Engle v. Wal-Mart ( 2016 )

IN THE SUPREME COURT OF THE STATE OF NEVADA
DIANNA ENGLE,
Appellant,
vs.
N°611
WAL-MART, FEB 2 6 2016
Respondent. TRACE K. UNDEMAN
CLER' F 81.1PREME COURT
BY
OEPU RK
ORDER OF REVERSAL AND REMAND
This is an appeal from a district court order denying a petition
for judicial review in a workers' compensation matter. Eighth Judicial
District Court, Clark County; Joanna Kishner, Judge.
In 2006, appellant Dianna Engle sustained a work-related
injury while employed by respondent Wal-Mart. Engle obtained a third-
party settlement. In 2012, after her workers' compensation claim had
been closed, Engle requested that her claim be reopened, although she had
not yet exhausted her third-party settlement proceeds. Relying on this
court's decision in Employers Insurance Co. of Nevada v. Chandler, 117
Nev. 421, 23 P.3d 255 (2001), Wal-Mart's third-party insurer denied
Engle's request to reopen her claim. The hearing officer, appeals officer,
and district court all affirmed the denial of Engle's reopening request.
On appeal, Engle raises the following issue: Whether the
district court properly affirmed the appeals officer's decision to deny
En.gle's request to reopen her workers' compensation claim, pursuant to
Chandler.
The district court erred by affirming the appeals officer's denial of Engle's
request to reopen her workers' compensation claim
This court's role in reviewing an administrative agency's
decision is identical to that of the district court. Elizondo v. Hood Mach.,
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Inc., 129 Nev., Adv. Op. 84, 312 P.3d 479, 482 (2013). This court considers
questions of law and statutory interpretation de novo. State, Dep't of
Motor Vehicles & Pub. Safety v. Lovett, 110 Nev. 473, 476, 874 P.2d 1247,
1249 (1994). Because the interpretation of Chandler and NRS 6160.390
are the central issues in the present case, de nova review is the
appropriate standard of review.
Chandler does not address the present issue
Although the facts in the present caseS are nearly identical to
those in Chandler, the Chandler court did not address the issue found in
the present case. The Chandler court was tasked with determining
whether an insurer is entitled to withhold payment of medical benefits for
a work-related injury until the claimant has exhausted any third-party
settlement proceeds. 117 Nev. at 425, 23 P.3d at 257-58. However, the
issue here is not whether Engle must exhaust her third-party settlement
proceeds before obtaining further medical benefits. The issue is whether a
claimant who has not yet exhausted her third-party settlement proceeds,
and does not seek additional medical benefits but otherwise meets the
requirements for the reopening of her claim under NRS 6160.390, is
entitled to that claim being reopened. Accordingly, Chandler is inapposite.
The appeals officer failed to address NRS 616C.390
NRS 6160.390(1), which deals with the reopening of claims
more than one year after they were closed, states:
If an application to reopen a claim to increase or
rearrange compensation is made in writing more
than 1 year after the date on which the claim was
closed, the insurer shall reopen the claim if:
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(a) A change of circumstances warrants an
increase or rearrangement of compensation during
the life of the claimant;
(b) The primary cause of the change of
circumstances is the injury for which the claim
was originally made; and
(c) The application is accompanied by the
certificate of a physician or a chiropractor showing
a change of circumstances which would warrant
an increase or rearrangement of compensation.
Therefore, if Engle meets these requirements, NRS 616C.390(1) mandates
that "the insurer shall reopen [her] claim." Id (emphasis added).
In her order, the appeals officer did not address Wal-Mart's
primary cause argument that Engle's lumbar spine injury did not occur
while Engle was working at Wal-Mart and that Engle had therefore not
met her burden under NRS 616C.390. Instead, the appeals officer relied
solely on Chandler in denying Engle's request to reopen her claim.
Therefore, the appeals officer committed legal error by relying on
Chandler instead of determining whether Engle met the requirements for
the reopening of her claim pursuant to NRS 616C.390.
The hearing officer must determine whether Engle met her burden
under NRS 616C.390.
Upon remand to the district court, the district court shall
remand and order the hearing officer to first determine the threshold
question of whether a change of circumstances warrants an increase or
rearrangement of compensation and subsequently determine whether the
injury complained of by Engle is related to the original injury caused by
the accident at Wal-Mart pursuant to NRS 616C.390. Only after
addressing these questions can the hearing officer apply Chandler. The
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matter of exhaustion of third-party settlement proceeds is thus not a
consideration until these determinations have been made.
Therefore, we
ORDER the judgment of the district court REVERSED AND
REMAND this matter to the district court for proceedings consistent with
this order.
F—LA
Hardesty
J.
Saitta
'U di/
J.
Pickering
cc: Hon. Joanna Kishner, District Judge
Persi J. Mishel, Settlement Judge
Greenman Goldberg Raby & Martinez
Law Offices of David Benavidez
Eighth District Court Clerk
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