In the Matter of the Worker's Compensation Claim Of: Lea v. Porter v. State of Wyoming, Ex Rel., Department of Workforce Services, Workers' Compensation Division
2017 WY 69
| Wyo. | 2017Background
- Lea Porter injured her left knee on July 18, 2014 while squatting at work and reported the injury; employer submitted an injury report to the Wyoming Workers’ Compensation Division.
- The on-site physician ordered an MRI (performed Aug. 1, 2014); MRI showed effusion and degenerative changes; physician considered MRI medically justified.
- On Aug. 26, 2014 the Division issued a final determination denying compensability and advised a written hearing request deadline (Sept. 11, 2014); Porter did not request a hearing.
- The Division denied payment for the MRI by a separate Oct. 15, 2014 final determination; Porter objected to that denial and the matter was referred to the Office of Administrative Hearings (OAH).
- OAH granted Division summary judgment, holding Porter's failure to timely contest the Aug. 26 compensability determination precluded her challenge to the Oct. determination; district court affirmed; Porter appealed to the Wyoming Supreme Court.
- The Supreme Court considered whether an uncontested Division compensability determination has collateral-estoppel effect to bar later challenges to medical-bill denials.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Porter's failure to timely contest the Aug. 26, 2014 Division compensability determination precludes her from contesting the Oct. 15, 2014 denial of MRI payment | Porter argued the Aug. determination was not entitled to preclusive effect and she can challenge the MRI denial | Division argued an initial compensability determination is final if uncontested and bars further administrative/judicial review unless redetermined within one year | Court held uncontested Division determinations (including initial compensability denials) do not get collateral estoppel effect; Porter may contest the MRI denial and case is remanded to OAH |
Key Cases Cited
- Tenorio v. State ex rel. Wyo. Workers’ Compensation Div., 931 P.2d 234 (Wyo. 1997) (Division’s uncontested award of benefits does not preclude later contest; legislative scheme reserves final adjudication to administrative hearing body)
- State ex rel. Workers’ Safety Div. v. Jackson, 994 P.2d 320 (Wyo. 1999) (refusing collateral estoppel for uncontested Division determinations denying benefits; OAH is the proper adjudicative forum)
- Snyder v. State ex rel. Wyo. Worker’s Compensation Div., 957 P.2d 289 (Wyo. 1998) (diagnostic testing may be compensable even if it rules out work-related injury)
- Mitcheson v. State ex rel. Wyo. Workers’ Safety & Compensation Div., 277 P.3d 725 (Wyo. 2012) (diagnostic measures compensable when objective physiologic connection exists between injury and test)
- Matter of Claim of Hood v. State ex rel. Wyo. Dep’t of Workforce Servs., 382 P.3d 772 (Wyo. 2016) (discussing collateral estoppel and its limited application in workers’ compensation context)
- Osenbaugh v. State ex rel. Wyo. Workers’ Safety and Compensation Div., 10 P.3d 544 (Wyo. 2000) (court will not give collateral estoppel effect to uncontested Division determinations denying benefits)