Introduction

In 2025 WY 104, the Wyoming Supreme Court clarifies and reinforces a critical procedural mandate in the state’s workers’ compensation framework: when the “primary issue” in a contested case turns on the application of medical judgment to complex medical facts or conflicting diagnoses—i.e., when the case is “medically contested”—the Department of Workforce Services, Workers’ Compensation Division must refer the case to the Medical Commission rather than the Office of Administrative Hearings (OAH). The Court reverses decisions of the OAH and the district court that had adjudicated the compensability of a cervical spine injury in the wrong forum.

The case arises from a December 28, 2020 workplace accident in which appellant Joseph Daniel Polzer fell into a manhole while inspecting an underground fiber optics project. The Division initially accepted injuries to his right shoulder, left knee, and lumbar spine, but later denied coverage for treatment of a cervical spine condition, concluding the neck condition was not causally related to the accident. The Division referred the dispute to the OAH, which agreed and denied benefits. On further appeal, the Wyoming Supreme Court holds that because the causation dispute involved conflicting medical opinions and complex medical facts, the matter fell within the statutory and regulatory definition of a “medically contested case” and should have been referred to a three-member Medical Commission panel in the first instance.

The principal issue presented and decided: whether the Division properly referred the causation dispute over Mr. Polzer’s cervical spine injury to the OAH instead of the Medical Commission under Wyo. Stat. Ann. § 27-14-616(b)(iv).

Summary of the Opinion

Writing for a unanimous Court, Justice Gray holds that:

• Wyoming law requires the Division to refer “medically contested cases” to the Medical Commission. The statute uses mandatory language (“shall”).
• “Medically contested cases” include disputes whose resolution is primarily dependent on medical judgment concerning complex facts or conflicting medical diagnoses (per the Division’s rule and the Court’s prior interpretations).
• The question whether Mr. Polzer’s work accident caused or aggravated a cervical spine condition was contested by multiple physicians and therefore demanded medical expertise to weigh competing diagnoses and the clinical significance of degenerative findings versus traumatic aggravation.
• Because the record available to the Division at the time of referral reflected conflicting medical evidence, the Division erred by sending the case to the OAH rather than the Medical Commission.

The Court reverses and remands with instructions that the matter be disposed of in accordance with the opinion—i.e., to be heard by the Medical Commission.

Analysis

Statutory and Regulatory Framework

The Court’s holding turns on the interpretation and application of:

• Wyo. Stat. Ann. § 27-14-616(b)(iv): “The division shall refer medically contested cases to the [Medical] commission for hearing by a medical hearing panel.”
• Wyo. Stat. Ann. § 27-14-601(k)(v): Directs the Division to notify the “appropriate hearing authority” upon receipt of a hearing request, tethering the choice to § 27-14-616.
• Division Rule, Ch. 6, § 1(a)(i): Defines “medically contested cases” to include, among other categories, “any other issue, the resolution of which is primarily dependent upon the evaluation of conflicting evidence as to medical diagnosis, medical prognosis, or the reasonableness and appropriateness of medical care.”
• Wyoming Administrative Procedure Act (WAPA), Wyo. Stat. Ann. § 16-3-114(c)(ii)(A), (D): Judicial review standards—agency action shall be set aside if “not in accordance with law” or made “without observance of procedure required by law.”

Precedents and Their Influence

The Court situates its decision within a mature line of Wyoming authority:

• Bando v. Clure Bros. Furniture, 980 P.2d 323 (Wyo. 1999): Two key points arise from Bando. First, the Division’s referral decision is subject to judicial review even though it is not subject to administrative review. Second, Bando stresses that the referral determination hinges on the nature of the issues and the evidence before the Division at the time of referral. Polzer explicitly follows Bando’s “time-of-referral” focus.
• French v. Amax Coal West, 960 P.2d 1023 (Wyo. 1998), and Jacobs v. State ex rel., Wyo. Med. Comm’n, 2005 WY 104, 118 P.3d 441: When the primary issue is purely legal (e.g., applicability of a rule, preclusion doctrines), the case properly belongs in the OAH, and the Medical Commission should not retain it. Polzer cites these to clarify the boundary: medical versus legal primacy.
• McIntosh v. State ex rel. Wyo. Med. Comm’n, 2007 WY 108, 162 P.3d 483: Confirms that the Division’s rule does not exhaustively define “medically contested” by listing set categories; rather, the rule is inclusive. The overarching principle is whether “the primary issue requires the application of a medical judgment to complex medical facts or conflicting diagnoses.” Polzer quotes and applies this standard.
• McCallister v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2022 WY 66, 510 P.3d 1051: Interprets “shall” in § 27-14-616(b)(iv) as mandatory—no discretion to keep medically contested cases out of the Medical Commission. Polzer leans on McCallister to reaffirm the mandatory nature of referral.
• Lysne, 2018 WY 107, 426 P.3d 290; Hart, 2022 WY 81, 512 P.3d 640; Guerrero, 2015 WY 88, 352 P.3d 262; Baker, 2017 WY 60, 395 P.3d 1095; Eaton, 2015 WY 107, 356 P.3d 765: These cases outline causation standards in Wyoming workers’ compensation law—most critically, that causation generally requires proof to a reasonable degree of medical probability, typically by expert testimony, though “exceedingly obvious” events may not require medical proof. Polzer uses these cases to show that while causation is sometimes straightforward, in this case it was medically complex and contested, which triggers Medical Commission referral.

