Alfredo Suarez, V. Masco Corporation

Court of Appeals of Washington·Decided January 19, 2022·No. 55377-5·Unpublished

Opinion

Filed

Washington State

Court of Appeals

Division Two

January 19, 2022

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION II

ALFREDO SUAREZ, No. 55377-5-II

Appellant,

v.

MASCO CORPORATION, TOPBUILD; and UNPUBLISHED OPINION DEPARTMENT OF LABOR AND INDUSTRIES OF THE STATE OF WASHINGTON,

Respondents.

GLASGOW, A.C.J.—Alfredo Suarez was injured while working for Masco Corporation, TopBuild (Masco), and he applied for workers’ compensation benefits. To administer Suarez’s claim, Masco requested that Suarez attend multiple independent medical examinations. Suarez’s counsel objected to one of the examinations, so Suarez did not attend. As a result, the Department of Labor and Industries suspended Suarez’s time-loss benefits. Both the Board of Industrial Insurance Appeals and the superior court affirmed the suspension.

On appeal, Suarez argues that he had good cause for failing to attend the medical examination and that the superior court erred because it failed to properly weigh all of the evidence. We hold substantial evidence supports the superior court’s factual findings, and those findings support the superior court’s conclusions that Suarez was required to submit to the examination and lacked good cause to refuse under RCW 51.32.110. Accordingly, we affirm.

FACTS

In 2012, while employed by Masco,1 Suarez injured his neck and right shoulder. Masco is a self-insured employer.

Suarez opened a claim with the Department and sought benefits. A third party claim administrator requested that Suarez attend several independent medical examinations: one in November 2013 with Dr. Clarence Fossier, an orthopedic surgeon; one in November 2014 with Dr. John Thompson, another orthopedic surgeon; and one in January 2015 with Dr. Thomas Rosenbaum, a neurosurgeon. Suarez attended all three of these examinations.

One of Suarez’s medical concerns was adhesive capsulitis, or “frozen shoulder,” causing pain and limiting movement in both of his shoulders. Certified Appeal Board R. (CBR) at 325. Fossier opined that Suarez’s frozen right shoulder was “causally related to the industrial injury on a more-probable-than-not basis.” CBR at 318. In contrast, Thompson reported that “the impairment of his shoulders is 100% due to diabetic frozen shoulder and not related to his work injury.” CBR at 337. Rosenbaum did not believe the pain in Suarez’s left shoulder was related to his industrial injury and attributed it to Suarez’s diabetes. But he opted to “defer to orthopedic surgery” on whether Suarez’s frozen right shoulder was related to Suarez’s industrial injury or his diabetes, as well as whether this condition required additional treatment or employment restrictions. CBR at 326-27.

In April 2015, the claim administrator requested that Suarez attend another examination in May with Dr. Joseph Lynch, a third orthopedic surgeon. The letter stated, “We require 7 days

1 At the time, Masco was named Gale Insulation.

notice of canceling or rescheduling exams.” CBR at 234. Suarez’s counsel promptly sent a letter advising that Suarez would not attend the examination, so the claim administrator “should cancel . . . to avoid a no show fee.” CBR at 235. He explained, “On January 30, 2015, you scheduled a medical evaluation with Thomas Rosenbaum, MD, which claimant attended. There is no reason to reschedule [another] medical evaluation less than four months [after] the previous one.” Id.

Masco’s counsel urged Suarez’s counsel to reconsider. He advised that Masco would seek to suspend all of Suarez’s benefits if he did not attend the examination and explained that the examination was intended to “provide clarity in determining whether the shoulder condition is related” to Suarez’s industrial injury. CBR at 236. Moreover, Suarez’s primary physician, Dr. Richard Heitsch, was “contending the shoulder condition is related but . . . also acknowledging that [Suarez] might not need more treatment.” Id.

Suarez did not attend the examination in May 2015 and was assessed a no-show fee. Masco asked Suarez’s counsel to “confirm in writing [his] belief as to good cause as to why the evaluation was unreasonable.” CBR at 238. Again, Suarez’s counsel explained that Suarez “just had a medical evaluation at the request of [Masco] less than four months ago, and it did not seem reasonable that he have another one so soon.” CBR at 239.

I. NO-SHOW FEE HEARING (DOCKET NO. 15 23126)

In July 2015, Masco requested that the Department’s claim adjudicator suspend Suarez’s benefits and order payment of the no-show fee. Suarez’s counsel wrote to the claim adjudicator, explaining that “when the notice came in” for this examination, “it had only been three months since the last medical evaluation, and I objected on that basis.” CBR at 242.

During this time, an appeal of Suarez’s entitlement to benefits during 2013 and 2014 was pending before the Board. In August, Suarez wrote to the Department’s penalty adjudicator, stating, “Employer’s attorney has two orthopedic surgeons scheduled to testify before the [Board] who have examined claimant, as well as Thomas Rosenbaum, MD, and claimant has one witness, Richard Heitsch, MD. So this looks like overkill to me to have another orthopedic surgeon available to testify.” CBR at 245.

The Department granted Masco’s request to reduce Suarez’s time-loss benefits by the amount of the no-show fee “because the worker refused or failed to attend the scheduled medical examination . . . without good cause.” CBR at 246. However, it “considered withdrawn” Masco’s request to suspend Suarez’s benefits because Masco’s letter did not meet the guidelines for establishing Suarez’s noncooperation. CBR at 248. The Department asked Masco to review the guidelines before resubmitting the request.

Suarez protested the no-show fee assessment, arguing he had good cause not to attend the May 2015 examination because he had attended two other examinations in the last six months— one in November 2014 and one in January 2015. The Department reconsidered and reaffirmed its decision, advising, “Not attending an independent medical examination because you previously attend[ed] an examination[] is not considered good cause.” CBR at 253.

Suarez appealed. At a hearing before Industrial Appeals Judge Steven Yeager, Suarez’s counsel testified that “the basis for objection” to the May 2015 examination with Dr. Lynch was that Suarez “just had an examination within a four-month period.” CBR at 270-71. He agreed that this was the reason given to Masco and the Department’s claims adjudicator and that he had told the Department’s penalty adjudicator “it looked like [Masco was] piling on essentially medical

examiners” to be witnesses in the separate, pending appeal of Suarez’s 2013 and 2014 benefits. CBR at 273. When specifically asked to articulate his reason for the objection for purposes of establishing good cause, Suarez’s counsel stated, “So that was a third examination within a six- month period of time, and I didn’t think it was reasonable.” CBR at 275.

Masco’s counsel then confirmed that one of the issues presented “per the litigation order, is whether or not [Suarez] had good cause for failing to attend” the examination. CBR at 276. Judge Yeager agreed that the issue of good cause appeared to be “encompassed in the department order.” Id. Masco’s counsel concluded, “[I]t’s our position that the worker has been noncooperative and that the fee should be assessed; and, in the alternative, if the fee should not be assessed because the attorney had let us know more than seven days in advance, that suspension of benefits would have been the appropriate remedy.” CBR at 295. In response, Suarez argued that he was the only party who appealed the Department’s order and that the order only assessed a no- show fee; it did not suspend benefits.

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