Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF JENSEN

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF JENSEN2001 WY 5124 P.3d 1133Case Number: 00-78Decided: 06/11/2001

APRIL TERM, A.D. 2001

 

            

IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF REX C.

JENSEN:

 

STATE OF 
WYOMING ex rel. WYOMING

WORKERS' 
SAFETY AND

COMPENSATION 
DIVISION,

Appellant(Respondent),

 

v.

 

REX C. 
JENSEN,

Appellee(Petitioner).

 

 

Appeal 
from the District Court of Sublette County

The 
Honorable D. Terry Rogers, Judge

 

Representing 
Appellant:

Gay 
Woodhouse, Attorney General; John W. Renneisen, Deputy Attorney General; Gerald 
W. Laska, Senior Assistant Attorney General; Bernard P. Haggerty, Senior 
Assistant Attorney General; and David L. Delicath, Assistant Attorney General 

 Representing 
Appellee:

            
William H. Twichell, Pinedale, Wyoming 

  

Before 
LEHMAN, C.J., and GOLDEN, HILL, and KITE, JJ.

 *This 
case was originally assigned to Justice Thomas on September 22, 2000, for the 
rendering of a proffered majority opinion.  
The case was reassigned to Justice Kite on February 5, 
2001.

 

            
KITE, Justice.

 [¶1]      Rex C. Jensen was 
denied worker's compensation benefits for a claim of injury he alleged resulted 
from manual labor performed at work.  
Following a hearing, the hearing examiner found that Mr. Jensen failed to 
file a timely written report of injury in accordance with Wyo. Stat. Ann. § 
27-14-502(a) (LEXIS 1999) and failed to demonstrate by clear and convincing 
evidence that a lack of prejudice had accrued to the Division of Workers' Safety 
and Compensation (the division) in monitoring medical care or investigating his 
claim pursuant to Wyo. Stat. Ann. § 27-14-502(c) (LEXIS 1999).  The district court reversed and remanded 
the Order Denying Benefits, and the division appeals.  We affirm the district court's 
conclusion that a presumption of claim denial did not arise and its remand to 
the hearing examiner for a determination of 
compensability.

 

 

ISSUES

 

[¶2]      The State of 
Wyoming ex rel. Wyoming Workers' Safety and Compensation Division presents the 
following issues for our review:

            

            
A Hearing Examiner found the Employee filed an untimely injury report and 
failed to overcome the presumption that his claim should be 
denied.

 

            
A.  Was the district court's 
decision improper?

 

            
B.  Was the Hearing 
Examiner's decision to grant judgment as a matter of law at the end of the 
Employee's case supported by substantial evidence, within his discretion, and in 
accordance with law?

 

Mr. 
Jensen phrases the issues as follows:

 

            
A 
Hearing Examiner found the employee filed an untimely injury report and failed 
to overcome the presumption as to the Division that his claim should be 
denied.

 

            
The district court's decision overruled the Hearing Examiner's 
ruling.

 

            
1[.]  Was the district 
court's decision improper?

 

            
2.  Was the Hearing 
Examiner's grant of a Rule 52(c) motion for judgment as a matter of law 
procedurally proper?

 

            
3.  Did the Hearing Examiner 
properly render findings of fact and conclusions of law in accordance with W.S. 
§ 16-3-110?

 

            
4.  What is the definition of 
injury under W.S. § 27-14-502?

 

            
5.  Did the Hearing Examiner 
properly construe and apply W.S. § 27-14-502?

 

            
6.  Was there substantial 
evidence to support the Hearing Examiner's decision that the employee did not 
timely report his injury by filing a report of injury in accordance with W.S. § 
27-14-502 and/or was there overwhelming evidence supporting the employee['s] 
contention he did timely report his injury?

 

 

FACTS

 

[¶3]      Mr. Jensen 
alleges that, on or about February 26, 1998, he sustained a work-related lower 
back injury while lifting heavy wood trusses and 4' x 8' sheets of plywood.  Mr. Jensen claims he made a timely oral 
report of his injury to his supervisor either that day or the following day 
pursuant to § 27-14-502(a).  He did 
not work the next four days due to soreness in his back.  At that point, he believed nothing more 
serious than muscle strain was to blame for his discomfort.  He returned to work that Friday for a 
half day and then saw a doctor the following Monday, March 9, 1998.  The doctor prescribed muscle relaxants 
and pain medication and told him to rest.  
The doctor informed Mr. Jensen that his back would "clear nicely."  The doctor also testified that he sees a 
half dozen people every day for the kind of low back pain Mr. Jensen had 
experienced "and the vast majority of those folks are cleared up with one or, at 
most, two treatments." 

