Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: LILLIAN TORRES V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: LILLIAN TORRES V. STATE OF WYOMING, ex rel.,  WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2005 WY 7105 P.3d 101Case Number: 04-43Decided: 01/27/2005
OCTOBER TERM, A.D. 2004

                                                                                                
   

IN 
THE MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

LILLIAN 
TORRES,

Appellant

(Petitioner/Employee-Claimant) 
,

v.

STATE OFWYOMING, ex rel., WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION,

Appellee

(Respondent) 
.

Appeal 
from the DistrictCourtofLaramieCounty

The 
Honorable E. James Burke, Judge

Representing 
Appellant:

Bernard 
Q. Phelan, Phelan-Watson Law Office, Cheyenne, Wyoming

Representing 
Appellee:

Patrick 
J. Crank, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; 
Steven R. Czoschke, Senior Assistant Attorney General; and Kristi M. Radosevich, 
Assistant Attorney General

Before 
HILL, C.J., and GOLDEN, KITE, and VOIGT, JJ., and KAUTZ, 
DJ.

  
            
HILL, Chief Justice.

[¶1]      Appellant, 
Lillian Torres (Torres), sought worker's compensation benefits claiming that she 
suffered a hernia while lifting heavy wet laundry at her workplace, Sage Holiday 
Inn, LLC, in Cheyenne.  
Benefits were denied by the Wyoming Workers' Safety and Compensation 
Division (Division) on the basis that Torres failed to timely report the injury 
and because she failed to meet the very specific burden of proof that pertains 
to hernia injuries.  Torres objected 
to the Division's decision to deny benefits and requested a contested case 
hearing before the Office of Administrative Hearings.  The presiding hearing examiner 
determined that Torres' claim was not timely filed and that she otherwise had 
not met her burden of proof.  Torres 
then filed a petition for review in the district court and the district court 
affirmed, embracing the hearing examiner's findings of fact and conclusions of 
law.  We also 
affirm.

[¶2]      Torres raises 
these issues:

            
1.  Is the hearing officer's finding that there was 
insufficient evidence showing "injury" under Wyo. Stat. § 27-14-603(c) supported 
by substantial evidence?

            
2.  May a hearing officer find that a claimant has failed to 
overcome the statutory presumption of prejudice due to "late filing" without 
notice of the specific nature of the claims and a prehearing determination, or 
is such a conclusion contrary to law?

The 
State enlarges on those issues:

I.          
A claimant seeking workers' compensation benefits for a hernia must meet 
the heightened burden of proof pursuant to Wyo. Stat. § 27-14-603(c), by clearly 
proving the hernia is work-related.  
Substantial evidence supports the hearing examiner's decision Ms. Torres 
failed to prove her hernia is work-related.

II.          
Wyo. Stat. § 27-14-502(c) provides a presumption that a claim will be 
denied if an employee's notice of injury is untimely filed.  A claimant may overcome the presumption 
if a lack of prejudice to the employer and Division is proven by clear and 
convincing evidence.  Ms. Torres 
claims she made no effort to show the absence of prejudice because she did not 
receive notice of the timeliness issue, although, the Workers' Compensation 
Division's Disclosure Statement included the timeliness issue, and the Division 
included this issue in the Initial Review issued nine months prior to the 
contested case hearing.  The hearing 
examiner's determination Ms. Torres failed to overcome the presumption of 
prejudice due to untimely filing is in accordance with 
law.

[¶3]      On April 25, 
2002, Torres submitted a report of injury form to the Division claiming that she 
suffered a work-related injury on February 20, 2002.  Torres worked in the 
laundry/housekeeping department at the Cheyenne Holiday Inn.  The injury suffered was an incisional 
hernia1 and its cause, according to Torres, 
was pulling and tugging at heavy laundry items in order to remove them from 
washing machines.  Management at the 
Holiday Inn did not believe the injury was work-related.

[¶4]      In a letter dated 
May 10, 2002, Laurie Tucker, Human Resources Director of the Holiday Inn, 
related this information to the Division:

The 
Holiday Inn-Cheyenne is disputing the Workers' Compensation Claim filed by 
Lillian Torres as we feel this is not a work-related 
injury:

·        
Ms. 
Torres never at any time told her supervisors or the HR Director that she had 
been injured on the job.

·        
On 2/18 
Ms. Torres left for lunch, called at the end of her break and told her 
supervisor she was not coming back as she had a doctor's 
appointment.

·        
2/19 Ms. 
Torres left for lunch, called at the end of her break and told her supervisor 
she had a doctor's appointment and was not coming back to work that 
day.

·        
2/20 Ms. 
Torres left for lunch, called at the end of her break and told her supervisor 
she was not coming back because she didn't feel well.

·        
2/21 Ms. 
Torres called in sick.  She did not 
speak to her supervisor as required by company policy; instead she left a 
message with an associate that she had to have an operation and would not be 
back for awhile.

