In the Matter of the Worker's Compensation Claim of: Tommy Hood v. State of Wyoming, ex rel., Department of Workforce Services, Workers' Compensation Division
2016 WY 104
| Wyo. | 2016Background
- Hood injured his neck at work in December 2008 and underwent cervical fusion in March 2010.
- Beginning April 2011 he experienced syncopal (fainting) episodes, allegedly beginning after the neck surgery; he had no prior history of syncope.
- Falls during syncope caused injuries (thumb fracture, wrist, ear) for which the Division paid medical bills and diagnostic testing without contest.
- A later fall (Feb. 2013) allegedly produced lower back injury; discography in Aug. 2013 showed disc tears and surgeons recommended lumbar surgery.
- The Division denied preauthorization for lumbar surgery after two independent reviewers found no medical evidence linking syncope to the cervical injury/surgery.
- The Medical Commission and the district court affirmed the denial; they found unanimous expert opinion failed to link the syncope (and thus the lumbar need) to the work-related neck injury.
Issues
| Issue | Hood's Argument | Division's Argument | Held |
|---|---|---|---|
| Whether Division is estopped from denying preauthorization because it previously paid for syncope-related care | Division’s uncontested payments amount to a final, binding determination that syncope was work-related, so Hood need not reprove causation | Prior uncontested payments do not preclude the Division from contesting causation of future benefits; claimant still must prove causation | Denied. Prior payments do not estop the Division; Hood must prove causation for the lumbar surgery claim |
| Whether the Commission acted arbitrarily/capriciously by discounting Hood’s testimony on causation | Commission should have credited Hood’s testimony that syncope began after surgery and accepted causation | Expert medical opinion is dispositive in medically complex causation issues; Hood’s lay testimony cannot overcome unanimous expert opinions denying causal link | Denied. Commission reasonably credited experts over lay testimony; substantial evidence supports its causation finding |
Key Cases Cited
- Dale v. S & S Builders, 188 P.3d 554 (discusses substantial‑evidence review and burden when agency rejects claimant proof)
- Bush v. State ex rel. Wyo. Workers’ Comp. Div., 120 P.3d 176 (defines substantial evidence standard)
- Johnson v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 321 P.3d 318 (burden on claimant to prove elements of workers’ comp claim)
- Middlemass v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 259 P.3d 1161 (when expert causation evidence is required versus immediate, direct causal cases)
- Tenorio v. State ex rel. Wyo. Workers’ Comp. Div., 931 P.2d 234 (collateral estoppel and limits of uncontested awards)
- Jacobs v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 301 P.3d 137 (uncontested Division payments do not bind future adjudication of causation)