Legal Reasoning

The Court’s reasoning unfolds in four linked steps:

1. Mandatory referral when the primary issue is medically contested. The statute’s “shall” is unequivocal: when a case is “medically contested,” the Division must refer it to the Medical Commission. This lacks administrative discretion and, if ignored, results in agency action “not in accordance with law” or “without observance of procedure required by law” under WAPA.
2. “Medically contested” means the primary issue requires medical judgment on complex facts or conflicting diagnoses. Drawing from the Division rule and McIntosh, the Court reiterates that the enumerated categories (impairment ratings, permanent total disability, continued TTD eligibility, and other disputes requiring evaluation of conflicting medical evidence) are illustrative, not exclusive. The touchstone is the primacy of medical judgment.
3. Referral decision must be based on the information available at the time of referral. Citing Bando, the Court emphasizes a fact-intensive, time-specific inquiry: what did the Division know when it decided to send the matter to the OAH? Here, the Division issued its final determination on June 22, 2023, and referred the case on August 23, 2023. By then, the record contained multiple medical opinions in conflict about causation and aggravation of a preexisting degenerative condition.
4. Application to the record: the case was medically contested. The Division knew:
   • Treating neurosurgeons (Drs. Schubert and Beer) supported that the fall caused or aggravated cervical pathology.
   • Two IME physicians (Drs. Shay and Monger) opined there was no causal relationship, referencing initial lack of neck complaints and degenerative findings.
   • A peer reviewer (Dr. Wieder) reported insufficient information to determine causation, and a second peer review (Dr. Eskay-Auerbach) aligned with Dr. Shay.
   This clash of expert medical views on diagnosis, mechanism, and the significance of degenerative changes versus traumatic aggravation made the dispute quintessentially medical. Consequently, § 27-14-616(b)(iv) and the Division’s rule required Medical Commission referral.

Having found the case medically contested, the Court reverses and remands for disposition consistent with its opinion—i.e., for the Medical Commission to hear and resolve the causation question.

Impact and Prospective Guidance

Polzer will have concrete, systemic effects on Wyoming workers’ compensation practice:

• Referral discipline and record review at the Division. The Division must systematically review the medical record before referral. If competing expert assessments exist on causation, prognosis, or the propriety of care, the case belongs in the Medical Commission. Sending medically contested cases to the OAH risks reversal, delay, and duplication of proceedings.
• Clearer forum boundaries. OAH remains the correct forum where the primary issue is legal (e.g., res judicata, collateral estoppel, statutory interpretation) or where medical issues are not contested or are “exceedingly obvious,” as in one-time traumatic incidents requiring no medical expertise to link event and injury.
• Strategic considerations for parties. Claimants and employers should identify and present conflicting medical opinions early. While the referral decision is not subject to administrative review, it is subject to judicial review. Parties should preserve the issue by clearly articulating the medical conflicts in the record when contesting an OAH referral.
• Medical Commission’s central role in causation-aggravation disputes. Aggravation of preexisting conditions—especially in the presence of degenerative findings—is a paradigmatic “medically contested” issue. Polzer signals that such disputes should presumptively be heard by a medical panel.
• Docket management. Expect a shift of medically complex causation disputes from the OAH to the Medical Commission, with attendant docket and scheduling considerations for the Commission’s three-physician panels.

Complex Concepts Simplified

• Medically Contested Case. A dispute where the main question cannot be answered without weighing medical expertise—most commonly:
  • Determining whether a work event caused, aggravated, or accelerated a condition;
  • Evaluating competing diagnoses or interpretations of imaging and clinical findings;
  • Assessing the reasonableness and necessity of medical treatment.
  It is not limited to impairment ratings or PTD determinations; any dispute primarily driven by conflicting medical evidence qualifies.
• Reasonable Degree of Medical Probability. The standard of proof for causation. Opinions couched as “possibly” or “could be” are generally insufficient. Opinions that a work event “probably” or “most likely” caused or materially contributed to the condition satisfy the standard.
• Aggravation of a Preexisting Condition. Wyoming recognizes compensability where a workplace incident materially aggravates a preexisting, even degenerative, condition. Sorting authentic aggravation from natural progression is inherently medical and often contested.
• OAH vs. Medical Commission. OAH is presided over by administrative law judges and is appropriate for legal or non-medically contested disputes. The Medical Commission is a three-physician panel that hears medically contested cases. The Division must send cases to the correct forum at the outset.
• Standard of Judicial Review (WAPA). Courts set aside agency action that is “not in accordance with law” or taken “without observance of procedure required by law,” and they review legal conclusions de novo. The Court does not defer to the district court; it reviews as if from the agency.
• Referral Decision Reviewability. Although the statute states the referral decision is “not subject to further administrative review,” it is still subject to judicial review. Parties may challenge an improper forum assignment on appeal.