·        
2/21/02 
an unidentified female entered the HR office and tossed a doctor's note on the 
desk.  The note simply stating Ms. 
Torres could not work until further notice and no further information was 
provided to us.

·        
Ms. 
Torres never filed a report of injury at the time she claims she was 
injured.

·        
Ms. 
Torres did not notify this office until 4/25/02, which was 2 months after she 
went on leave to have surgery.

·        
Ms. Torres has received training on the proper procedures in 
reporting a work-related injury.

·        
Ms. Torres signed a Workers' Compensation Policy which 
outlines the company policies on work-related injuries.

·        
Workers' Compensation informational posters are posted 
throughout the hotel where all associates can read it.  These posters are 
located next to the time clock and in the break rooms.

[¶5]      On April 29, 2002, the 
Division sent Torres a Notice of Lack of Information that contained these 
directions:

This is not a denial of benefits.  The Workers' 
Compensation Division has received and reviewed your employer's report of your 
report of injury' and needs the following information to make a 
determination:

·        
The Division needs additional information to help determine 
the compensability of your claim.  The Division is requesting all medical treatment records 
based on your report of "abdominal pain" to the claims analyst per phone 
conversation on 4/23/02 @ 9:30 a.m.  Please contact your health care provider about 
submitting all medical records related to your Abdomen prior to and subsequent of the injury on 
2/20/2002.  
Wyoming Statute 27-14-102(a)(xi).

·        
The Division is unable to process claims until the enclosed 
copy of your injury report is reviewed, signed by you and returned to the 
Division.  
Your signature is a release of information for medical records. (Wyoming Statute 
27-14-502)

·        
If an employee suffers a hernia, he/she is entitled to 
compensation if he/she clearly proves that:

(i)         The hernia is of recent 
origin.

(ii)        Its appearance was accompanied by 
pain.

(iii)       It was immediately preceded by some 
accidental strain suffered in the course of the employment.

(iv)       It did not exist prior to the date of 
the alleged injury.

If an employee established his/her right to compensation for 
a hernia as provided and elects not to be operated on, he/she will not be 
compensated for the results of future strangulation of the hernia.  (Wyoming Statute 27-14-603(c)(d))

·        
Your injury was not reported to the employer within the 
72-hour time limit required by Wyoming Statute 27-14-502(a).

·        
Your injury report was not filed with the Division within 
the 10-day time limit required by Wyoming Statute 27-14-502(a).  Please send in a written response as 
to why you did not file within the 10-day limit.  Failure of the injured worker to file the 
injury report with the Division within 10 days is a presumption that the claim 
shall be denied.  Wyoming Statute 27-14-502(c)

·        
Definition of injury does not include:  Any injury or condition preexisting 
at the time of employment with the employer against whom a claim is 
made.  
(Wyoming Statute 27-14-102(a)(xi)(F))

·        
The burden of proof in contested cases involving injuries 
which occur over a substantial period of time is on the employee to prove by 
competent medical authority that his/her claim arose out of and in the course of 
his/her employment and to prove by a preponderance of the evidence that:

a.         There is a direct causal connection 
between the condition or circumstances under which the work is performed and the 
injury.

b.         The injury can be seen to have 
followed as a natural incident of the work as a result of the 
employment.

c.         The injury can fairly be traced to 
the employment as the proximate cause.

d.         The 
injury does not come from a hazard to which employees would have been equally 
exposed outside of employment.

e.         The injury is incidental to the 
character of the business and not independent of the relation of employer and 
employee.  
(Wyoming Statute 27-14-603(a))  [Emphasis in 
original.]

[¶6]      On May 24, 2002, the 
Division communicated its Final Determination to Torres:

The Workers' Compensation Division has reviewed your case 
file and has determined that we cannot approve payment of benefits:

·                    
The statutory requirements of work-related hernia include 
proving the following:  
(i) The hernia is of recent origin; (ii) Its appearance was accompanied 
by pain; (iii) It was immediately preceded by some accidental strain suffered in 
the course of the employment; (iv) It did not exist prior to the date of the 
alleged injury.  
This injury does not meet 
the guidelines, as substantiated by objective medical evidence.  (Wyoming Statute 27-14 
603(c)(d))

·                    
The incident, as reported to the Division, does not meet the 
following definition:  
"Injury" means any harmful change in the human organism other than normal 
aging and includes damage to or loss of any artificial replacement and death, 
arising out of and in the course of employment while at work in or about the 
premises occupied, used or controlled by the employer and incurred while at work 
in places where employer's business requires an employee's presence and which subjects the employee to 
extrahazardous duties incident to the business.  (Wyoming Statute 
27-14-102(a)(xi))

·                    
Definition of injury does not include:  Any injury or condition preexisting 
at the time of employment with the employer against whom a claim is 
made.  
(Wyoming Statute 27-14-102(a)(xi)(F))

·                    
Your injury was not reported to the employer within the 
72-hour time limit required by Wyoming Statute 27-14-502(a).

