In the Matter of the Worker's Compensation Claim of: Valerie Price v. State of Wyoming, ex rel., Department of Workforce Services, Workers' Compensation Division
2017 WY 16
| Wyo. | 2017Background
- In 2004 Price slipped at work and later underwent a right shoulder arthroscopy in 2005 that the Workers’ Compensation Division covered.
- Price continued to have shoulder pain and in 2013 underwent arthroscopic debridement for calcific tendinitis performed by Dr. Bienz; during that surgery he found and repaired a hole in the fascia over the acromioclavicular (AC) joint.
- Price asserted the fascial defect was caused by the 2005 surgery (and thus was a second compensable injury causally related to the 2004 work injury); the Division denied coverage for the 2013 treatment.
- The Medical Commission found Price failed to prove the 2013 treatment was causally related to the 2004 injury or 2005 surgery and denied benefits; the district court affirmed and Price appealed to the Wyoming Supreme Court.
- The Supreme Court held the Commission erred by supplementing the record with its own medical observations and by discounting unreasonably portions of Dr. Bienz’s testimony, but nonetheless affirmed because the record failed to show the fascial repair was necessary medical treatment related to the work injury.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Commission had substantial evidence to deny causal link between 2004 injury/2005 surgery and 2013 surgery | Price: hole in fascia was caused by 2005 surgery; therefore 2013 repair is a second compensable injury | Division: Dr. Bienz’s testimony did not establish causation and Commission properly rejected it | Court: Commission wrongly supplemented record and improperly discounted parts of Dr. Bienz’s opinion, but overall record did not show causation alone is sufficient — causal link to hole supported but not dispositive because necessity lacking |
| Whether the fascial repair was compensable (reasonable and necessary) | Price: repair was necessary and thus compensable if causally related to prior compensable injury | Division: repair was incidental, not shown necessary for treating calcific tendinitis and thus not compensable | Held: Repair was not shown to be necessary treatment related to the work injury; denial of benefits affirmed |
| Whether Commission improperly applied apportionment | Price: Commission apportioned between preexisting and work-related conditions incorrectly | Division: apportionment not applicable or appropriate | Held: Court need not decide apportionment because lack of necessity for repair disposes of case |
Key Cases Cited
- Kenyon v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 247 P.3d 845 (Wyo. 2011) (review standard for appeals from agency decisions)
- Worker’s Comp. Claim of Bailey v. State ex rel. Wyo. Dep't of Workforce Servs., 342 P.3d 1210 (Wyo. 2015) (substantial evidence and agency factfinding review principles)
- Matter of Worker’s Comp. Claim of Jensen v. State, 378 P.3d 298 (Wyo. 2016) (definition of substantial evidence and review of medical causation determinations)
- Hoffman v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 291 P.3d 297 (Wyo. 2012) (second compensable injury rule and necessity of showing initial injury ripened into condition requiring further intervention)
- Boyce v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 105 P.3d 451 (Wyo. 2005) (expert testimony that an injury ‘most likely’ arose from workplace activities can establish nexus)
- Beall v. Sky Blue Enterprises, Inc., 271 P.3d 1022 (Wyo. 2012) (workers’ compensation covers only reasonable and necessary medical care related to the workplace injury)