assist in 
our discussion of prejudice to the employer. First, we recite the hearing 
examiner's findings on the timeliness of Payne's injury 
report:

13. Claimant did 
not inform Frontier of his claim that his CTS was work-related until February 8 
or 9, 1996 and did not file his injury report until February 20, 
1996.

14. Whether 
Claimant became aware, or should have become aware, that his CTS was 
work-related on May 3, 1995, or November 24, 1995, or sometime in between, and 
whether he notified his employer of his claim that his CTS was work-related on 
December 19, 1995, or February 8, 1996, he failed to meet the two reporting 
requirements found in Wyo. Stat. § 27-14-502(a) (1986).

Second, because 
the hearing examiner found that Frontier had not been prejudiced in 
investigating Payne's CTS, we are only dealing with prejudice in monitoring 
Payne's medical treatment.

[¶16]   We turn then to the hearing 
examiner's finding that Payne failed to establish by clear and convincing 
evidence that there was a lack of prejudice to Frontier in monitoring his 
medical treatment. The hearing examiner found:

18. Employer had 
in place a policy of requiring the reporting of any accident, injury, or "near 
miss" within 24 hours. The purpose of this policy was to facilitate the 
investigation and discovery of the causes of on-the-job injuries and to prevent 
their recurrence.

19. In addition, 
the contract under which Claimant worked contained a provision establishing a 
joint Labor-Management Health and Safety Committee. The purpose of this 
committee was, among other things, to consider, investigate, and review health 
and safety conditions and practices. The committee also had the authority to 
hire independent industrial health consultants to survey health hazards in the 
workplace. The Employer agreed to pay for any physical and medical tests found 
necessary in light of the findings of the industrial health 
consultants.

20. By failing 
to timely report his CTS, the Claimant frustrated Frontier's ability to monitor 
his medical treatment through the use of industrial health consultants or other 
medical personnel. The Employer was deprived of the ability to employ 
"conservative treatment" options short of surgery, such as rest periods, hand 
exercises on the job, job modification, proper ergonomics during job 
performances, or even wrist splints. All of these treatments are recommended as 
treatment alternatives by at least some health care professionals and could have 
been implemented by Frontier in this case.

[¶17]   Frontier argues that the case of 
Curnow v. State ex rel. Workers' Compensation Div., 899 P.2d 875 (Wyo. 1995), is 
controlling. As in the present case, Curnow suffered from CTS and failed to file 
a timely injury report. In addition, the hearing examiner in Curnow found that 
the claimant had failed to establish a lack of prejudice in monitoring medical 
treatment. On that issue, we wrote:

The hearing 
examiner found Curnow had not established by clear and convincing evidence a 
lack of prejudice to the employer or the Division in monitoring medical 
treatment. The Division, through the assistant human resources manager at WOTCO, 
established WOTCO had a policy of requiring the report of any accident or injury 
during the shift in which it occurred. It was WOTCO's policy to follow up by 
investigating accidents or causes of difficulty. A part of the job of the 
assistant human resources manager was to determine what the problem was and work 
with an employee and a doctor to find out what could be done to lessen the 
problem. WOTCO also had a policy of monitoring health care treatment. In this 
instance, WOTCO, because of the tardy reporting, was not aware medication was 
being prescribed. It did not know braces had been prescribed for Curnow, and it 
had no opportunity to monitor the decision of Curnow not to use braces. The 
assistant human resources manager testified there were several different styles 
of braces which potentially would have been useful to Curnow. 

[¶18]   It is clear WOTCO had an 
affirmative policy of monitoring the health care of its employees in situations 
such as this and assisting in whatever ways were possible to permit an 
adjustment to the working conditions. That monitoring, obviously, was more 
proactive than simply knowing what the health care provider was doing. It also 
extended to affirmative assistance in working with the problem. This information 
in the record provided substantial evidence before the hearing examiner of 
prejudice to the employer and to the Division, through the employer, in 
monitoring Curnow's medical treatment. Curnow offered nothing in the record to 
counteract this evidence, and we agree with the district court that substantial 
evidence supports the determination by the hearing examiner that Curnow did not 
establish "by clear and convincing evidence a lack of prejudice to the employer 
or division . . . in monitoring medical treatment."

Curnow, 899 P.2d  
at 878.

[¶19]   Although Curnow is similar to the 
present case in several respects, we do not agree that it is controlling. Like 
the employer in Curnow, Frontier had a policy of monitoring employee health care 
in this type of situation, and Frontier's policy was likewise "more proactive 
than simply knowing what the health care provider was doing." Id. However, the 
simple fact is that Payne's physician referred him for surgery, and he 
ultimately had surgery. Payne's physician prescribed neither work restriction 
nor conservative treatment. In fact, there is no indication that conservative 
treatment options were discussed at Payne's May or November examinations.1 In this respect, Curnow is clearly 
distinguishable. There, unknown to the employer, Curnow was prescribed 
medication and braces but he opted not to wear the braces. The employer was thus 
prejudiced because "it had no opportunity to monitor the decision of Curnow not 
to use braces." Id. Here, there were no restrictions or conservative treatment 
that Payne could deviate from, and Frontier could not be prejudiced by its lack 
of ability to monitor non-existent restrictions or 
treatment.