·                    
The employer has indicated their objection on the injury 
report.  
(Wyoming Statute 27-14-506(a)(ii))

·                    
The burden is on the claimant to prove each essential 
element of his or her claim by a preponderance of the evidence.  [Emphasis in original.]

[¶7]      Torres requested a 
hearing to challenge that determination.  Prior to the hearing, the Division gave notice 
to Torres that the first burden of proof that fell to her was "for a late 
reported injury requiring the Employee-Claimant to prove a lack of prejudice to 
both the Division and the Employer by clear and convincing evidence under 
W.S. § 27-14-502."  The hearing was held on February 18, 
2003.  In order 
to meaningfully articulate the facts presented at the hearing, they must be 
organized along the lines of the statute that mandates the burden of proof 
applicable in a case where the injury suffered is a hernia.  Wyo. Stat. Ann. § 
27-14-603(c) (LexisNexis 2003) provides:

(c)  If an employee suffers a hernia, he is 
entitled to compensation if he clearly proves that:

            
(i)  The hernia is of recent origin;

            
(ii)  Its appearance was accompanied by pain;

            
(iii)  It was immediately preceded by some accidental strain 
suffered in the course of the employment; and

            
(iv) It did not exist prior to the date of the alleged injury.

[¶8]    Torres, a fifty-five year old, 
testified that she had worked for the Holiday Inn for about five years at the 
time of her injury.  
She claimed that she suffered an incisional hernia sometime after her 
abdominal surgery in December of 2001, but before February 20, 2002.  She did not know 
exactly what was wrong with her until about that date, when an actual diagnosis 
was made.  On 
that date, she was told she had a hernia and that she should go to Take Pullos, 
M.D., in order to have it surgically repaired.  Dr. Pullos' notes indicate that he conveyed 
additional information to Torres on February 21, 2002, indicating that she had 
suffered an incisional hernia.  Dr. Pullos performed surgery to repair Torres' 
hernia on March 5, 2002.

 [¶9]     Torres testified that she 
had surgery to remove an ovarian cyst in late 2001.  Several weeks after 
the surgery, her attending physician deemed her fit to return to work.  She did return to 
work, but reported to her supervisor that she could not unload washing machines 
that had been packed full of bed linens and towels.  The problem was the 
strain of removing the very wet, very heavy, and very tangled linens from the 
washers.  Her 
supervisor told her that was her job and that she had to do it.  When she performed 
those tasks, she felt a pain in her abdomen at the site of her surgical 
incision.  While 
her testimony was quite disorganized, especially with respect to time, a fair 
reading of it was that she experienced pain while working from the time she 
returned to work in late 2001 or early 2002, until the incident that prompted 
her to seek medical attention on February 20, 2002.  On or about that 
date, she discerned that something was seriously wrong (i.e., her intestine was 
protruding through the abdominal wall) and she sought medical attention.  Torres also claimed 
that the Human Resources Director at the Holiday Inn refused to give her the 
worker's compensation forms necessary to report her injury because she did not 
believe that Torres needed to see a doctor.  Torres asserted that she was threatened with 
loss of her job as well, "if you are going to keep this up."  Cross examination of 
Torres revealed that she did no activities outside of work that would have 
produced the hernia.

[¶10]  The Order Denying Benefits included these 
findings of fact:

            
1.  The issue in this case is whether Torres' incisional hernia 
that was surgically repaired on March 5, 2002 is a compensable, work-related 
injury.  At 
hearing, Torres was a very poor historian making it difficult for this Hearing 
Examiner to determine, with accuracy, when important events occurred.

            
2.  Torres has been employed as a housekeeper in the laundry 
department at the Holiday Inn for approximately five years.  On April 25, 2002 
Torres filed a Wyoming Report of Injury with the Division alleging that she 
sustained an incisional hernia on February 20, 2002.  Exhibit S-A.  The Division denied 
coverage contending that Torres did not report her injury to her employer within 
72 hours of its occurrence, that her hernia was preexisting and that her 
employer had objected to the claim.  Exhibit S-F.

            
3.  Torres sought medical attention for her hernia on February 
21, 2002, with Dr. Take Pullos, M.D.  Dr. Pullos diagnosed Torres with an incisional 
hernia.  Torres 
had surgery on her ovaries in December 2001 and the hernia occurred at the 
incisional site of the prior abdominal surgery.  Exhibit S-B, p.3.  Dr. Pullos repaired 
the hernia on March 5, 2002.  Exhibit S-B, p. 5.

  

            
4.  Dr. Pullos testified by deposition that he was 
unable to determine whether or not Torres' hernia was present before February 
20, 2002.  
Exhibit 1, p.12, lines 20 through 25.  Dr. Pullos did not recall being informed by 
Torres of some accidental strain that preceded her hernia and admitted that an 
incisional hernia could occur without any identifiable incident and that he did 
not know the cause of Torres' hernia.  Exhibit 1, p. 13, line 5 through page14, line 
13.  Dr. Pullos 
testified that Torres may have aggravated her hernia by her work activities but 
also admitted that the hernia could have been due to some inadequacy of the 
healing process at her incisional site.  Exhibit 1, p. 15, lines 10 through 18 and 
p.17, line 17 through p. 18, line 3.

