Bahmiller v. N.D. Workforce Safety & Ins.

• Decision Date: 05 August 2021
• Docket Number: No. 20210033,20210033
• Citation: 963 N.W.2d 272
• Parties: Bruce BAHMILLER, Appellee v. NORTH DAKOTA WORKFORCE SAFETY & INSURANCE, Appellant and Matt's Automotive Service Center, Respondent
• Court: North Dakota Supreme Court

963 N.W.2d 272

Bruce BAHMILLER, Appellee

v. NORTH DAKOTA WORKFORCE SAFETY & INSURANCE, AppellantandMatt's Automotive Service Center, Respondent

No. 20210033

Supreme Court of North Dakota.

FILED AUGUST 5, 2021

Dean J. Haas, Bismarck, ND, for appellee.

Jacqueline S. Anderson, Special Assistant Attorney General, Fargo, ND, for appellant.

Jensen, Chief Justice.

[¶1] North Dakota Workforce Safety and Insurance ("WSI") appeals from a district court judgment reversing an administrative order sustaining a WSI order denying Bruce Bahmiller's claim for workers’ compensation benefits. We affirm the district court judgment, and conclude the administrative law judge's ("ALJ") finding, that Bahmiller failed to file a timely claim for benefits within one year of his work injury, is not supported by the weight of the evidence.

I

[¶2] Bahmiller has been employed as a full-time auto mechanic since 1984. On April 12, 2019, Bahmiller was diagnosed with carpal tunnel syndrome. His physician recommended he undergo surgery. On April 25, 2019, Bahmiller's employer filed a workers’ compensation claim on behalf of Bahmiller.

[¶3] WSI found Bahmiller's injury involved symptoms of numbness, tingling, and paresthesia in both of his wrists and hands beginning as mild bilateral carpal tunnel syndrome in 2013, a condition which progressed until requiring surgery in 2019. On June 13, 2019, WSI issued a notice of decision denying benefits after concluding Bahmiller's claim was not timely filed because Bahmiller knew he had a work-related injury in 2013 and the claim was required to be filed within one year of the injury. WSI again denied the claim after Bahmiller requested reconsideration.

[¶4] Bahmiller requested a hearing before an ALJ. At the hearing, the ALJ received testimony from Bahmiller, WSI's claims adjuster, and WSI's medical consultant. The ALJ also reviewed Bahmiller's medical records from 1996 through 2019. The ALJ affirmed WSI's order denying Bahmiller workers’ compensation benefits. The ALJ found the greater weight of the evidence established that Bahmiller knew or should have known he suffered a compensable, work-related injury for his carpal tunnel syndrome in 2013 after receiving medical treatment in 2013. The ALJ found Bahmiller was aware in 2013 his work activities prompted his symptoms, and he failed to identify any other activities that would have contributed to the symptoms in his hands and wrists. The ALJ noted Bahmiller's symptoms had significantly limited his ability to perform his job, and he sought medical treatment to address that issue. The ALJ further found Bahmiller did not file a claim earlier because his injury was not debilitating and he did not believe the severity of his condition warranted filing a claim. The ALJ determined Bahmiller filed a claim in 2019 because the severity of his symptoms increased, he was advised he required surgery, and his physician told him to file a workers’ compensation claim.

[¶5] Bahmiller appealed the ALJ's decision to the district court. The court determined Bahmiller's claim was timely and reversed the ALJ's order dismissing Bahmiller's claim for benefits.

[¶6] On appeal, WSI argues the ALJ correctly affirmed WSI's order denying Bahmiller's claim for benefits as untimely. WSI argues the weight of the evidence supports the ALJ's finding that a reasonable person in Bahmiller's position knew or should have known he suffered a compensable injury in 2013.

II

[¶7] Our review of an administrative agency's decision is limited and governed by the Administrative Agencies Practice Act, N.D.C.C. ch. 28-32. Brendel Constr., Inc. v. N.D. Workforce Safety & Ins. , 2021 ND 3, ¶ 10, 953 N.W.2d 612. This Court must affirm an order of an administrative agency unless:

1. The order is not in accordance with the law.

2. The order is in violation of the constitutional rights of the appellant.

3. The provisions of this chapter have not been complied with in the proceedings before the agency.

4. The rules or procedure of the agency have not afforded the appellant a fair hearing.

5. The findings of fact made by the agency are not supported by a preponderance of the evidence.

6. The conclusions of law and order of the agency are not supported by its findings of fact.

7. The findings of fact made by the agency do not sufficiently address the evidence presented to the agency by the appellant.

8. The conclusions of law and order of the agency do not sufficiently explain the agency's rationale for not adopting any contrary recommendations by a hearing officer or an administrative law judge.

