IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: JODY J. SWEETALLA, Appellant (Petitioner),
v.
STATE OF WYOMING, ex rel. DEPARTMENT OF WORKFORCE SERVICES, WORKERS' COMPENSATION DIVISION, Appellee (Respondent).
Appeal
from the District Court of Laramie County The Honorable
Thomas T.C. Campbell, Judge
Representing Appellant: Elizabeth B. Lance and M.J. Hall,
Lance & Hall, LLP, Cheyenne, Wyoming.
Representing Appellee: Bridget L. Hill, Attorney General;
Michael J. McGrady, Deputy Attorney General; J.C. DeMers,
Senior Assistant Attorney General; Peter Howard, Assistant
Attorney General.
Before
DAVIS, C.J., and FOX, KAUTZ, BOOMGAARDEN, and GRAY, JJ.
BOOMGAARDEN, JUSTICE
[¶1]
Jody J. Sweetalla appeals from the district court's order
affirming the Office of Administrative Hearings' (OAH)
order upholding the Department of Workforce Services,
Workers' Compensation Division's (Division) Final
Determination Regarding Compensability. OAH affirmed the
Division's final determination denying benefits on the
basis that Mr. Sweetalla did not file a claim for benefits
within the one-year statute of limitations set forth in
Wyoming Statute § 27-14-503(a). Because OAH erred in its
determination that equitable estoppel did not bar the
Division from asserting the statute of limitations as a
defense, we reverse and remand.
ISSUE
[¶2]
Did OAH err when it upheld the Division's final
determination because Mr. Sweetalla did not file a claim for
benefits within the one-year statute of limitations set forth
in Wyoming Statute § 27-14-503(a)?
FACTS
[¶3]
On January 16, 2014, Mr. Sweetalla injured his left shoulder
when he attempted to open a garage door while working for
Legend Services, Inc. (Legend Services). Mr. Sweetalla
immediately notified Legend Services of the injury and sought
medical care the same day. Legend Services requested that Mr.
Sweetalla not file an injury report with the Division. In
exchange for not filing an injury report, Legend Services
kept Mr. Sweetalla on salary and paid his out-of-pocket
medical expenses. Mr. Sweetalla subsequently underwent two
shoulder surgeries and extensive rehabilitation, but he did
not return to work. On December 28, 2015, Legend Services
terminated Mr. Sweetalla's employment and told him it
would no longer pay his medical expenses.
[¶4]
On February 14, 2016, Mr. Sweetalla signed and filed a Report
of Injury with the Division. Approximately one week later, a
claims analyst for the Division spoke with Mr. Sweetalla. The
claims analyst recorded the following relevant details
regarding their conversation:
[It] was explained [to Mr. Sweetalla] that because of our
statutes of limitations, an injury report must be filed
within one year of the date of injury to be determined
compensable. Because this claim is more than 2 years old,
[Mr. Sweetalla] was told that the claim will be denied once a
signed injury report is received from the ER. [Mr. Sweetalla]
understands that he will need to request a hearing once he
receives his denial letter.
Over
the next couple of weeks, the Division requested additional
information from Mr. Sweetalla.
[¶5]
In April 2016, the Division issued a Final Determination
Regarding Compensability in reference to "Claim Number:
201601767." In the letter, the Division informed Mr.
Sweetalla that it had reviewed his injury report and did not
approve payment of benefits for two reasons:
■ An injury report was not filed before one year of the
date the injury occurred. Your reported injury occurred on
1/16/2014 and an injury report was not submitted until
02/16/2016. W.S. 27-14-503(a)
■ A work injury arising out of the course and scope of
your employment could not be determined because the requested
medical records were never received by the Division. (Wyoming
Statute 27-14-102(a)(xi))
The
Division made no reference to a claim for benefits or lack
thereof. Rather, the Division informed Mr. Sweetalla that he
could object to the determination and request a hearing.
[¶6]
Mr. Sweetalla requested a contested case hearing and objected
to the Division's final determination, stating: "My
employer instructed me not to file for worker[']s
compensation. Both my employer and the
Division are estopped from raising the delay in filing as a
bar to the claim." (Emphasis added.)
[¶7]
The Division submitted a Statement of Issues and Defenses to
OAH in June 2016. Although the Division could not provide
"[a] precise list of issues" because it had
"very limited information," it identified several
"possible issues," including, for the first time,
whether Mr. Sweetalla, "in addition to the proper and
timely filing of an injury report, file[d] an application or
claim for benefits within one (1) year after the injury
occurred, as required by W.S. § 27-14-503(a)[.]"
[¶8]
In the Disclosure Statement the Division filed on January 9,
2017, approximately two weeks before the hearing, the
Division identified the following narrower issue regarding
Mr. Sweetalla's failure to file a claim for benefits:
Did the Claimant, in addition to the proper and timely filing
of an injury report, file an application or claim for
benefits within one (1) year after the injury occurred, as
required by W.S. § 27-14-503(a)? (According to a review
of the file by the Claim[]s Analyst [], there have been no
requests for benefits filed in this matter. ([Exhibit] S-U).)
[¶9]
After the contested case hearing on January 26, 2017,
[1] OAH
issued its Findings of Fact, Conclusions of Law, and Order
upholding the Division's final determination. At the
beginning of its analysis, OAH found:
There is no dispute that Sweetalla failed to file a claim for
benefits within one year of the date that Sweetalla's
injury occurred as is required by Wyoming Statute §
27-14-503 (LexisNexis). Sweetalla admitted he knew he had
suffered a work-related injury on January 16, 2014, and that
it was more than just a minor injury. Sweetalla had surgery
on his left shoulder on April 1, 2014. As of the date of the
hearing, January 26, 2017, Sweetalla had not filed a claim
for benefits or an application for benefits with the
Division.
[¶10]
OAH acknowledged that Mr. Sweetalla could "avoid the
application of the workers' compensation statute of
limitations" if he "prove[d] that equitable
estoppel applies." It then evaluated whether Mr.
Sweetalla met his burden to "prove by a preponderance of
the evidence: (a) Legend's statements and actions
amounted to actual or legal fraud or constituted providing
incorrect information to Sweetalla; (b) Sweetalla relied on
Legend's fraud or incorrect information to his detriment;
and (c) Sweetalla's reliance on Legend's fraud or
incorrect information was justifiable and reasonable under
the circumstances of the case as a whole." OAH found
that Mr. Sweetalla proved each of these requirements. In
particular, OAH found that Mr. Sweetalla "relied on
[Legend Services'] fraud or incorrect information to his
detriment" because, as a result of not filing a claim,
he "was paid less than he was earning at the time of his
injury" and "without workers' compensation
coverage for his left shoulder injury, [he] lost access to
potential awards for permanent partial impairment award,
permanent partial disability, and permanent total
disability." After OAH determined that equitable
estoppel applied, it concluded that equitable estoppel
"prevent[ed] application of Wyoming Statute ...