 

[¶4]      After not working 
the balance of the week to rest his back pursuant to doctor's orders, Mr. Jensen 
returned to work on March 16, 1998.  
He could no longer work beyond March 18, 1998, due to the pain in his 
back and revealed such information to his employer.  He saw the doctor the following day, and 
at that time the doctor indicated to Mr. Jensen that he suspected at least a 
moderate herniated disk.  Mr. Jensen 
claims it was on that day, March 19, 1998, that he first realized he might have 
a compensable injury.  Prior to that 
date, he thought his back pain would dissipate like his other back strains had 
done in the past.

 

[¶5]      On March 23, 
1998, Mr. Jensen filled out a report, and he delivered it to his employer the 
next day and asked the supervisor "to fill out their part and send [the written 
report] in."  The division received 
the report on April 6, 1998.  On 
March 25, 1998, Mr. Jensen tried to go back to work and was told by his employer 
he needed to obtain a work release, which he did receive from his doctor.  The doctor also gave him a steroid 
injection and told him it would help or, if it did not, he had a more serious 
problem.  Mr. Jensen worked March 26 
and 27, 1998, but by March 27 he could hardly stand up or walk.  On March 30, 1998, he went back to the 
doctor who in turn sent him to have an MRI done.  The MRI revealed that he had a severely 
herniated disk in his back.  

 

[¶6]      On April 1, 1998, 
Mr. Jensen applied for temporary total disability.  He filed an amended report after he 
realized that he originally stated the date he had been injured was on March 5, 
1998, rather than on or about February 26, 1998.  He explained the discrepancy by noting 
that the later date marked his return to work and contemporaneous realization 
that he was dealing with something more severe than a simple sore back.  The division issued a Final 
Determination denying benefits on the bases of an alleged failure to file a 
written report within ten days after the injury became apparent and a failure to 
demonstrate the occurrence of a compensable injury.

 

[¶7]      Mr. Jensen 
disputed the division's Final Determination at a contested case hearing before 
the Office of Administrative Hearings held on October 6, 1998.  At the conclusion of Mr. Jensen's 
presentation of evidence, the division moved the hearing examiner to dismiss his 
claim pursuant to W.R.C.P. 52(c).  
The division argued Mr. Jensen failed to make a written report of his 
injury within ten days pursuant to § 27-14-502(a) and presented no evidence to 
rebut the presumption of prejudice to its capacity to investigate the injury and 
monitor medical care pursuant to § 27-14-502(c).  The hearing examiner granted the 
division's motion and found that Mr. Jensen's claim was untimely and he failed 
to demonstrate a lack of prejudice had accrued to the division.  

 

[¶8]      Mr. Jensen 
petitioned the district court for a review of the hearing examiner's 
decision.  He argued that he did not 
know of the serious nature of his injury until March 19, 1998, when his doctor 
first suggested he might have a herniated disk.  The district court reversed the hearing 
examiner's determination finding that Mr. Jensen "did everything reasonable that 
was required of him under the circumstances" and to "deny him compensation is 
mean and cruel spirited, and in brutal departure from the entire purpose of the 
Worker's Compensation system."  From 
that order, the division timely filed this appeal.

 

 

STANDARD 
OF REVIEW

 

[¶9]      This court 
accords no special deference to the district court's decision and will consider 
the case as if it came directly from the agency.  State ex 
rel. Wyoming Workers' Compensation Division v. Brewbaker, 972 P.2d 962, 964 (Wyo. 1999).  
Our 
review is limited to a determination of the factors specified in Wyo. Stat. Ann. 
§ 16-3-114(c) (LEXIS 1999).  The 
reviewing court shall:

 

(ii) 
Hold unlawful and set aside agency action, findings and conclusions found to 
be:

 

(A) 
Arbitrary, capricious, an abuse of discretion or otherwise not in accordance 
with law;

. . .

 

(E) 
Unsupported by substantial evidence in a case reviewed on the record of an 
agency hearing provided by statute.

 

Section 
16-3-114(c)(ii).

 

[¶10]   The interpretation and correct 
application of the provisions of the Wyoming Worker's Compensation Act are a 
question of law over which our review authority is plenary.  Wesaw v. 
Quality Maintenance, 2001 
WY 17, ¶8, 19 P.3d 500, ¶8 (Wyo. 2001).  
We 
affirm an administrative agency's conclusions of law only if they are in accord 
with the law.  Id.  We do 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.  
Id.  In reviewing 
findings of fact, we examine the entire record to determine whether there is 
substantial evidence to support an agency's findings.  Wesaw, ¶9.  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.  Id.  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency's 
conclusions.  Id.  It is more than a scintilla of 
evidence.  
Id.

 

 

DISCUSSION

 

A.        
Statutory Presumption of Claim Denial

 

[¶11]   If the injured employee fails to 
report an injury, serious consequences can result.  Section 27-14-502(c) 
provides:

 

(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.