            
5.  Dr. Pullos' testimony was equivocal and did not prove, by 
clear and convincing evidence, that Torres sustained an incisional hernia during 
the course and scope of her employment at the Holiday Inn on February 20, 
2002.

            
6.  Additionally, the evidence supported that Torres failed to 
timely report her injury to her employer and failed to timely file for 
benefits.  
Torres testified she sustained her hernia sometime in January 2002 while 
working in the laundry department pulling tangled sheets and pillowcases from a 
washer.  Torres 
testified the injury occurred because her supervisor, Travis Durand (Durand), 
stuffed too many sheets into the washer.  Torres testified she immediately reported her 
injury to Durand and Durand refused to allow her to go home after she reported 
her injury to him.  
Torres also testified she spoke with Brenda Cooper (Cooper), her 
assistant supervisor in February 2002 and Cooper refused to fill out workers' 
compensation paperwork.  Cooper told Torres that she didn't need to 
seek medical attention, but instead needed to come to work.

  

            
7.  Both Cooper and Durand denied any knowledge of 
Torres' reported injury and wrote letters to the Division, which are in Torres' 
file, after learning that Torres had filed a report of injury in April 2002 and 
claimed to have reported the injury to them.  Cooper wrote a letter denying any knowledge of 
a work-related incident until after Torres filed for workers' compensation 
benefits in April 2002.  Exhibit S-D.  Durand, who had been employed at the Holiday 
Inn for 15 years, wrote a letter stating that at no time during his employment 
with Holiday Inn did Torres ever report an accident or injury to him.  Exhibit S-E.  Durand also 
testified at the contested case hearing that he left employment at the Holiday 
Inn in December 2001, prior to Torres' claim that she injured herself in January 
2002 because of Durand's actions.  Durand's credible testimony, corroborated by 
his letter to Torres' file, clearly showed that Torres did not and could not 
have reported an injury to him as she claimed at hearing.

            
8.  Torres filed her report of injury on April 25, 2002 
claiming she sustained her hernia on February 20, 2002.  Torres testified 
that she filed in April 2002 because that was the date Dr. Pullos told her she 
had suffered a hernia.  
However, Dr. Pullos' medical records clearly reflect that he diagnosed 
Torres with a hernia on February 21, 2002 and surgically repaired it on March 5, 
2002.

            
9.  Torres is not relieved of her statutory obligation to 
timely report and timely file for benefits.  Torres' reporting and filing for benefits in 
this case was clearly untimely.  Because of the two-month delay in reporting 
the hernia injury and filing for benefits, both Holiday Inn and the Division 
were prejudiced in investigating the accident and monitoring medical 
treatment.  By 
the time Holiday Inn and the Division learned of the accident and hernia injury, 
at least three months had passed since the alleged accident and Torres had 
already received surgical intervention.  No evidence was submitted by Torres to rebut 
the presumption of denial of benefits in this case.

[¶11]  The district court affirmed the hearing 
examiner's denial of benefits, and essentially adopted the findings of fact and 
conclusions of law contained in the Order Denying Benefits.

[¶12]   Our standard of review for reviewing 
administrative agency action was clarified and refined in the case of Newman v. State ex rel. Workers' Safety and Compensation 
Division, 2002 WY 91, ¶¶7-25, 49 P.3d 163, ¶¶7-25 (Wyo. 2002).  That case held that 
"the substantial evidence test is the appropriate standard of review ... when 
factual findings are involved and both parties submit evidence."  Newman, ¶22.  In appeals where both parties submitted 
evidence at the hearing below and the dispute is over the soundness of the 
factual findings of the agency, Newman mandates the 
appellate review be limited to application of the substantial evidence 
test.  This is 
true regardless of which party appeals from the agency decision.  The substantial 
evidence test provides:  "In reviewing findings of fact, we examine the 
entire record to determine whether there is substantial evidence to support an 
agency's findings.  
If the agency's decision is supported by substantial evidence, we cannot 
properly substitute our judgment for that of the agency and must uphold the 
findings on appeal.  
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."  Newman, ¶12 (quoting State ex 
rel. Wyoming Workers' Safety and Compensation Division v. Jensen, 2001 WY 
51, ¶10, 24 P.3d 1133, ¶10 (Wyo. 20010)).  Moreover,

            
When factual findings are challenged, we will affirm those findings if 
they are supported by substantial evidence.

