Wyoming Worker's Compensation Claim of Beall v. Sky Blue Enterprises, Inc.
2012 WY 38
| Wyo. | 2012Background
- Beall received preauthorization for an orchiectomy claimed related to a 10/13/2008 work injury; Sky Blue objected and the matter went to the Medical Commission Hearing Panel.
- Beall underwent the surgery before the contested hearing; the Commission denied reimbursement as not reasonable or necessary for the work injury.
- The Division’s preauthorization process under Wyo. Stat. § 27-14-601(o) purportedly allowed objections and further review via subsection (k); no presumption shifted burden.
- The Medical Commission found no causal link between the orchiectomy and the 2008 injury, concluding any related care after Feb. 2009 was non-compensable.
- The district court affirmed the Commission; Beall appealed, arguing burden-shifting and lack of substantial evidence; the Wyoming Supreme Court affirmed.
- Key evidentiary issues included Beall’s credibility, completeness of medical histories provided to doctors, and the interpretation of imaging and clinical findings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Burden of proof for reimbursement after preauthorization | Beall argues burden shifts to Sky Blue | Sky Blue argues burden remains with Beall | Burden stays with Beall; no presumption from preauthorization |
| Sufficiency of substantial evidence linking orchiectomy to the October 13, 2008 injury | Beall asserts substantial evidence supports linkage | Beall’s evidence fails to show causality | Evidence supports Commission’s finding that surgery was not causally related to the injury |
| Whether preauthorization procedures improperly allocated proof burden | Lane-Walter requires shifting burden to Division | Statutes preserve employer’s right to object; no shift | Lane-Walter does not require burden shift here; Beall bears burden |
Key Cases Cited
- Lane-Walter v. State ex rel. Wyo. Workers' Safety & Comp. Div., 250 P.3d 513 (Wyo. 2011) (presubmission burden shift under unusual circumstances not applicable here)
- Martinez v. State ex rel. Wyoming Workers' Safety & Comp. Div., 917 P.2d 619 (Wyo. 1996) (employer can dispute awards; §27-14-606 preserves challenges to benefits)
- Kenyon v. State ex rel. Wyo. Workers' Safety & Comp. Div., 247 P.3d 845 (Wyo. 2011) (claimant bears burden of proving elements by preponderance)
- Dale v. S&S Builders, LLC, 188 P.3d 554 (Wyo. 2008) (arbitrary and capricious review safety net; substantial evidence standard)
- McIntosh v. State ex rel. Wyo. Med. Comm'n, 162 P.3d 483 (Wyo. 2007) (hearing panel credibility determinations binding absent clear error)