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

• Decision Date: 24 January 1997
• Docket Number: No. 96-14,96-14
• Citation: 931 P.2d 234
• Parties: Francis TENORIO, Appellant (Claimant-Respondent), v. STATE of Wyoming, ex rel., WYOMING WORKERS' COMPENSATION DIVISION, Appellee (Petitioner).
• Court: Wyoming Supreme Court

Page 234

931 P.2d 234

Francis TENORIO, Appellant (Claimant-Respondent), v. STATE of Wyoming, ex rel., WYOMING WORKERS' COMPENSATION DIVISION, Appellee (Petitioner).

No. 96-14.

Supreme Court of Wyoming.

Jan. 24, 1997.

Rehearing Denied Feb. 4, 1997.

Bernard Q. Phelan, Cheyenne, for appellant.

William U. Hill, Attorney General; John W. Renneisen, Deputy Attorney General; Gerald W. Laska, Senior Assistant Attorney General; and Jennifer A. Evans; Assistant Attorney General, Cheyenne, for appellee.

Before TAYLOR, C.J., and THOMAS, MACY and LEHMAN, JJ., and ROGERS, District Judge.

TAYLOR, Chief Justice.

Appellant appeals the district court's reversal of the hearing examiner's order granting her permanent partial disability benefits. The district court found that the hearing examiner erred in refusing to consider the Wyoming Workers' Compensation Division's evidence of an intervening cause of injury and remanded the case for further consideration. We affirm the district court's decision.

I. ISSUES

Appellant, Francis Tenorio (Tenorio), presents the following issues for our review:

I

In a workers' compensation case, is an application for permanent partial disability, pursuant to W.S. § 27-14-405, an application for additional benefits based upon an "increase" in incapacity due solely to the injury pursuant to the "reopening" statute found at W.S. § 27-14-605?

II

Does the doctrine of res judicata preclude an inquiry regarding compensability of the injury after compensability has been determined regarding claims for medical and temporary total disability for the same injury?

Appellee, the Wyoming Workers' Compensation Division (the Division), phrases the debate as a single issue:

Whether the hearing examiner erred in ruling that the Division's payment of medical and temporary total disability benefits for a work injury estopped it from denying permanent disability benefits and relieved Claimant of her burden of proving her permanent physical impairment resulted from her work accident.

II. FACTS

Tenorio was injured in a work-related accident in January 1989. The Division paid for various medical treatments, including surgeries to Tenorio's cervical spine and shoulder. The Division also paid for temporary total disability during certain periods of time between 1989 and 1994. In early 1995, Tenorio reached maximum medical improvement and filed a claim for permanent partial disability of twenty percent. The Division contested Tenorio's claim, alleging that the permanent partial disability was not due solely to her work-related injury but was caused, at least in part, from a subsequent car accident in 1991.

A contested case hearing was held on April 25, 1995. The hearing examiner made no findings regarding the cause of the twenty percent disability; instead, he reasoned as follows:

The Division has raised the issue as to whether the employee/claimant's permanent impairment is a result of the industrial accident or exposure. As the Division has paid for the surgeries and temporary total disability in this case, the employee is not required to prove that her permanent physical impairment is a result of the industrial accident or work exposure.

The Division appealed the order granting benefits to the district court, which reversed the hearing examiner's decision on procedural and substantive grounds. The district court found that Tenorio's current claim for permanent partial disability should have been a petition for modification or additional benefits brought pursuant to Wyo.Stat. § 27-14-605 (1991), which requires a claimant to prove an increase in incapacity due solely to the work-related injury. Therefore, the district court determined that the hearing examiner erred when finding that Tenorio need only show "maximum medical improvement." The district court also found that the Division's previous payments for medical treatment and temporary total disability did not preclude the Division from raising the issue of intervening cause in the determination of whether the permanent physical impairment resulted solely from the work-related injury. Consequently, the district court reversed and remanded the case for further action. This timely appeal followed.

III. STANDARD OF REVIEW

The issues on appeal are a matter of law. Pursuant to W.R.A.P. 12.09, our review of an agency action is in accordance with Wyo.Stat. § 16-3-114(c)(ii)(A) (1990) which requires a reviewing court to "[h]old unlawful and set aside agency action, findings and conclusions found to be * * * [a]rbitrary, capricious, an abuse of discretion or otherwise not in accordance with law[.]" We accord no special deference to the conclusions of the district court, instead reviewing the action as if it came to us directly from the agency. Martinez v. State ex rel. Wyoming Workers' Compensation Div., 917 P.2d 619, 621 (Wyo.1996); Wyoming Steel & Fab, Inc. v. Robles, 882 P.2d 873, 875 (Wyo.1994). If the agency's conclusions of law are correct, its decision will be affirmed. Martinez, 917 P.2d at 621; Matter of Corman, 909 P.2d 966, 970 (Wyo.1996). If the agency has not invoked and applied the correct rule of law, we correct it. Martinez, 917 P.2d at 621; Matter of Gneiting, 897 P.2d 1306, 1308 (Wyo.1995).

