Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: KIRK JACOBS V. STATE OF WYOMING, ex rel., WYOMING MEDICAL COMMISSION and WYOMING WORKERS' SAFETY AND COMPENSATION DIVISON

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: KIRK JACOBS V. STATE OF WYOMING, ex rel., WYOMING MEDICAL COMMISSION and WYOMING WORKERS' SAFETY AND COMPENSATION DIVISON2005 WY 104118 P.3d 441Case Number: 04-236Decided: 08/26/2005
APRIL TERM, A.D. 2005

 
 
IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 
 
KIRK 
JACOBS,

 
 
Appellant

(Petitioner),

 
 
v.

 
 
STATE OFWYOMING, ex rel., WYOMING

MEDICAL 
COMMISSION and WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION,

 
 
Appellees

(Respondents).

 
 

 
 

Representing 
Appellant:

 
 
            
Bill G. Hibbler, Cheyenne, Wyoming.

 
 

Representing 
Appellees:

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

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

 
 
  
            
VOIGT, Justice.

 
 
[¶1]      Kirk Jacobs 
(Jacobs) appeals from the district court's affirmance of a Medical Commission 
order denying to him worker's compensation benefits.  We reverse and remand to the Medical 
Commission for further remand to the Wyoming Workers' Safety and Compensation 
Division (the Division) for referral to the Office of Administrative Hearings 
for proceedings consistent herewith.

 
 
ISSUE

 
 
[¶2]      The parties have 
listed and briefed four issues, but have failed to address the issue that we 
consider determinative of this matter:  
Does the Medical Commission have jurisdiction to reach legal conclusions 
in a case where it finds there are no medically contested 
issues?

 
 
FACTS

 
 
[¶3]      In 1982, Jacobs 
suffered a work-related injury when a piece of rebar fell on his right little 
toe.  Jacobs later developed an 
allergic reaction to an antibiotic used to treat an infection that developed in 
his foot.  In 1996, we stated the 
following relevant facts in an opinion reversing a hearing examiner's award of 
home health care to Jacobs:

 
 
The 
reaction manifested itself as colitis and nerve damage which left Jacobs with 
severe chronic pain and an intermittent inability to accomplish the activities 
of daily life without assistance.

 
 
            
Jacobs received a seventy-eight percent permanent partial disability 
award in 1990, and still requires high doses of morphine for reported pain.  Approximately $400,000.00 in worker's 
compensation benefits have thus far been awarded to Jacobs, who continues to 
receive approximately $3,000.00 per month for morphine 
alone.

 
 

Matter 
of Workers' Compensation Claim of Jacobs, 924 P.2d 982, 983 (Wyo. 
1996) (Jacobs I).  The award of home health care was 
reversed because Jacobs had not proven the statutorily required mutual agreement 
among the employer, the employee, and the Division that such care be 
provided.  Id. at 984.  The work-relatedness of this condition, 
characterized throughout these and related proceedings as "chronic abdominal 
pain," was not the ratio decidendi of 
our opinion, and we did not directly address the hearing examiner's finding that 
Jacobs "is a severely disabled individual who is able to function only with the 
administration of high doses of narcotics."

 
 

[¶4]      In 2001, Jacobs 
filed worker's compensation claims for lung and knee problems that he alleged 
were caused by the narcotic pain medication he took for the chronic abdominal 
pain.  The matter was referred to 
the Medical Commission when Jacobs objected to the Division's claim denial.  The resolution of the lung and knee 
claims was described in Jacobs v. State 
ex rel. Wyoming Workers' Safety and Compensation Div., 2004 WY 136, ¶ 4, 100 P.3d 848, 849 (Wyo. 2004) (Jacobs 
II):

 
 
The 
Commission sustained the Division's denial of benefits, finding that Jacobs 
failed to prove that the pain medication caused his lung or knee problems.  As part of its findings, the Commission 
also stated that Jacobs failed to establish a causal link between the 
work-related toe injury and his chronic abdominal pain.

 
 

[¶5]      In Jacobs II, Jacobs did not appeal the 
denial of benefits for his lung and knee problems, but instead, contested what 
he discerned to be the Medical Commission's denial of medical benefits for the 
chronic abdominal pain.  We declined 
to address that issue because, despite the Medical Commission's finding that 
Jacobs had not even proven that the work-related toe injury caused his chronic 
abdominal pain, Jacobs was not an "aggrieved party" because the Division had not 
yet denied benefits for the chronic abdominal pain.  Jacobs II, 2004 WY 136, ¶¶ 6-8, 100 P.3d  
at 849-51.

