345 P.3d 875
Wyo.2015Background
- Hildebrant suffered a compensable workplace injury from a fall on August 3, 2011 affecting the low back, mid back, and right shoulder.
- Treatment included pain management and, after limited relief, a spinal cord stimulator trial was recommended by Dr. Hammond.
- The Division denied preauthorization for the trial; the OAH upheld the denial as premature and not warranted.
- Hildebrant and the Division disputed causation and medical necessity, with opinions from Narotzky and Wieder favoring denial and Hammond advocating treatment.
- Hildebrant’s extensive prior back injuries and surgeries were revealed, complicating causation and prognostic considerations.
- The hearing examiner favored Narotzky’s reasoning, finding a causal link to the compensable injury but not medical necessity, and the district court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is there substantial evidence of causality? | Hildebrant argues there is causal connection between the compensable injury and the proposed treatment. | Division contends there is insufficient causal link between the work injury and the stimulator trial. | Substantial evidence supports causality. |
| Is implantation of a spinal cord stimulator medically necessary? | Hildebrant argues the stimulator is reasonable and necessary to relieve pain. | Division argues not medically necessary given other issues and lack of clear necessity. | Substantial evidence supports not medically necessary. |
Key Cases Cited
- Beall v. Sky Blue Enters., Inc., 2012 WY 38, 271 P.3d 1022 (Wyo. 2012) (causation and purpose of Act; burden on claimant to prove causal link)
- Dale v. S & S Builders, LLC, 2008 WY 84, 188 P.3d 554 (Wyo. 2008) (substantial evidence standard for reviewing agency findings)
- Spletzer v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2005 WY 90, 116 P.3d 1103 (Wyo. 2005) (agency deference regarding medical evidence and weighing testimony)
- Taylor v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2005 WY 148, 123 P.3d 143 (Wyo. 2005) (scope of substantial evidence and credibility determinations)
- Judd v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2010 WY 85, 233 P.3d 956 (Wyo. 2010) (apportionment not permitted under Wyoming statute)
- Faulkner v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2007 WY 31, 152 P.3d 394 (Wyo. 2007) (regulatory framework for preauthorization and medical necessity)