In contested cases conducted before administrative agencies, 
the deference that normally is accorded the findings of fact by a trial court is 
extended to the administrative agency, and we do not adjust the decision of the 
agency unless it is clearly contrary to the overwhelming weight of the evidence 
on record.  Mekss [v. Wyoming Girls' School, State of Wyoming, 813 P.2d 185 (Wyo.1991)]; 
State ex rel. Wyoming Workers' Compensation Div. 
v. Brown, 805 P.2d 830 (Wyo.1991).  This is so because, in such an instance, the 
administrative body is the trier of fact and has the duty to weigh the evidence 
and determine the credibility of witnesses.  Gilmore v. Oil and Gas 
Conservation Comm'n, 642 P.2d 773 (Wyo.1982).  Wyoming Steel & 
Fab, Inc., 882 P.2d  at 875.

State of Wyoming ex rel. Wyoming Workers' Safety and 
Compensation Division v. Armijo, 2004 WY 116, ¶7, 99 P.3d 445, ¶7 (Wyo. 2004).

 [¶13]  The interpretation and correct application of 
the provisions of the Wyoming Worker's Compensation Act is a question of law 
over which our review authority is plenary.  Conclusions of law made by an administrative 
agency are affirmed only if they are in accord with the law.  This Court does not 
afford any deference to the agency's determination, and we will correct any 
error made by the agency in either interpreting or applying the law.  Wesaw v. Quality Maintenance, 2001 WY 17, ¶8, 19 P.3d 500, ¶8 (Wyo. 2001).

 [¶14]  The time lines for filing a report of injury 
are of particular importance in this case.  Wyo. Stat. Ann. § 27-14-502 (LexisNexis 2003) 
provides, in pertinent 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, in writing or by other means approved by the 
department, report the occurrence and general nature of the accident or injury 
to the employer.  
In addition, the injured employee shall within ten (10) days after the 
injury became apparent, file an injury report with the employer and the division 
in a manner and containing information prescribed by division rule and 
regulation.  If 
the injured employee is physically unable to comply, a personal representative 
of the employee, his dependents or a personal representative of the dependents 
in case of death shall, following notification by the employer or department of 
reporting requirements, make and file the report for the injured employee.

  
(b)  If an injured employee, any dependent or personal 
representative makes a written report of the injury to the employer or his 
representative, the employer shall acknowledge receipt of the report in writing 
either upon the report or a copy of the report.

  
(c)  Failure of the injured employee, any dependent or personal 
representative to report the accident or injury to the employer and to file the 
injury report 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 injury and in monitoring medical 
treatment.

 [¶15]  Of course, the statutory limitations periods 
are of pivotal importance in circumstances like this because failure to comply 
with those limitation periods may be fatal to even a very meritorious 
claim.  The 
rules and regulations of the Workers' Compensation Division provide some 
additional direction:

Section 1.  Worker Report of the 
Injury.  
The report of the injury is not a claim for benefits.  W.S. 
§27-14-503(a).  
The injured worker is required by the statute to report the occurrence 
and general nature of the injury to the employer as soon as practical within 72 
hours after the injury becomes apparent, and to file a signed injury report on 
the required form with the Division within ten days after the injury becomes 
apparent.[2]  Otherwise, there is a statutory presumption 
that the claim shall be denied.  However, this presumption may be rebutted if 
the worker can establish by clear and convincing evidence that the delay does 
not prejudice the employer or Division in investigating the injury and in 
monitoring medical treatment.

Section 2.  Contents of the Worker's Report.   
The report shall be on a form provided by the Division, 
available from the Division or employer, and shall contain the following 
information:

(a)  The worker's full name, mailing address, 
telephone number and Social Security Number;

(b)  The worker's birth date, sex, marital status 
and number of dependents;

(c)  The employer's full name, address and 
telephone number;

(d)  The worker's date of hire and job site;

(e)  A statement of whether the worker is a 
regular worker, volunteer, inmate, a governmentally subsidized work experience 
program participant, or has an interest in the business as owner, partner, or 
corporate officer;

(f)  The worker's current monthly earnings;

(g)  The date, time and location of the accident 
or injury;

(h)  A statement of how the injury occurred, 
including what the worker was doing at the time and what objects or substances 
caused the injury;

(j)  A statement identifying the parts of the 
worker's body affected by the injury;

(k)  The name(s) of any witness(es) to the events 
causing the injury;

(l)  The names and addresses of all health care 
providers who have treated or provided medical services to the worker for the 
injury being reported;

(m)  If the report is prepared by a person other 
than the worker, the full name, address and telephone number of the person 
preparing the report, and that person's relationship to the worker;

(n)  Such additional information as the Division 
deems appropriate; and

(o)  The report form shall be signed and dated by 
the worker, or his personal representative if the worker is incapacitated.

Section 3.  Employer Report of the 
Injury.  
The employer must file a report of injury within ten days after the date 
on which the employer is notified of the injury.  Failure by an employer to report may result in 
a fine or jail. W.S. § 27-14-506(c).  The report must be filed with the Division; it 
shall be on the required form, dated, signed by the employer or employer's 
authorized representative and shall contain the following information:

            
(a)  The worker's date of hire and job title;

            
(b)  A statement of whether the worker is a regular employee, 
volunteer, inmate, a governmentally subsidized work experience program 
participant, or has an interest in the business as owner, partner, or corporate 
officer;

            
(c)  The worker's current monthly earnings;

            
(d)  The opinion of the employer as to whether the worker 
suffered a work-related injury that is compensable under the Act; and

            
(e)  If the employer's opinion is that the injury is not 
compensable under the Act, the employer shall specify its reason for that 
opinion.  Those 
matters will be addressed by the Division as part of the determination 
process.

