State v. Felan

• Decision Date: 03 June 2021
• Docket Number: No. 20200354,20200354
• Citation: 960 N.W.2d 805
• Parties: STATE of North Dakota, BY AND THROUGH WORKFORCE SAFETY AND INSURANCE, Appellant v. Gloria FELAN, application for death benefits for Fred Felan, Appellee and KB & O Partnership, Respondent
• Court: North Dakota Supreme Court

960 N.W.2d 805

STATE of North Dakota, BY AND THROUGH WORKFORCE SAFETY AND INSURANCE, Appellant

v. Gloria FELAN, application for death benefits for Fred Felan, AppelleeandKB & O Partnership, Respondent

No. 20200354

Supreme Court of North Dakota.

FILED JUNE 3, 2021

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

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

Crothers, Justice.

[¶1] WSI appeals from a judgment ordering payment of death benefits to Gloria Felan. WSI argues the administrative law judge (ALJ) misapplied the law in finding Gloria Felan proved a compensable injury. We reverse and remand for proceedings consistent with this decision.

I

[¶2] On September 14, 2017, Fred Felan was injured when driving a loaded truck that tipped on its side. Julie Schulz of KBO Farms, Fred Felan's employer, arrived at the scene a short time later. Fred Felan declined an ambulance but agreed to allow Schulz to drive him to the hospital in Oakes. At the hospital Fred Felan complained of left chest and rib pain. Fred Felan had a normal heart rate, rhythm and sounds but had decreased breath sounds in his lower left and right chest and some breast tenderness. X-rays taken at the hospital did not reveal any fractures. Hydrocodone was prescribed for pain as well as a rib belt for comfort.

[¶3] The morning of September 15, 2017, Schulz picked up Fred Felan from the hotel and brought him to eat. Schulz noted Fred Felan was falling asleep during the meal and expressed concern he should return to the hospital to get checked again. Fred Felan declined, responded he was fine, and informed Schulz he had taken five hydrocodone. When Schulz expressed concern about the amount of hydrocodone Fred Felan had taken, he responded he was a big man, that he had taken that many before, and declined to return to the hospital.

[¶4] Fred Felan was discovered dead in his hotel room on September 16, 2017. WSI received information of Fred Felan's death on September 20, 2017. On September 22, 2017, WSI accepted Fred Felan's claim for injuries relating to his truck accident for contusion of thorax. Gloria Felan informed WSI she was unsure if the death was due to Fred Felan's injury because he was doing alright after the accident, but that she was having an autopsy conducted. WSI also reported the death and stated it was not believed to be due to the work injury because Fred Felan had multiple health problems including some related to his heart and diabetes. The autopsy confirmed Fred Felan died of congestive cardiomyopathy and arteriosclerotic heart disease.

[¶5] In September of 2018, Gloria Felan filed a claim for death benefits. WSI investigated and gathered information from Gloria Felan and KBO Farms. WSI denied the claim under N.D.C.C. § 65-01-02(11)(a)(3). On December 13, 2018, WSI issued its administrative order denying the claim for death benefits.

[¶6] Gloria Felan requested an administrative hearing. A hearing was held November 7, 2019, with the only issue being "whether Claimant's surviving spouse has proven by a preponderance of the evidence entitlement to payment of death benefits in connection with claim filed on September 15, 2017."

[¶7] On February 25, 2020, the ALJ issued its findings of fact, conclusions of law, and order reversing WSI's administrative order. The ALJ found the following:

"Under North Dakota law, a claimant seeking WSI benefits has the burden of proving by a preponderance of the evidence that the claimant had suffered a compensable injury and is entitled to benefits. A ‘compensable injury’ is defined in North Dakota Century Code section 65-01-02, Subd. 10 (now Subd. 11) 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. The statute goes on to state that a compensable injury includes ‘Injuries due to heart attack or other heart-related disease, stroke, and physical injury caused by mental stimulus, but only when caused by the employee's employment with reasonable medical certainty, and only when it is determined with reasonable medical certainty that unusual stress is at least fifty percent of the cause of the injury or disease as compared with all other contributing causes combined. Unusual stress means stress greater than the highest level of stress normally experienced or anticipated in that position or line of work.’ I note that the Legislature did not place ‘injuries due to heart attack or other heart-related disease’ in the paragraph that defines what is not a compensable injury, for example, pre-existing conditions. The Legislature could have, but did not, enact a law that ‘injuries due to heart attack or other heart-related disease is not compensable unless caused by the employee's employment with reasonable medical certainty, and only when it is determined with reasonable medical certainty that unusual stress is at least fifty percent of the cause of the injury or disease as compared with all other contributing causes combined.’

"This ALJ reads the ‘heart attack ’ portion of the statute as one that includes heart attacks and heart disease as being compensable if certain criteria are met as opposed to one that precludes heart attacks and heart disease if those criteria are not met, like the Legislature has done with pre-existing conditions. Therefore, a claimant who claims a heart attack or heart disease injury can still prove a compensable injury if they show ‘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.’ "

(Citations omitted.)

[¶8] WSI appealed the ALJ's decision to the district court. On November 2, 2020, the district court affirmed the decision. WSI appeals from that judgment.

II

[¶9] WSI argues the ALJ and the district court misapplied the law by failing to properly apply N.D.C.C. § 65-01-02(11)(a)(3).

[¶10] This Court under N.D.C.C. §§ 28-32-46 and 28-32-49 affirms 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."

[¶11] "When an independent ALJ issues final findings of fact, conclusions of law and order under N.D.C.C. § 65-02-22.1, courts apply the same deferential standard of review to the ALJ's factual findings as used for agency decisions." Bishop v. N.D. Workforce Safety & Ins. , 2012 ND 217, ¶ 6, 823 N.W.2d 257. However, no deference is given to an ALJ's legal conclusions, and questions of law are fully reviewable on appeal. Id. "On appeal from the district court's decision, we review the administrative agency's decision in the same manner as the district court, giving due respect to the district court's analysis and review." Bergum v. N.D. Workforce Safety & Ins. , 2009 ND 52, ¶ 8, 764 N.W.2d 178.

[¶12] Under N.D.C.C. § 65-01-02(11)(a)(3), compensable injuries include:

"Injuries due to heart attack or other heart-related disease, stroke, and physical injury caused by mental stimulus, but only when caused by the employee's employment with reasonable medical certainty, and only when it is determined with reasonable medical certainty that unusual stress is at least fifty percent of the cause of the injury or disease as compared with all other contributing causes combined. Unusual stress means stress greater than the highest level of stress normally experienced or anticipated in that position or line of work."

[¶13] "Our primary goal when interpreting a statute is to determine the intent of the legislature by first looking to the plain language of the statute and attempting to give each word, phrase, and sentence its ordinary meaning." State v. Long , 2020 ND 216, ¶ 6, 950 N.W.2d 178. This Court does not examine legislative history unless a statute is ambiguous. N.D.C.C. § 1-02-05. When a provision is unambiguous, this Court looks only to the plain language of the statute to ascertain its meaning. Long , at ¶ 6. "A statute is ambiguous when it is susceptible to differing, but rational, meanings." Schulke v. Panos , 2020 ND 53, ¶ 8, 940 N.W.2d 303.

[¶14] Here, the ALJ improperly applied N.D.C.C. § 65-01-02(11)(a)(3). The statute makes clear that to prove a compensable heart injury or disease, it is insufficient to look only at the event claimed to have caused the condition. Instead, the statute requires that the claimant prove at least 50% of the cause of the injury or disease was unusual stress through their employment. The ALJ's conclusion that the statute is one that "includes heart attacks and heart disease as being compensable if certain criteria are...