Pittman v. State ex rel. Wyoming Workers' Compensation Div.

• Court: Wyoming Supreme Court
• Writing for the Court: Before THOMAS, MACY, TAYLOR, and LEHMAN, JJ., and RYCKMAN; LEHMAN
• Citation: Pittman v. State ex rel. Wyoming Workers' Compensation Div., 917 P.2d 614 (Wyo. 1996)
• Decision Date: 31 May 1996
• Docket Number: No. 95-216,95-216
• Parties: Theodore W. PITTMAN, Appellant (Employee-Claimant), v. STATE of Wyoming, ex rel. WYOMING WORKER'S COMPENSATION DIVISION, Appellee (Objector-Defendant).

Page 614

917 P.2d 614

Theodore W. PITTMAN, Appellant (Employee-Claimant), v. STATE of Wyoming, ex rel. WYOMING WORKER'S COMPENSATION DIVISION, Appellee (Objector-Defendant).

No. 95-216.

Supreme Court of Wyoming.

May 31, 1996.

Harry G. Bondi, Casper, for appellant.

William U. Hill, Attorney General, Jennifer A. Evans, Assistant Attorney General, for appellee.

Before THOMAS, MACY, TAYLOR, and LEHMAN, JJ., and RYCKMAN, District Judge.

LEHMAN, Justice.

Theodore W. Pittman (Pittman) appeals from an order of the district court affirming a denial of worker's compensation benefits, based upon the expiration of the one-year statutory filing limit prescribed by W.S. 27-14-503(a).

We affirm.

ISSUES

Pittman raises four issues:

1. Is the legal conclusion by the hearing examiner that employee-claimant is absolutely barred under the doctrine of res judicata on his claim for benefits for eye surgery legally correct and supported by substantial evidence?

2. Did the hearing examiner in invoking the doctrine of res judicata improperly place the burden of proof upon employee-claimant to establish what issues were actually and necessarily litigated in the October 1, 1992 contested case hearing?

3. Is the legal conclusion by the hearing examiner that employee-claimant is barred under the statute of limitations of W.S. § 27-14-503 legally correct and supported by substantial evidence?

4. Is the legal conclusion by the hearing examiner that employee-claimant is not the "real party in interest" regarding the payment for the medical expenses of the eye surgery legally correct and supported by substantial evidence?

The Worker's Compensation Division (Division) presents us with three issues:

A. Whether the hearing examiner's determination, that the claim for medical benefits arising from Claimant's 1991 cataract surgeries is barred by the doctrine of res judicata, is supported by substantial evidence and is in accordance with law.

B. Whether the hearing examiner's determination that Claimant's application for benefits was not made within the time limits prescribed by Wyo. Stat. 27-14-503(a) is supported by substantial evidence and is in accordance with law.

C. Whether the hearing examiner's determination, that if medical benefits were to be awarded for the costs of Claimant's eye treatment, payment should be made to the health care providers rather than to Claimant, is in accordance with law.

FACTS

On September 26, 1989, Pittman was working as a pipe fitter at the Dave Johnson Power Plant when a 800 pound valve fell, causing him to fall backwards and strike his head. Pittman sustained numerous injuries and was awarded medical and disability benefits for injuries to his neck, ribs and right leg.

In August 1991, Pittman sought treatment from an ophthalmologist for his deteriorating eyesight. On August 14, 1991, the ophthalmologist, Dr. Ellsworth, diagnosed Pittman with posterior subcapsular (PSC) cataracts in both of his eyes. Pittman underwent surgery for treatment of the cataracts on September 4, 1991 and December 16, 1991. Following surgery on his right eye, Pittman suffered a retinal detachment of the right eye as a result of a complication of the cataract surgery. Surgery was performed on Pittman's right eye to repair the retinal detachment on February 18, 1992.

On October 1, 1992, a hearing was held wherein the Division was contesting payment for medical costs unrelated to the cataracts. In the supplemental disclosure statement for this hearing, Pittman attached the medical records of Dr. Ellsworth relating to the cataracts although he had not previously filed any bills or claims. Subsequently, the Division, in its disclosure statement for this hearing, contended that the costs of the medical treatment for Pittman's eye problems were also at issue. In its Order Awarding Benefits, the hearing examiner concluded that the cataract operations had not been shown to be reasonably related to Pittman's September 26, 1989 injury, and accordingly, Pittman was not entitled to have the Division pay for those medical expenses. Pittman did not appeal this order.