Section 4.  Injury Report Forms.  Injury report forms are available, without charge, from the 
Division or its district offices.  W.S. § 27-14-502(a) and (c).  The limitation of 
time for filing does not apply if the worker is mentally incompetent or a minor 
and has no guardian.  
W.S. § 27-14-505.  The form shall contain a statement in boldface 
type that the report is not a claim for benefits.

Section 5.  Notification of 
Injury.  
Any affected party may give notice, by electronic means to the Division, 
of an occurrence of injury to a worker in covered employment.  Upon receipt of 
notice of injury, the Division will mail the appropriate forms to the injured 
worker and the employer for completion and signatures:

            
(a)  If notification was electronically submitted within the 
deadline prescribed in W.S. § 27-14-502(a) and the Division receives the signed 
report within ten days of its mailing by the Division, the report shall be 
deemed to have been timely filed.  In such a case, the Division's allotted time 
to respond will begin when it receives the signed report.

            
(b)  If the Division receives the signed report more than ten 
days after its mailing by the Division, the report shall be deemed filed on the 
date the signed report is received by the Division.

            
(c)  The Division will not approve any award nor pay any claim 
prior to its receipt of a signed waiver from the injured employee, on a form 
provided by the Division, authorizing the Division to release benefit, 
employment or medical information to those parties designated recipients in W.S. 
§ 27-14-805(d).

            
(d)  Nothing in this section shall relieve any party of the 
duty to submit documents bearing original signatures, when required by the Act 
or these Rules.

3 Weil's Code of Wyoming Rules, Department of Employment, Workers' Compensation Medical Commission, Rules of Practice 
and Procedure, Chapter 4, Sections 1-4, Injury Report 
Procedure, 025 220 001-14, -15 (2004).

[¶16]  These rules appear to suggest a hospitable 
environment designed to accommodate the claims of workers who do not always have 
the means or the skills to meet head-on the consequences of a limitations 
statute such as that at issue here.  The circumstances of this case, however, as 
well as many others like it, counsel that workers must be hyper-vigilant and 
super-diligent if they are to protect their constitutional and statutory rights 
to worker's compensation benefits.  Workers must understand that the employer is 
often an adversary in this process.  Worker's compensation benefits are a form of 
industrial insurance, and workers must be aware that the Division's role in the 
process is also an adversarial one, just as insurance companies are many times 
adversaries to their insureds when claims are filed.

[¶17]  With respect to the date on which a 
compensable injury occurs, we have held:

An employee is required to timely notify his employer of an 
injury and file an injury report with the Division.  Wyo. Stat. Ann. § 27-14-502(a) 
(LexisNexis 2003).  
A failure to timely report the accident or injury as required by statute 
is a presumption that the claim shall be denied.  § 27-14-502(c).  The statutory reporting requirements do not 
begin to run until the employee becomes aware that an accident has caused an 
injury; and the term "injury" as used in the compensation statutes means 
compensable injury.  
Rice v. State ex rel. Wyo. Workers' Safety and 
Comp. Div., 2001 WY 21, ¶13, 19 P.3d 508, ¶13 (Wyo.2001); Wesaw v. Quality Maintenance, 2001 WY 17, ¶10, 19 P.3d 500, ¶10 (Wyo.2001); Baldwin v. Scullion, 50 Wyo. 
508, 530-31, 62 P.2d 531, 539 (Wyo.1936).

            
Our law on determining the date of a compensable injury is 
well-established.  
Rice, ¶13; Bemis v. 
Texaco, Inc., 401 P.2d 708, 709 (Wyo.1965).  We have consistently held that when a correct 
diagnosis or prognosis of present or likely future disability is communicated to 
the claimant, the injury is discovered, it is compensable, and the statute of 
limitations begins to run.  City of Casper v. 
Haines, 886 P.2d 585, 589 (Wyo.1994) (citing Aanenson 
v. State ex rel. Worker's Comp. Div., 842 P.2d 1077, 1081-83 (Wyo.1992) 
(discussing this Court's decisions regarding compensable injury)).  "[W]hen determining 
the time a particular injury became compensable, it should be asked:  When would a 
reasonable person, under the circumstances, have understood the full extent and 
nature of the injury and that the injury was related to his or her 
employment?"  Aanenson, 842 P.2d  at 1082.   This question 
necessarily requires a careful evaluation of all facts to determine when an 
employee reasonably understood the nature and seriousness of his condition and 
that it was work-related.