N.D.C.C. § 28-32-46 ; see also N.D.C.C. § 28-32-49. On appeal from a district court order reviewing the decision of an ALJ, we review the decision of the ALJ and not that of the district court. See N.D.C.C. § 28-32-49.

[¶8] Our standard of review in an administrative appeal has been explained as follows:

When reviewing an appeal from a final order issued by an independent ALJ, courts apply the same deferential standard of review to the ALJ's factual findings as used for agency decisions. Recognizing the ALJ had the opportunity to observe witnesses and the responsibility to assess the credibility of witnesses and resolve conflicts in the evidence, in reviewing the ALJ's findings of fact we do not make independent findings or substitute our judgment for that of the ALJ; we determine only whether a reasoning mind reasonably could have determined the findings were proven by the weight of the evidence from the entire record. We do not, however, give deference to an independent ALJ's legal conclusions, and questions of law are fully reviewable on appeal.

Brendel , 2021 ND 3, ¶ 11, 953 N.W.2d 612 (quoting Beam v. N.D. Workforce Safety & Ins. Fund , 2020 ND 168, ¶ 14, 946 N.W.2d 486 ).

[¶9] Section 65-05-01, N.D.C.C., sets forth the requirement for timely filing a workers’ compensation benefits claim:

All original claims for benefits must be filed by the injured employee, or someone on the injured employee's behalf, within one year after the injury .... The date of injury for purposes of this section is the first date that a reasonable person knew or should have known that the employee suffered a work-related injury and has either lost wages because of a resulting disability or received medical treatment.

N.D.C.C. § 65-05-01. A claimant is not entitled to receive benefits if they fail to file a written claim for benefits within the specified time under the statute. Ringsaker v. Workforce Safety & Ins. Fund , 2005 ND 44, ¶ 12, 693 N.W.2d 14. It is the claimant's burden to prove their entitlement to workers’ compensation benefits. Workforce Safety & Ins. v. Sandberg , 2019 ND 198, ¶ 14, 931 N.W.2d 488.

[¶10] A reasonable person standard is used to determine the date of an injury under N.D.C.C. § 65-05-01. A reasonable person is an ordinary reasonable lay person, not a person learned in medicine. Lechner v. N.D. Workforce Safety & Ins. , 2018 ND 270, ¶ 11, 920 N.W.2d 288. Additionally, an injury under N.D.C.C. § 65-05-01 means a compensable injury. Klein v. N.D. Workers Comp. Bureau , 2001 ND 170, ¶ 13, 634 N.W.2d 530 ; see N.D.C.C. § 65-01-02(11) (defining "compensable injury" as "an injury by accident arising out of and in the course of hazardous employment which must be established by medical evidence supported by objective medical findings"). "[T]he date of injury for purposes of N.D.C.C. § 65-05-01 is the first date a reasonable lay person, not learned in medicine, knew or should have known that he suffered a compensable work-related injury and has either lost wages or received medical treatment." Lechner , at ¶ 11.

[¶11] "To have a compensable injury, a claimant must know or have reason to know the significance, or seriousness, of her condition and that the injury is work-related." Anderson v. N.D. Workers Comp. Bureau , 553 N.W.2d 496, 499 (N.D. 1996). If a person experiences minor pain or other symptoms while working, they are not charged with knowing or having reason to know they suffer a significant or serious injury. Id. at 500. Seeking medical treatment also does not necessarily establish a claimant knows or has reason to know they have a significant work-related injury. Id. at 499 ; but see Ringsaker , 2005 ND 44, ¶ 19, 693 N.W.2d 14 (determining evidence of claimant's injury was more severe than minor pain after claimant visited doctors on five occasions promptly following injury, including one visit to emergency room, was given numerous injections to alleviate the pain, and was prescribed medication for his pain).

[¶12] The claimant must also know or have reason to know their injury or condition is work-related. Anderson , 553 N.W.2d at 499. We have previously determined when a claimant suffers from a "complex, insidious" injury or condition, the individual is not expected to know or have reason to know their injury is work-related until they receive medical advice linking the individual's condition to their employment. Klein , 2001 ND 170, ¶ 19, 634 N.W.2d 530. In Klein , we noted the following:

The Legislature has removed the requirement that the employee be informed by his treating health care provider that his work is a substantial contributing cause of his condition, and we do not mean to suggest that a doctor must specifically inform the claimant that his work activities caused the claimant's injury in every case. 1997 N.D. Sess. Laws ch. 539, § 1. Certainly, some injuries are obviously caused by the claimant's work and do not require a doctor to inform the claimant his injuries are work related. In these situations, the limitations period begins to run in the absence of any medical advice. Other complex, insidious injuries, however, require knowledge in medical matters because their causes and effects are not immediately apparent to the reasonable lay person, not learned in medicine. These causes and effects can be complex and controversial even for physicians. A specific diagnosis of a claimant's condition, therefore, may

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