Provins v. Workforce Safety & Ins. Fund

• Decision Date: 08 December 2022
• Docket Number: 20220060
• Citation: 982 N.W.2d 559
• Parties: Cliff PROVINS, Appellant v. WORKFORCE SAFETY AND INSURANCE FUND, Appellee and Environmental LLC/Center Coal Co., Respondent
• Court: North Dakota Supreme Court

982 N.W.2d 559

Cliff PROVINS, Appellant

v. WORKFORCE SAFETY AND INSURANCE FUND, AppelleeandEnvironmental LLC/Center Coal Co., Respondent

No. 20220060

Supreme Court of North Dakota.

Filed December 8, 2022

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

Mitchell D. Armstrong, Bismarck, ND, for appellee.

Jensen, Chief Justice.

[¶1] Cliff Provins appeals from a district court judgment affirming an administrative law judge's ("ALJ") decision that affirmed a Workforce Safety and Insurance ("WSI") order denying liability for his post-traumatic stress disorder

("PTSD") and ending disability benefits in November 2019. We conclude the ALJ did not err in concluding Provins's PTSD was not compensable and a reasoning mind could reasonably conclude his physical injuries did not cause his PTSD. We affirm.

I

[¶2] In May 2019 Provins sustained injuries to his ribs and chest at work when a trailer fell on him while he was working underneath it. WSI accepted his claim for benefits for physical injuries to the scalp, chest and ribs, and internal organs (liver contusion). Provins was treated for those injuries and was subsequently diagnosed with PTSD. In August 2020 WSI issued an order denying benefits in connection with his PTSD and discontinuing disability benefits as of November 5, 2019. Provins requested an administrative hearing.

[¶3] In April 2021 an ALJ held an evidentiary hearing on the issues of whether Provins's PTSD was compensable and whether he was entitled to disability benefits. In July 2021 the ALJ issued findings of fact, conclusions of law, and an order affirming WSI's order. The ALJ determined Provins's PTSD was not a compensable injury and discontinued disability benefits after November 5, 2019.

[¶4] Provins petitioned for reconsideration. In August 2021 the ALJ issued an order on reconsideration, amending the prior decision to address disability benefits in the event his PTSD was determined to be compensable on appeal. The ALJ concluded Provins was not entitled to disability benefits after November 15, 2019, based on his termination from employment after he had returned to work following his injury. Provins appealed to the district court, which affirmed the ALJ's decision.

II

[¶5] "Courts exercise limited appellate review of administrative agency decisions under the Administrative Agencies Practice Act, N.D.C.C. ch. 28-32." State by & through Workforce Safety & Ins. v. Tolman , 2020 ND 223, ¶ 5, 950 N.W.2d 144. In an appeal, a reviewing 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. On appeal from a district court order reviewing an ALJ's decision, this Court reviews the ALJ's decision and not that of the district court. N.D.C.C. § 28-32-49.

[¶6] "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." Tolman , 2020 ND 223, ¶ 6, 950 N.W.2d 144 (quoting Beam v. N.D. Workforce Safety & Ins. Fund , 2020 ND 168, ¶ 14, 946 N.W.2d 486 ); see also State ex rel. Workforce Safety & Ins. v. Questar Energy Servs., Inc. , 2017 ND 241, ¶ 7, 902 N.W.2d 757.

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.

Tolman , at ¶ 6 (quoting Beam , at ¶ 14 ). We do not give deference to an independent ALJ's legal conclusions, and questions of law are fully reviewable on appeal. Id.

III

[¶7] Provins argues that the physical injuries he suffered when he was crushed under a trailer are at least 50 percent of the "proximate cause" of his PTSD, and the PTSD is therefore a "compensable injury" under N.D.C.C. § 65-01-02(11)(a)(6), formerly codified at N.D.C.C. § 65-01-02(10)(a)(6).

[¶8] A claimant has the burden to prove by a preponderance of evidence that the claimant has sustained a "compensable injury" and is entitled to workers’ compensation benefits. N.D.C.C. § 65-01-11 ; State ex rel. Workforce Safety & Ins. v. Sandberg , 2021 ND 39, ¶ 13, 956 N.W.2d 342 ; Davenport v. Workforce Safety & Ins. Fund , 2013 ND 118, ¶ 13, 833 N.W.2d 500. A claimant must prove the medical condition for which benefits are sought is causally related to a work injury. Davenport , at ¶ 13 ; Bergum v. N.D. Workforce Safety & Ins. , 2009 ND 52, ¶ 11, 764 N.W.2d 178. To establish this "causal connection," a claimant must demonstrate the claimant's employment was a "substantial contributing factor" to the disease or injury and need not show the employment was the sole cause of the injury. Davenport , at ¶ 13 ; Bruder v. N.D. Workforce Safety & Ins. Fund , 2009 ND 23, ¶ 8, 761 N.W.2d 588.