  

            
Our previous decisions have never burdened an employee with 
filing claims for trivial injuries to avoid timeliness issues.  Big Horn Coal Co. v. Wartensleben, 502 P.2d 187, 188 
(Wyo.1972) (citing Potter v. Midland Cooperatives, 
Inc., 248 Minn. 380, 80 N.W.2d 59, 61 
(1956)).  The 
employee, however, may not ignore these requirements for compensable injuries 
because notice requirements and the statute of limitations exist to allow 
employers to investigate claims, monitor medical care, and avoid stale 
claims.  Sherwin-Williams Co. v. Borchert, 994 P.2d 959, 964 
(Wyo.2000).  The 
finder of fact is charged with determining the time and cause of a compensable 
injury; however, whether an employee's claim is to be barred for failure to 
timely file notice or a claim is a mixed question of fact and law.  Aanenson, 842 P.2d  at 1080.

Worker's Compensation Claim of Iverson v. Frost 
Construction, 2003 WY 162, ¶¶14-16, 81 P.3d 190, ¶¶14-16 (Wyo. 
2003).

[¶18]   In addition, we have held:

Pursuant to Wyo. Stat. Ann. § 27-14-603(c) (Michie 1997), an 
employee seeking worker's compensation benefits for a hernia bears a heavy 
burden.  That 
statute provides:

(c)  If an employee suffers a hernia, he is 
entitled to compensation if he clearly proves that:

(i)  The hernia is of recent origin;

(ii)  Its appearance was accompanied by pain;

(iii)  It was immediately preceded by some 
accidental strain suffered in the course of the employment;  and

(iv)  It did not exist prior to the date of the 
alleged injury.

            
An employee's burden to "clearly prove" the elements of 27-14-603(c) 
requires evidence that is clear and convincing.  In re Hardison, 429 P.2d 320, 322 (Wyo.1967).  Clear and convincing evidence is something 
more than a preponderance, but less than proof beyond a reasonable doubt.  Id. It is the kind of proof that 
would persuade a trier of fact that the truth of the contention is highly 
probable.  Matter of Paternity of TS, 917 P.2d 183, 185 
(Wyo.1996);  Matter of GP, 679 P.2d 976, 982 (Wyo.1984).

Bando v. Clure Brothers Furniture, 980 P.2d 323, 329 (Wyo. 1999).

[¶19]   We address this issue first because it 
is a threshold issue.  
If Torres' reports were not timely, and the presumption of prejudice that 
attaches thereto was not rebutted by Torres, then we need not dispositively 
address the hearing examiner's findings that Torres failed to offer adequate 
proof of her hernia injury.

[¶20]   Here, the record is quite clear that 
Torres did not report her injury to her employer within 72 hours of the date on 
which a correct diagnosis was communicated to her.  Likewise, her report 
of the injury was not submitted to the Division within ten days of that same 
date.  Because 
neither report was timely filed, the presumption of prejudice to the Division 
and the employer arose.  Wesaw, ¶14.  Torres concedes, and 
the record bears out the concession, that she made no attempt to overcome the 
presumption of prejudice to the employer and the Division because she did not 
deem the issue to have been joined by the Division's papers.  We conclude that the 
issue of the timeliness of Torres' reports was clearly placed into controversy 
and that there is substantial evidence to support the hearing examiner's 
findings of fact in that regard.  We also conclude that the hearing examiner's 
conclusions of law were in consonance with the governing statute.

[¶21]  Because we affirm on the basis that Torres' 
reports were not timely, it is unnecessary for us to dispositively address the 
merits of Torres' injury claim.  However, it is appropriate for us to comment 
on the hearing examiner's findings in a very limited way.  The hearing examiner 
found that Dr. Pullos' testimony was "equivocal."  A fair reading of the record reveals that his 
testimony was not equivocal, though its certainty may have been clouded by 
Torres' failure to communicate her medical condition with precise clarity.  Of course, it is 
apparent that her consultation with Dr. Pullos was not for the purpose of 
establishing a claim for worker's compensation benefits, but for treatment of 
her medical condition.  
Dr. Pullos' testimony was, in sum, that her work effort "clearly did 
cause her incisional hernia to be aggravated."  Dr. Pullos also made clear that his opinion in 
that regard was as certain as medical science could be in a circumstance such as 
this.  Moreover, 
there was no testimony to contradict Torres' testimony that her hernia did occur 
at work, or at least that it was aggravated by her work effort over a period of 
days or weeks.  
See, e.g., In re 
Armijo, ¶8.

[¶22]  The purpose of the Wyoming Worker's 
Compensation Act bears repeating here:

§ 27-14-101. Short title; statement of intent.

            
(a)  This act may be cited as the "Wyoming Worker's 
Compensation Act".

