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Hayes v. State Industrial Insurance System12/30/1998
The district court granted judicial review and reversed the decision of an administrative appeals officer who granted appellant Edna Hayes' industrial compensation claim. Ms. Hayes sought treatment of her right knee for pain and other physical problems relating to her right knee which arose out of and were caused by industrially-related partial permanent disability of her left knee. We reverse the judgment of the district court and remand with instructions to reinstate the decision of the appeals officer who granted the claim.
The appeals officer reversed the State Industrial Insurance System's ("SIIS") denial of the claim and authorized treatment of Ms. Hayes' right knee after concluding that the "claimant's right knee condition is a compensable consequence" of the work-related left knee injury. The appeals officer recognized that part of Ms. Hayes' right knee problems might be related to her gain in weight and to the aging process, but determined, in accordance with NRS 616C.160, that, because of the "causal relationship" between the industrial injury and Ms. Hayes' right knee complaints, Ms. Hayes was entitled to treatment.
SIIS's position in denying this claim is that overlaying NRS 616C.160 is another, superseding statute, NRS 616C.175(2), which prevents Ms. Hayes from being treated for her work-related right knee problems unless she can show that her permanently injured left knee is not only the cause, but the primary cause, of her right knee problems. As pointed out in the district court's order, the appeals officer "rejected SITS' argument and refused to apply NRS 616C.175." We conclude that the appeals officer was right and that NRS 616C.175 does not apply to the facts of this case. NRS 616C.175(2) was devised to require the greater, "primary cause" burden of proof to be applied only in cases in which a claimant's industrial injuries were aggravated by a non-industrial cause and not to cases in which there was no intervening cause, but merely an extension of the injuries suffered in the industrial accident. NRS 616C.175(2) does not apply in cases such as this one, where the industrial injury manifests itself in the form of symptoms that were not present at the time of the original compensable injury but were "newly developed" manifestations of the original, industrial injury. NRS 616C.160.
It should be noted early on that Ms. Hayes' right knee disability is an industrial injury. Although it took some time to manifest itself, her right knee injury was part of the industrial accident suffered on September 13, 1979. Just as the 1979 fall caused physical injuries to the left knee which resulted in a joint replacement, it also caused physical injury (albeit, later-manifesting, "newly developed" injury) to her right knee. Ms. Hayes' antalgic (pain-avoiding) limp caused the problems in her right knee. It might just as well have caused hip or back problems, in which case these injuries would have to be defined as being part of the industrial accident and not an "aggravation" of injuries caused by the industrial accident. As discussed below, an aggravation of her left knee injury would be the result of a subsequent, intervening injury or cause that caused her left knee to be put into a worse condition than it was put into by the accident. Let it be understood that Ms. Hayes' right knee problems are the result of the September 13, 1979 accident and not merely an "aggravation" of her left knee injuries.
The appeals officer properly concluded that Ms. Hayes was merely seeking treatment for "newly developed," industrially-related knee problems and that she was, therefore, entitled to coverage under NRS 616C.160 merely by showing that her right knee problems were "
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