Pittman finally submitted claims for payment of the treatment of his cataracts on June 2, 1993. The Division denied the benefits, and the matter was set for a contested hearing. On October 20, 1994, the hearing examiner issued an Order Denying Benefits based on the following: 1) the claim for benefits for the treatment of the cataracts had been previously adjudicated in the October 1992 hearing, and thus was barred by the doctrine of res judicata; 2) the one-year statutory filing limit began to run when the condition was diagnosed in August 1991, and thus the claims were barred by the W.S. 27-14-503(a) statute of limitations; and 3) Pittman's private insurance carrier had paid the costs of Pittman's eye surgeries, and thus Pittman was not the real party in interest. Pittman filed a petition for review in the district court. The district court affirmed the Order Denying Benefits, concluding that Pittman's claims were outside the W.S. 27-14-503(a) statute of limitations for applying for benefits. Finding this to be dispositive of the case, the district court declined to address the other issues. Pittman timely appeals that determination.

STANDARD OF REVIEW

We will reverse a determination that a claimant is not entitled to worker's compensation benefits only if it is arbitrary, capricious, an abuse of discretion, not in accordance with law, or is unsupported by substantial evidence. W.S. 16-3-114(c)(ii)(A) and (E) (1990); Stuckey v. State ex rel. Worker's Compensation Div., 890 P.2d 1097, 1099 (Wyo.1995); Worker's Compensation Claim of Taylor v. State ex rel. Worker's Compensation Div., 890 P.2d 559, 560-61 (Wyo.1995); Bohren v. State ex rel. Worker's Compensation Div., 883 P.2d 355, 357-58 (Wyo.1994). We review factual issues and agency factual findings using the substantial evidence standard:

Our task is to examine the entire record to determine whether substantial evidence supported the hearing examiner's findings. We will not substitute our judgment for that of the hearing examiner when substantial evidence supports his decision. Substantial evidence is relevant evidence which a reasonable mind might accept in support of the agency's conclusions.

Matter of Worker's Compensation Claim of Fisher, 914 P.2d 1224, 1226 (Wyo.1996) (quoting Latimer v. Rissler & McMurry Co., 902 P.2d 706, 708-09 (Wyo.1995)); see also City of Casper v. Haines, 886 P.2d 585, 587 (Wyo.1994); Stuckey, 890 P.2d at 1099; and Aanenson v. State ex rel. Worker's Compensation Div., 842 P.2d 1077, 1079 (Wyo.1992). The party appealing an administrative determination has the burden of proving the agency's ruling was unsupported by substantial evidence. Jaqua v. State ex rel. Workers' Compensation Div., 873 P.2d 1219, 1221 (Wyo.1994).

Agency conclusions of law are not afforded the same deference as agency factual findings. If the conclusion is in accordance with law, it is affirmed; if it is not, it is to be corrected. Haines, 886 P.2d at 587; Aanenson, 842 P.2d at 1079. As to our review of mixed questions of law and fact, our standard has been stated this way:

When an agency's determinations contain elements of law and fact, we will not treat them as findings of fact. We extend deference only to agency findings of "basic fact." When reviewing a finding of "ultimate fact," we divide the factual and legal aspects of the finding to determine whether the correct rule of law has been properly applied to the facts. If the correct rule of law has not been properly applied, we do not defer to the agency's finding but correct the agency's error in either stating or applying the law.

Aanenson, at 1079-80 (quoting Union Pacific R.R. Co. v. State Bd. of Equalization, 802 P.2d 856, 860-61 (Wyo.1990)); see also Haines, 886 P.2d at 587.

DISCUSSION

A claimant has the burden of proving each essential element of his claim by a preponderance of the evidence. Gilstrap v. State ex rel. Workers' Compensation Div., 875 P.2d 1272, 1273 (Wyo.1994). A corollary to this rule is that the claimant has the burden of following procedures and rules contained within the Worker's Compensation Act before he is entitled to worker's compensation benefits.

(a) A payment for benefits involving an injury which is the result of a single brief occurrence rather than occurring over a substantial period of time shall not be made unless in addition to the proper and timely filing of the reports of the accident, an application or claim for benefits is filed * * * within one (1) year after discovery of the injury by the employee. The report of accident is not a claim for benefits.

W.S. 27-14-503(a) (1991) (emphasis added).

Thus, we begin with the question of when Pittman discovered that he had a compensable injury.

[W]hen determining the time a particular injury became compensable, it should be asked: When would a...