IV. DISCUSSION

The parties take exception to the district court's comment that they "reexamine the procedural posture of this case" and on remand, bring Tenorio's claim as a request for benefit modification or increase under Wyo.Stat. § 27-14-605(a). The parties contend that Tenorio's first application for permanent benefits pursuant to Wyo.Stat. § 27-14-405 (1991) is a new claim for benefits which does not entail "an increase or decrease" in disability, but a determination as to the permanent effect of the original disability, thus rendering Wyo.Stat. § 27-14-605(a) inapplicable to this case. We agree.

Initially, we note that the determination of the claimant's rights is guided by the statute in effect at the time the injury occurred in January 1989. State ex rel. Director, Worker's Compensation Division v. Tallman, 589 P.2d 835, 838 (Wyo.1979). As it does today, the Wyoming Worker's Compensation Act authorized several separate categories of benefits: medical benefits; temporary total disability benefits; permanent disability benefits; and death benefits. Wyo.Stat. §§ 27-14-401 through 27-14-406 (1991). Wyo.Stat. § 27-14-605(a) generally set forth the basis for modification of, or an addition to, benefits which were previously awarded. We have characterized this provision as allowing a "reopening" of the claimant's case upon a showing of an increase or decrease in benefits, fraud, or mistake. Stockdale v. Transystems Services, Inc., 908 P.2d 980, 982 (Wyo.1995).

When a claimant sustains permanent impairment from the injury after receiving total temporary benefits, however, the legislature has expressly provided for a transition from temporary to permanent benefits. Wyo.Stat. § 27-14-404(c) mandates the cessation of payments for total temporary benefits when the employee's recovery is complete, or as in this case, when "[t]he employee has an ascertainable loss and qualifies for [permanent] benefits under W.S. 27-14-405 or 27-14-406." An "ascertainable loss" is

that point in time in which it is apparent that permanent physical impairment has resulted from a compensable injury, the extent of the physical impairment due to the injury can be determined and the physical impairment will not substantially improve or deteriorate because of the injury[.]

Wyo.Stat. § 27-14-102(a)(ii) (1991). Wyo.Stat. § 27-14-405(a) states, in relevant part:

Subject to W.S. 27-14-602, upon receipt of a physical impairment rating * * * an employee shall receive compensation for specific losses provided by this section. * * * An employee shall not receive compensation authorized under this section while receiving benefits under W.S. 27-14-404 or 27-14-406.

Thus, Tenorio's case was not "reopened" under Wyo.Stat. § 27-14-605, but proceeded as specifically required by Wyo.Stat. §§ 27-14-404(c) and 27-14-405(a).

Although Tenorio's request for permanent partial disability benefits under Wyo.Stat. § 27-14-405 arose after her award of temporary benefits, this does not relieve her of showing a causal relationship between the work-related injury and the permanent impairment. A worker's compensation claimant must prove each essential element of her claim by a preponderance of the evidence. Martinez, 917 P.2d at 621; Pittman v. State ex rel. Wyoming Workers' Compensation Div., 917 P.2d 614, 617 (Wyo.1996). To receive permanent partial disability benefits, Wyo.Stat. § 27-14-404(c) required Tenorio to show not only that she had suffered a permanent impairment which would not substantially change in the future, but also the extent to which the permanent impairment resulted from the compensable injury.

Tenorio contends that when the Division and her employer failed to object to her award of medical and temporary total disability benefits after knowledge of her car accident, any issue relating to the impact of the car accident on her work-related injury was necessarily decided in her favor. She argues that the uncontested award is a final determination as to all issues which could have been raised at that time. Tenorio's argument relies on Wyo.Stat. § 27-14-606 (1991), which provides:

Each determination or award within the meaning of this act is an administrative determination of the rights of the employer, the employee and the disposition of money within the worker's compensation account as to all matters involved. No determination shall be final without notice and opportunity for hearing as required by this act.

Thus, Tenorio concludes that the Division and her employer are precluded by the operation of res judicata and collateral estoppel from challenging the causation of her current claim.

The doctrines of res judicata and collateral estoppel incorporate " 'a universal precept of...