Applying Polzer: Practical Checkpoints for Referral Decisions

To operationalize Polzer, the Division (and counsel) can use the following checkpoints at the time of referral:

1. Identify the primary issue. Is it causation, impairment extent, treatment reasonableness, or a purely legal question?
2. Inventory the medical record. Are there conflicting physician opinions, IMEs, or peer reviews on diagnosis, mechanism, or treatment necessity?
3. Assess whether resolving the dispute requires medical judgment about complex facts (e.g., imaging interpretation, degenerative vs. traumatic changes, symptom onset and biomechanics).
4. If yes to (2) or (3), refer to the Medical Commission; if the primary issue is purely legal or medically obvious and uncontested, refer to the OAH.
5. Document the basis for referral keyed to what is known at the time. This record will be the yardstick for judicial review if challenged later.

Case-Specific Observations

• Conflicting medical evidence was unmistakable. Treating neurosurgeons supported causation/aggravation; two IMEs opposed it; peer review was mixed. This is the archetype of a medically contested case.
• “No neck pain” in initial records is not dispositive of the forum. While relevant to the merits, the presence of such facts weighed differently by medical experts underscores why the Medical Commission—which can evaluate those conflicts from a clinical vantage—is the proper tribunal.
• The Court did not reach the merits of causation. Polzer is about forum selection, not whether Mr. Polzer’s cervical condition is compensable. On remand, the Medical Commission will resolve the merits under the “reasonable degree of medical probability” standard.
• Temporal focus matters. The Court anchored its analysis to what the Division knew as of June–August 2023 when it decided the referral. That snapshot included conflicting medical opinions; thus, referral to the Medical Commission was mandatory at that time.

Conclusion

Polzer v. State ex rel. Department of Workforce Services, Workers’ Compensation Division crystallizes and applies a settled but critical procedural rule: if the primary issue in a workers’ compensation dispute is medically contested—meaning it turns on medical judgment in the face of complex facts or conflicting diagnoses—the Division must refer the case to the Medical Commission. The Court underscores that the referral decision must be grounded in the record as it exists at the time of referral and that the statute’s “shall” leaves no discretion to deviate. The decision promotes adjudicative accuracy by ensuring medically complex disputes are resolved by panels with clinical expertise, reduces the risk of misallocation to the OAH, and provides clear guidance to the Division and litigants. Going forward, parties should expect causation-aggravation controversies, particularly those involving degenerative conditions and divergent expert opinions, to be heard by the Medical Commission in the first instance.

Key Authorities Cited

• Wyo. Stat. Ann. § 27-14-616(b)(iv) (mandatory Medical Commission referral for medically contested cases)
• Wyo. Stat. Ann. § 27-14-601(k)(v) (notice to appropriate hearing authority)
• Division Rule, Ch. 6, § 1(a)(i) (definition of “medically contested cases”)
• Wyo. Stat. Ann. § 16-3-114(c)(ii)(A), (D) (WAPA judicial review standards)
• Bando v. Clure Bros. Furniture, 980 P.2d 323 (Wyo. 1999)
• French v. Amax Coal West, 960 P.2d 1023 (Wyo. 1998)
• Jacobs v. State ex rel., Wyo. Med. Comm’n, 2005 WY 104, 118 P.3d 441
• McIntosh v. State ex rel. Wyo. Med. Comm’n, 2007 WY 108, 162 P.3d 483
• McCallister v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2022 WY 66, 510 P.3d 1051
• Hart v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2022 WY 81, 512 P.3d 640
• Guerrero v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2015 WY 88, 352 P.3d 262
• Baker v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2017 WY 60, 395 P.3d 1095
• Eaton v. State ex rel. Dep’t of Workforce Servs., 2015 WY 107, 356 P.3d 765
• Matter of Lysne, 2018 WY 107, 426 P.3d 290
• Vandom v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2023 WY 51, 529 P.3d 1084
• Boylen v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2022 WY 39, 506 P.3d 765
• Matter of Worker's Comp. Claim of Vinson, 2020 WY 126, 473 P.3d 299