 

We note 
that the hearing examiner's decision was made prior to Wesaw, 
wherein 
we explained, "the plain language of subsection (c) indicates that the statutory 
presumption does not arise unless an employee failed to report within 72 hours 
and failed to file an injury report within ten days."  Wesaw, ¶14.  The division argues Mr. Jensen did not 
properly file an injury report pursuant to § 27-14-502(a) which required him to 
file a report with his employer and to additionally submit a report to the 
division.  The division further 
argues that substantial evidence supports the hearing examiner's finding that 
Mr. Jensen failed to file within ten days pursuant to § 27-14-502(a).  The hearing examiner stated in his oral 
ruling that the injury most likely became apparent to Mr. Jensen when he first 
saw a doctor on March 9, 1998.  The 
hearing examiner acknowledged it was not until March 19, 1998, that the doctor 
informed Mr. Jensen he might be suffering from a herniated disk.  However, whether or not Mr. Jensen 
properly complied with the ten-day filing requirement is not relevant because he 
sufficiently complied with the requirement to report to his employer within 
seventy-two hours pursuant to § 27-14-502(a).  Therefore, a presumption of claim denial 
does not arise.

 

[¶12]   The issue of whether Mr. Jensen 
properly satisfied the seventy-two-hour requirement did not seem to be in 
contention before the hearing examiner.  
The hearing examiner did not make a finding on this issue and disposed of 
the case on other grounds.  Mr. 
Jensen testified that he notified his employer of a work-related back injury 
within seventy-two hours by making an oral report to his supervisor.  In a letter to the division, the 
supervisor admitted that Mr. Jensen had notified him within the required time 
period and claimed Mr. Jensen stated that he had injured his back at home.  The employer's suggestion that the 
injury occurred at home is only relevant to the issue of compensability and will 
be pertinent evidence upon remand.  
A report provided within seventy-two hours presents an employer with 
sufficient notice of a potential injury, whether or not it is specifically 
claimed to be work related.  The 
uncontroverted evidence reveals that Mr. Jensen timely complied with the 
requirement that he report the occurrence and general nature of his injury to 
his employer within seventy-two hours after the injury became apparent.  Therefore, upon proper application of 
Wesaw, the statutory presumption of claim denial does not arise.  The hearing examiner's ruling that Mr. 
Jensen did not meet his burden of proof was not in accordance with the law.  

 

B.        
W.R.C.P. 52(c)

 

[¶13]   The parties also raise the issue of 
the proper standard of review when W.R.C.P. 52(c) is utilized in a worker's 
compensation case.  "[W]hether 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."  
Wesaw, ¶11.  The 
standard provides that, "when 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 
v. State ex rel. Wyoming Worker's Compensation Division, 842 P.2d 1077, 1082 (Wyo. 1992); see also Wesaw, ¶11.  The 
division argues the hearing examiner properly weighed the factual evidence 
without affording Mr. Jensen the benefit of any special inference.  Mr. Jensen argues the standard of review 
required the hearing examiner to take his evidence as true and afford it all 
favorable and reasonable inferences.  
The factual issues presented in this appeal are not in dispute, but 
rather the parties disagree as to the proper application of the law to those 
facts.  Therefore, the appropriate 
standard of review for factual issues is of no consequence as the application of 
law to the facts is determinative.  
Nevertheless, we will address the propriety of W.R.C.P. 52(c) in the 
instant case.

 

[¶14]   We conclude W.R.C.P. 52(c) was an 
available tool for the hearing examiner to utilize.  However, hearing examiners should bear 
in mind our suggestion set forth in Rice v. 
State ex rel. Wyoming Workers' Safety and Compensation Division, 2001 
WY 21, ¶18, 19 P.3d 508, ¶18 (Wyo. 2001), which 
explained that, when contested case hearings are conducted which take evidence 
on all issues, hearing examiners should make proper findings of fact and 
conclusions of law on all issues properly before them to best serve judicial 
economy and facilitate appellate review.  
It seems apparent that the hearing examiner in this case determined Mr. 
Jensen's failure to file a report of injury within ten days pursuant to § 
27-14-502(a) and his subsequent failure to rebut the presumption of claim denial 
were dispositive of this case.  
However, the hearing examiner did not make a determination of whether Mr. 
Jensen carried his burden of proof that he suffered a compensable injury, which 
upon remand must be proved.  
Therefore, the hearing examiner's decision to grant the W.R.C.P. 52(c) 
motion on certain limited issues did not serve the interests of judicial 
economy.

 

[¶15]   We affirm the district court's 
conclusion that a presumption of claim denial did not arise and its remand to 
the hearing examiner for a determination of 
compensability.