 
 
[¶6]      The Medical 
Commission's order denying benefits to Jacobs for his lung and knee complaints 
was issued on February 22, 2003.  
That denial, which was the focus of Jacobs II, was followed by the 
Division's Final Determination of March 27, 2003, which addressed Jacobs' 
periodic claim for medication for chronic abdominal pain, and which stated in 
relevant part:

 
 
The 
Workers' Compensation Division has reviewed your case and has determined that we 
can not approve payment of benefits.

 
 
Current 
treatment is not related to the original work injury to the right foot of 
9-24-82.  (Wyoming Statute 
27-14-102(a)(xi))[.]

 
 
Jacobs 
objected to the Final Determination and requested a hearing.1  That hearing took place before the 
Medical Commission on October 28, 2003.  
On November 25, 2003, Jacobs submitted legal arguments in the form of a 
motion for judgment as a matter of law.2  His contentions can be summarized as 
follows:

 
 
1.         
The Division paid benefits for Jacobs' chronic abdominal pain for over 
twenty years and could only seek modification of the amount of such benefits 
under Wyo. Stat. Ann. § 27-14-605(a) (LexisNexis 2003).  The statute does not allow the Division 
to seek a redetermination of compensability.

 
 

2.         
The hearing examiner's finding on February 9, 1995, that Jacobs "is a 
severely disabled individual who is able to function only with the 
administration of high doses of narcotics," coupled with the confirmation of 
that fact in Jacobs I, 924 P.2d at 
983 ("[t]he reaction manifested itself as 
colitis and nerve damage which left Jacobs with severe chronic pain"), evidence 
the fact that the question of whether or not the chronic abdominal pain was work 
related has been fully litigated.  
Consequently, the doctrines of collateral estoppel and res judicata prohibit relitigation of 
the issue.

 
 
[¶7]      The Division 
subsequently filed a motion to dismiss the claim based upon the following 
arguments:

 
 
1.         
The issue of the work-relatedness of Jacobs' chronic abdominal pain was 
previously litigated and determined in the Medical Commission's order of 
February 22, 2003, which contained the following findings and 
conclusions:

 
 
a.         
"In this case Mr. Jacobs contends that as a result of this injury he 
developed an infection in his toe which was treated with Keflex and the Keflex 
caused abdominal pain which has required his continued use of narcotic pain 
medication.  . . .  Obviously critical to this inquiry is 
whether the abdominal pain and consequent need for medication is related to the 
work injury."

 
 
b.         
"The burden is on Mr. Jacobs to prove all essential elements of his claim 
by a preponderance of the evidence.  
. . .  One element is that 
the chronic abdominal pain requiring pain medication is related to the work 
injury.  An additional element is 
that the medication is causing breathing problems which require 
treatment."

 
 
c.         
"Mr. Jacobs has not met his burden of proof that his abdominal pain is 
related to his work injury.  . . 
.  There are many non-work related 
medical reasons that could equally, if not more likely, explain Mr. Jacobs' 
complaints and problems."

 
 
d.         
"As the Panel cannot relate his abdominal pain to the work injury, the 
need for treatment of breathing problems related to medication for abdominal 
pain also is found not to be compensable."

 
 
2.         
The doctrines of collateral estoppel and res judicata prohibit relitigation of 
this issue.

 
 
[¶8]      In an order dated 
January 22, 2004, the Medical Commission granted the Division's motion, based 
upon the following findings and conclusions:

 
 
1.         
The issue of the compensability of Jacobs' original injury was not in 
dispute and was not addressed in the hearing examiner's decision dated February 
9, 1995, and it was not before the Wyoming Supreme Court in Jacobs I.

 
 
2.         
To the contrary, in the proceedings leading to its February 22, 2003, 
order, the Medical Commission had the obligation to determine whether the 
underlying chronic abdominal pain was related to Jacobs' initial work-related 
injury, and did not find such work-relatedness after a full and fair 
hearing.

 
 
3.         
The issue having been fully litigated, the doctrines of collateral 
estoppel and res judicata prohibit 
its relitigation.