            
(b)  It is the intent of the legislature in creating the 
Wyoming worker's compensation division that the laws administered by it to 
provide a worker's benefit system be interpreted to assure the quick and 
efficient delivery of indemnity and medical benefits to injured and disabled 
workers at a reasonable cost to the employers who are subject to the Worker's 
Compensation Act.  
It is the specific intent of the legislature that benefit claims cases be 
decided on their merits and that the common law rule of "liberal construction" 
based on the supposed "remedial" basis of workers' benefits legislation shall 
not apply in these cases.  The worker's benefit system in Wyoming is based on a mutual 
renunciation of common law rights and defenses by employers and employees 
alike.  
Accordingly, the legislature declares that the Worker's Compensation Act 
is not remedial in any sense and is not to be given a broad liberal construction 
in favor of any party.

Wyo. Stat. Ann. § 27-14-101 (LexisNexis 2003).  The worker's 
compensation statutes are founded in the language of Wyo. Const. art. 10, § 4.3  This constitutional provision has sometimes 
been referred to as the "constitutional quid pro quo."  See generally Mills v. Reynolds, 807 P.2d 383 
(Wyo. 1991).  As the statutory 
limits on a worker's benefits increase, and as the procedural hurdles for 
workers become more burdensome, the balance required to sustain the "quid pro 
quo" comes into question.  See In re Claim of 
Summers, 987 P.2d 153, 157 (Wyo. 1999); Mauch v. 
Stanley Structures, Inc., 641 P.2d 1247, 1248 (Chief Justice Rose specially 
concurring) (Wyo. 1982); 
and Markle v. Williamson, 518 P.2d 621, 625 
(Wyo. 1974).

[¶23]  We perceive that the hearing examiner was 
correct in its resolution of the merits of Torres' claim in that Torres did not 
present evidence that satisfied the onerous requirements of the governing 
statute.  That 
is, her own testimony was quite uncertain as to whether the hernia was of recent 
origin and as to whether it existed prior to the time of the accidental strain 
that caused her to seek medical attention.  As set out more fully above, it is apparent 
from her own testimony that Torres experienced difficulty from the time she 
returned to work after her abdominal surgery, until the time that she finally 
sought additional medical care.  Torres' burden at hearing was a heavy one, but 
it was not necessarily insurmountable.4

[¶24]  We affirm the district court's order affirming 
the Order Denying Benefits entered by the hearing examiner.

 

FOOTNOTES

  14 
Lawyers' Medical Cyclopedia of Personal Injuries and Allied Specialties, 
§ 30.161, Richard M. Patterson, J.D., Editor (4th ed. 
1998), describes such a hernia:

§ 30.161 Ventral or incisional herniae.

These herniae occur through the weak point 
constituted by part or all of a healed abdominal incision.  Any one or more of a 
number of factors may contribute to their development.  General factors such 
as malnutrition, and therefore poor healing during the post operative phase, or 
persistent straining such as occurs with a chronic cough are not uncommon.  Local conditions 
include inadequate suturing of the wound, faulty suture material, and wound 
infection.  Of 
the three, the last is most common.

            
The development of an incisional hernia does not, per se, indicate negligence on the part of the surgeon 
in closing the wound.  
Whatever the cause, the resultant hernia assumes similar characteristics 
to the adult umbilical hernia, except that it occurs through an incision and the 
neck of the sac may be very large.

  2However, 
it is important for all parties to note our recent construction of Wyo. Stat. 
Ann. § 27-14-502(c).  
See Wesaw v. Quality Maintenance, 2001 WY 17, 
¶14, 19 P.3d 500, ¶14 (Wyo. 2001).  ("[T]he statutory presumption [of prejudice to 
employer and Division] does not arise unless an employee failed to report within 
72 hours and failed to file an injury report within 
ten days.") (Emphasis added.)

   3§ 4. Damages for personal injuries or death not to be 
limited; worker's compensation.

            
No law shall be enacted limiting the amount of damages to be recovered 
for causing the injury or death of any person.  Any contract or agreement with any employee 
waiving any right to recover damages for causing the death or injury of any 
employee shall be void.  As to all extrahazardous employments the 
legislature shall provide by law for the accumulation and maintenance of a fund 
or funds out of which shall be paid compensation as may be fixed by law 
according to proper classifications to each person injured in such employment or 
to the dependent families of such as die as the result of such injuries, except 
in case of injuries due solely to the culpable negligence of the injured 
employee.  The 
funds or funds shall be accumulated, paid into the state treasury and maintained 
in such manner as may be provided by law.  Monies in the fund shall be expended only for 
compensation authorized by this section, for administration and management of 
the Worker's Compensation Act, debt service related to the fund and for 
workplace safety programs conducted by the state as authorized by law.  The right of each 
employee to compensation from the fund shall be in lieu of and shall take the 
place of any and all rights of action against any employer contributing as 
required by law to the fund in favor of any person or persons by reason of the 
injuries or death.  
Subject to conditions specified by law, the legislature may allow 
employments not designated extrahazardous to be covered by the state fund at the 
option of the employer.  To the extent an employer elects to be covered 
by the state fund and contributes to the fund as required by law, the employer 
shall enjoy the same immunity as provided for extrahazardous employments.

   
4See 2 Larson's Workers' 
Compensation Law, §§ 43.01 and 43.02[1] (1999).