[¶9] Regarding whether a "compensable injury" includes a "mental or psychological condition," N.D.C.C. § 65-01-02(10), at the relevant time, provided in part:

"Compensable injury" means 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.

a. The term includes:

....

(6) A mental or psychological condition caused by a physical injury, but only when the physical injury is determined with reasonable medical certainty to be at least fifty percent of the cause of the condition as compared with all other contributing causes combined , and only when the condition did not pre-exist the work injury.

....

b. The term does not include:

....

(10) A mental injury arising from mental stimulus.

(Emphasis added.)

[¶10] In Davenport , 2013 ND 118, ¶ 17, 833 N.W.2d 500, this Court construed N.D.C.C. § 65-01-02(10)(a)(6) and N.D.C.C. § 65-01-02(10)(b)(10) and explained the "causal connection" necessary in this context to establish when a mental or psychological condition is compensable under the statutory scheme:

The legislature permits compensation for mental or psychological conditions "only when the physical injury is determined with reasonable medical certainty to be at least fifty percent of the cause of the condition as compared with all other contributing causes combined." N.D.C.C. § 65-01-02(10)(a)(6). A compensable injury does not include a "mental injury arising from mental stimulus." N.D.C.C. § 65-01-02(10)(b)(10). The plain language of those provisions requires a physical injury to be at least 50 percent of the cause of a mental or psychological condition and contemplates a comparative assessment of other causes contributing to a mental or psychological condition. That language authorizes benefits only when at least a 50 percent causal connection exists between the claimant's physical injury and mental or psychological condition and does not permit benefits for an indeterminate relationship between a claimant's work situation and the claimant's mental or psychological condition.

(Emphasis added.)

[¶11] Under N.D.C.C. § 65-02-08, the legislature authorized WSI to promulgate and enforce administrative rules necessary to carry out Title 65, N.D.C.C. WSI has adopted N.D. Admin. Code § 92-01-02-02.5, further clarifying the requisite "causal connection" under N.D.C.C. § 65-01-02(10)(a)(6) for when a physical injury is at least 50 percent of the cause of the mental or psychological condition and defining what the phrase "other contributing causes" includes. At the time relevant here, N.D. Admin. Code § 92-01-02-02.5 (2018), which WSI adopted to implement N.D.C.C. § 65-01-02, provided:

As used in subparagraph 6 of subdivision a of subsection 10 of North Dakota Century Code section 65-01-02 :

1. "A mental or psychological condition" must be directly caused by a physical injury. To be directly caused it must be shown with objective medical evidence that the mental or psychological condition is the physiological product of the physical injury.

2. "Other contributing causes" include emotional circumstances that generally accompany work-related injuries, such as the loss of function, loss of self-esteem, loss of financial independence, divorce, loss of career or employment position, disruption to lifestyle or family units, anxiousness , uncertainty, or compromised ability to participate in lifestyles, hobbies, or pastimes.

(Emphasis added.)

A

[¶12] Properly promulgated administrative rules have the force and effect of law. N.D.C.C. § 28-32-06. An administrative rule that exceeds or supersedes an agency's statutory authority or conflicts with the statute it implements, however, is void or invalid. Sloan v. N.D. Workforce Safety & Ins. , 2011 ND 194, ¶ 10, 804 N.W.2d 184 (citing N.D. Dep't of Human Servs. v. Ryan , 2003 ND 196, ¶ 10, 672 N.W.2d 649 ; Little v. Tracy , 497 N.W.2d 700, 704 (N.D. 1993) ; Moore v. N.D. Workmen's Comp. Bureau , 374 N.W.2d 71, 74 (N.D. 1985) ; Steele v. N.D. Workmen's Comp. Bureau , 273 N.W.2d 692, 701 (N.D. 1978) ). "Whether an administrative agency has acted within its statutory authority presents a question of law, which is fully...