 
 
[¶9]      Jacobs petitioned 
to have the Medical Commission's decision reviewed by the district court.  After reviewing the record and the 
briefs of the parties, the district court affirmed the Medical Commission's 
order.3  Succinctly stated, the district court 
concluded that collateral estoppel applied to Jacobs' claim as argued by the 
Division.  In other words, the 
question of the work-relatedness of the chronic abdominal pain claim had been 
determined against Jacobs in the Medical Commission's February 22, 2003, order 
and the proceedings leading thereto, and could not now be raised 
again.

 
 

DISCUSSION

 
 

[¶10]   Resolution of this case is dictated 
by the principles enunciated in French v. 
Amax Coal West, 960 P.2d 1023, 1027-1030 ( Wyo. 1998).  See also Bando v. Clure Bros. Furniture, 
980 P.2d 323, 327-28 (Wyo. 1999) and Russell v. State ex rel. Wyoming Workers' 
Safety and Compensation Div., 944 P.2d 1151, 1154-56 (Wyo. 1997).  The Medical Commission does not have 
subject matter jurisdiction in the absence of a medically contested case.  "When hearing a medically contested 
case, the panel shall serve as the hearing examiner and shall have exclusive 
jurisdiction to make the final administrative determination of the validity and 
amount of compensation payable under this act."  Wyo. Stat. Ann. § 27-14-616(b)(iv) (LexisNexis 
2003).  When the Medical Commission 
determined in this instance that there were no medically contested issues before 
it, all such issues having been previously litigated and determined, the Medical 
Commission was obligated to return the case to the Division for referral to the 
Office of Administrative Hearings.  
French, 960 P.2d  at 
1030.

 
 
            
Wyo. Stat. § 27-14-616 (b)(iv) limits the jurisdiction of the Medical 
Commission to hear only "medically contested cases."  A "medically contested case," as defined 
by the Division, is one in which the primary issue requires the application of a 
medical judgment to complex medical facts or conflicting diagnoses.  In this case, the ultimate issue was an 
issue of law, thereby placing the case outside the jurisdiction of the Medical 
Commission.

 
 

French, 
960 P.2d  at 1030.  The 
Medical Commission has a limited area of expertise, and the legislature did not 
expect it to have the legal training and expertise to determine issues of 
law.  Id.

 
 
[¶11]   We are mindful of the fact that, 
because of the complex procedural history of Jacobs' worker's compensation 
claims, it may assist the parties and the Division if we remark briefly on what 
we have, and have not, decided in this opinion.  Most significantly, we have not decided 
whether Jacobs' chronic abdominal pain was caused by his 1982 work injury.  Neither have we decided whether that 
particular question has been previously litigated and decided.  Thus, we have also not decided whether 
collateral estoppel or res judicata 
should be applied to bar his current claim.  All we have said is that the Medical 
Commission is not the proper body to make this last determination.  Furthermore, we are not presently 
situated to answer questions that have not been brought directly to us through 
proper briefing.  For example:  (1) does payment of benefits over the 
years equal a final determination of compensability; (2) if not, does such 
payment affect the burden of proof; (3) assuming notice is required, did Jacobs 
have notice that one issue in the lung and knee claim proceedings would be the 
work-relatedness of the chronic abdominal pain; and (4) was the issue of the 
work-relatedness of the chronic abdominal pain actually decided in that 
proceeding, or in some prior proceeding, or not at all?  Similarly, although the issue was 
raised, we have not herein decided whether the Division is required under these 
circumstances to seek a modification of benefits under Wyo. Stat. Ann. § 
27-14-605(a).

 
 

CONCLUSION

 
 
[¶12]   The Medical Commission has 
jurisdiction to hear only medically contested cases.  Having concluded that this was not such 
a case, the Medical Commission did not then have the statutory authority to 
proceed to consider the legal issues involved.

 
 
[¶13]   Reversed and remanded to the 
Medical Commission for further remand to the Division for referral to the Office 
of Administrative Hearings.

 
 

FOOTNOTES

  1Although not identified in the Final 
Determination, other documents in the record reveal that the "current treatment" 
for which benefits are being denied is the pain medication taken for Jacobs' 
chronic abdominal pain.

 
 
  2See W.R.C.P. 
52(c).

 
 
  3The district court order treated the 
order of the Medical Commission as an order granting summary judgment, and the 
parties have not suggested that it was anything other than that.  The record does not directly address or 
explain why this matter was treated in summary fashion after a contested case 
hearing.  The answer apparently lies 
in the fact that, having determined that the medically contested issues had been 
litigated and decided in an earlier proceeding, the Medical Commission simply 
concluded that any facts presented in the current proceeding were 
irrelevant.