Wyo.: Fall Victim’s Hip Condition Not Compensable Workers’ Comp Claim

By By Kirk Rafdal Dec 31, 2014

Because a workers’ compensation hearing examiner reasonably relied on medical evidence in denying an injured employee’s claim, the Wyoming Supreme Court declined to reverse the hearing examiner’s decision.

In October 2010, Phylis Stevens slipped and fell down some steps outside her workplace. Stevens visited a local clinic immediately thereafter and was treated by a physician’s assistant who diagnosed her with injuries to the left hand. Aside from the pain in her hand, Stevens did not complain of any other issues related to the fall. The next day, Stevens consulted an orthopedic surgeon who, after examining her, performed minor surgery on her fractured hand and issued pain medication.

During the following week, Stevens completed a workers’ compensation injury report and paid a follow-up visit to her orthopedic surgeon. Aside from discussing her injured hand, Stevens made no other medical complaints. In early November, the state of Wyoming found Stevens’ hand to be a compensable injury.

On Nov. 29, 2010, Stevens again was examined by her orthopedic surgeon, who noted that her hand was healing well. However, Stevens mentioned for the first time that she also was experiencing soreness in her right hip. The physician concluded Stevens likely was suffering from bursitis and prescribed anti-inflammatory medication.

On a subsequent visit a month later, the orthopedic surgeon determined that the injuries to Stevens’ hand were clear and that she had an increasing range of motion. The physician’s notes disclosed no mention of Stevens’ hip during this visit.

In January of 2011, approximately two-and-one-half months after her fall, Stevens returned to the local clinic complaining of pain in her right hip. Initial x-rays revealed nothing unusual, but MRIs and other testing over subsequent months indicated several possible issues with Stevens’ hip, including degenerative disease. Stevens at first was ordered to use crutches, but she later was prescribed water therapy. None of the treatments was successful, however, and Stevens eventually underwent a total hip replacement in December 2011.

In the meantime, Stevens submitted a new workers’ compensation claim for her hip injury, but the application was denied on the grounds that “the right hip is not related to the original work injury to the left hand.” Stevens was granted a contested hearing at which she and certain of her coworkers testified as to her fall. Stevens asserted that she had complained about both her hand and hip immediately after the fall, but her coworkers could not consistently recall whether Stevens made mention of her hip immediately following her fall. Stevens’ orthopedic surgeon testified that her hip injury might have been caused by her fall, but he would not say he was certain. A physician for the state provided a more definitive opinion based on his examination of Stevens and the diagnostic record. He concluded it was “very unlikely” that Stevens’ hip condition was the direct result of her fall.

The hearing examiner again denied Stevens’ claim and noted that while all of the witnesses were credible, he placed greater weight on the opinion of the state’s physician and less on that of Stevens’ orthopedic surgeon, whose testimony was more “speculative.”

Stevens asked for review by a state court, which affirmed the hearing examiner’s denial, and she then filed an appeal with the state’s supreme court. The main issue on appeal was whether there was substantial evidence to support the hearing examiner’s ruling.

Stevens argued that the hearing examiner gave too much weight to the testimony of the state’s physician while disregarding the medical evidence and her orthopedic surgeon’s opinion. She further asserted that because she exhibited no hip-related problems prior to the accident, the hearing examiner overlooked a substantive causal connection between the timing of her fall and the injury.

The court noted, however, that Steven’s surgeon was rather equivocal as to the cause of the hip injury, and much of his testimony took the form of conjecture. The medical evidence likewise did not strongly support Stevens’ claim in that she made no mention of any hip pain until a substantial time period after the accident, the court said. On the other hand, the court found the testimony of the state’s physician to be more credible in that he relied on his own examination of the claimant and a thorough review of the medical records in support of his conclusion. As such, the court was unwilling to disturb the ruling of the hearing examiner.

The court affirmed the denial of Stevens’ workers’ compensation claim.

Stevens v. State ex rel. Dep't of Workforce Servs., Workers' Safety & Comp. Div., Wyo., No. S-14-0076 (Dec. 2, 2014).

Kirk Rafdal, J.D., is a staff writer for SHRM.

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