Lechner v. N. Dakota Workforce Safety & Ins.

• Decision Date: 06 December 2018
• Docket Number: No. 20180203,20180203
• Citation: 920 N.W.2d 288
• Parties: Nicholas LECHNER, Appellant v. NORTH DAKOTA WORKFORCE SAFETY AND INSURANCE, Appellee and M I Drilling Fluids, Respondent
• Court: North Dakota Supreme Court

920 N.W.2d 288

Nicholas LECHNER, Appellant

v.NORTH DAKOTA WORKFORCE SAFETY AND INSURANCE, AppelleeandM I Drilling Fluids, Respondent

No. 20180203

Supreme Court of North Dakota.

Filed December 6, 2018

Stephen D. Little, Bismarck, N.D., for appellant.

Brayden K. Harwood, Special Assistant Attorney General, Fargo, N.D., for appellee.

Tufte, Justice.

[¶1] Nicholas Lechner appeals from a judgment affirming an administrative order sustaining a Workforce Safety and Insurance ("WSI") order denying his claim for workers' compensation benefits. Lechner argues he proved by the greater weight of the evidence that he suffered a compensable injury and that his claim was timely. We affirm, concluding the administrative law judge's finding that Lechner failed to file a timely claim for benefits is supported by a preponderance of the evidence.

I

[¶2] On May 5, 2016, Lechner filed a claim with WSI for workers' compensation benefits. Lechner alleged he was injured at work on December 5, 2013. He claimed he was locked in a small room without a functioning heater, it was thirty degrees below zero outside, and he "screamed and banged for help for hours" before someone let him out of the room. He alleged he "had a panic attack and was traumatized with severe anxiety, sleep disorders, and left unable to function normally."

[¶3] On June 24, 2016, WSI sent Lechner notice it was denying his claim for benefits. The letter stated Lechner's claim was denied because he did not file a claim within one year after the date of the injury.

[¶4] Lechner requested reconsideration. In August 2016, WSI denied Lechner's claim. WSI found he did not allege a physical injury and there were no medical records indicating that he suffered any physical injuries. WSI found the evidence indicated Lechner suffered a mental injury arising out of a mental stimulus, he sought counseling because of anxiety related to work, and he should have reasonably known that the condition was work-related at that time. WSI concluded Lechner suffered a mental injury arising from a mental stimulus which was not a compensable injury and his claim was not timely.

[¶5] Lechner appealed WSI's order. After a June 2017 hearing before an independent administrative law judge ("ALJ"), the ALJ affirmed WSI's order denying Lechner benefits. The ALJ found the greater weight of the evidence indicates Lechner may have sustained a mental injury which arose out of a mental stimulus and Lechner did not prove that he sustained a compensable injury or that he sustained a physical injury. The ALJ found none of the medical records introduced at the hearing indicated that Lechner reported, prior to February 2017, that he had sustained a physical injury during the December 5, 2013, work incident; that Lechner failed to establish he sustained a concussion or other head injury

as a result of the work injury on December 5, 2013; and that he failed to establish his current psychological condition was caused by a physical injury. The ALJ also found the claim was not timely filed, Lechner's 29-month delay in filing for benefits was not reasonable, Lechner should reasonably have known that he suffered a work-related injury well before he filed his claim in May 2016, and Lechner's failure to disclose the alleged injury was the only reason for the delay in his diagnosis.

[¶6] Lechner petitioned for reconsideration, arguing he was first diagnosed with a concussion and post-concussion syndrome

in February 2017, the concussion is a physical injury, the post-concussion syndrome is a mental injury caused by the physical injury, and he did not know his symptoms were attributable to a concussion until he was diagnosed with a concussion. The ALJ affirmed its prior order.

[¶7] Lechner appealed the ALJ's order to the district court. The court affirmed the ALJ's decision.

II

[¶8] Lechner argues the ALJ erred in affirming WSI's order denying his claim for benefits. He contends he is entitled to workers' compensation benefits because he sustained a compensable injury and he filed his claim in a timely manner. He claims he received a concussion during the December 5, 2013, work incident and he suffers from memory loss, post traumatic stress disorder

, and sleep disturbance, all of which are related to his concussion. He contends his injury is compensable because the concussion is a physical injury. He asserts his May 2016 claim for benefits was filed in a timely manner because the concussion was not properly diagnosed for three years.

[¶9] This Court's review of an appeal from a decision of an administrative agency is limited under the Administrative Agencies Practice Act, N.D.C.C. ch. 28-32. Brockel v. N.D. Workforce Safety & Ins. , 2014 ND 26, ¶ 9, 843 N.W.2d 15. The agency's order must be affirmed unless one of the following is established:

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. In an administrative appeal, we do not make independent findings, but instead decide "whether a reasoning mind reasonably could have determined the findings were proven by the weight of the evidence from the entire record." Brockel , at ¶ 9. We give deference to the ALJ's factual findings. Id.

[¶10] Section 65-05-01, N.D.C.C., describes requirements for timely filing of claims for workers' compensation benefits:

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.

"The statute expressly provides that no benefits are allowed if the claimant fails to file a written claim for benefits within the specified time." Ringsaker v. Workforce Safety & Ins. Fund , 2005 ND 44, ¶ 12, 693 N.W.2d 14. The claimant has the burden to prove any entitlement to workers' compensation benefits. N.D.C.C. § 65-05-01.

[¶11] Section 65-05-01, N.D.C.C., uses a reasonable person standard to determine the date of injury. This Court has said that "the Legislature had in mind the ordinary reasonable lay person and not a person learned in medicine." Evjen v. N.D. Workers Comp. Bureau , 429 N.W.2d 418, 419 (N.D. 1988) (quoting Teegarden v. N.D. Workmen's Comp. Bureau , 313 N.W.2d 716, 718 (N.D. 1981) ); see also Klein v. N.D. Workers Comp. Bureau , 2001 ND 170, ¶ 16, 634 N.W.2d 530 (explaining the current version of N.D.C.C. § 65-05-01 was amended in 1997 to reflect the policy of the pre-1993 version of the statute, and the amendment revived prior case law regarding the reasonable person standard). This Court has also said the term "injury" as used in the statute means a compensable injury. Klein , at ¶ 17. We have held the 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. Klein , at ¶¶ 16-17 ; see also Ringsaker , 2005 ND 44, ¶ 20, 693 N.W.2d 14.

[¶12] The statute does not require that a doctor specifically inform the claimant that his work activities caused his injury. Klein , 2001 ND 170, ¶ 19, 634 N.W.2d 530. But this Court has explained:

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 not be

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