[¶20]   The question is thus whether 
Frontier was prejudiced by being "deprived of the ability to employ 
`conservative treatment' options short of surgery." While the record does 
establish a number of viable treatment options, nothing in the record suggests 
that conservative treatment would have made a difference, i.e., that surgery, 
which was the only treatment suggested by Payne's physician, would have been 
avoided if conservative treatments were employed in the brief interim between 
Payne learning of the injury and making the injury report. In addition, Payne 
established that, after his report of the injury, Frontier never offered either 
light duty employment, job modification, or any other form of conservative 
treatment. The record is void of any evidence suggesting that Frontier employed 
job modifications or conservative treatments when it had the opportunity. In any 
event, nothing in the Worker's Compensation Act gives the employer the power to 
dictate medical treatment. While the act does provide for an independent medical 
examination in a contested case, Wyo. Stat. Ann. § 27-14-604 (Lexis 1999), the 
injury report statute limits the employer to investigating the accident and 
monitoring medical treatment.

[¶21]   Frontier also directs us to the 
case of Matter of Zielinske, 959 P.2d 706 (Wyo. 1998), for the proposition that 
an employee who continues to re-expose himself to the harmful work condition 
prejudices the employer. In that case, Zielinske suffered various breathing 
problems as a result of her exposure to cleaning chemicals at work. 959 P.2d  at 
708. Zielinske informed the employer that, pursuant to doctor's orders, she was 
to avoid working with certain chemicals, and the employer agreed to comply with 
the doctor's recommendations. Id. Unbeknownst to the employer, however, 
Zielinske's medical treatment also dictated that she re-expose herself to 
restricted cleaning products to verify the cause of her breathing problems. In 
addition, Zielinske monitored her breathing four times a day. Id. The pertinent 
discussion from Zielinske provides:

[D]espite the 
School District's attempt to comply with the work restrictions imposed by Dr. 
Schumann, the hearing examiner found that Zielinske gave the School District no 
warning of her voluntary re-exposure to the restricted products, or the 
existence of alternatives to such re-exposure. In addition, Zielinske did not 
notify her supervisors of the purpose of her daily peak flow monitoring 
activities, and therefore afforded them no opportunity to ensure the reliability 
of that data. The Division also presented testimony which established that 
medically trained personnel routinely review the medical treatment provided to a 
claimant, but in this case the opportunity to review or monitor the treatment 
was prevented by Zielinske's actions.

959 P.2d  at 
710-11.

[¶22]   We do not read Zielinske for the 
broad proposition for which Frontier cites it. There, the employer was aware of 
a portion of Zielinske's medical treatment - she was to avoid exposure to 
certain chemicals. However, the employer was not aware that Zielinske was 
re-exposing herself to restricted chemicals and monitoring her breathing as part 
of her treatment. Therefore, the prejudice to the employer arose from lack of 
knowledge of these portions of Zielinske's medical treatment. Contrary to 
Frontier's argument, the prejudice in Zielinske did not arise simply from 
re-exposure to the work environment.

[¶23]   Finally, there is another reason 
why we cannot accept the argument that, by continuing to work, Payne prejudiced 
the employer. We long ago recognized that a putative injured worker should not 
be penalized for continuing in good faith to perform his craft. In the case of 
Baldwin v. Scullion, 50 Wyo. 508, 530, 62 P.2d 531, 539 (1936), we wrote the 
following, which has been upheld by this court on many 
occasions.

Medical science 
and diagnosis have advanced with well-nigh miraculous strides in the last decade 
or two, yet they cannot at this time, and probably never will be able to, 
foretell accurately the reaction of every particular human body to every 
particular hurt it may sustain in industrial employment. Under these 
circumstances, it seems to us palpably unjust to the employee to deny him 
compensation because he has tried to keep his place on the employer's pay roll 
by doing his regular work and then has found that conditions produced at the 
time of the accident, and which medical science could not recognize or whose 
final consequences it could not forecast, have gradually and ultimately produced 
a compensable injury.

(Emphasis 
supplied.) We find this language equally applicable in this 
case.

CONCLUSION

[¶24]   The overwhelming evidence in this 
case establishes that Payne was referred for surgery and that he underwent 
surgery. Because there was neither treatment in the interim nor any evidence 
that alternative treatment would have prevented surgery, Payne's employer could 
not be prejudiced by the untimely injury report. Therefore, after reviewing the 
entire record in this case, we conclude that the hearing examiner's finding on 
the issue of prejudice in monitoring medical treatment is clearly contrary to 
the weight of the evidence. The order denying benefits is reversed, and this 
case is remanded to the Office of Administrative Hearings for a determination of 
whether Payne established that his CTS is compensable under the requirements of 
Wyo. Stat. Ann. § 27-14-603(a). This being our decision, we need not address 
Payne's contention that the hearing examiner's use of the labor agreement was 
improper.

Footnotes

1 The only 
attempt at conservative treatment occurred when Payne's surgeon prescribed wrist 
splints in March of 1996; however, this was after Payne filed an injury report.