Cascade Valley Hosp. v. Stach

215 P.3d 1043
CourtCourt of Appeals of Washington
DecidedSeptember 21, 2009
Docket61940-3-I
StatusPublished
Cited by5 cases

This text of 215 P.3d 1043 (Cascade Valley Hosp. v. Stach) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cascade Valley Hosp. v. Stach, 215 P.3d 1043 (Wash. Ct. App. 2009).

Opinion

215 P.3d 1043 (2009)

CASCADE VALLEY HOSPITAL and Public Hospital District Workers Compensation Trust, Appellants
v.
Lori D. STACH and State of Washington, Department of Labor and Industries, Respondents.

No. 61940-3-I.

Court of Appeals of Washington, Division 1.

September 21, 2009.

*1044 Gilbert Stratton, Marne Horstman, Craig Jessup & Stratton PLLC, Tacoma, WA, for Appellants.

William Taylor, Attorney at Law, Everett, WA, James Hawk, Office of Attorney General, Seattle, WA, for Respondents.

ELLINGTON, J.

¶ 1 In this workers' compensation case, we are asked to clarify the authority of the director of the Department of Labor and Industries (the Department) in so-called over-seven claims (that is, claims alleging improvement or aggravation of a work related injury made more than seven years after the claim was first closed).[1] Where aggravation is shown, the director has discretion to reopen over-seven claims for consideration of medical and time loss benefits. A grant of specific benefits must be supported by a preponderance of the evidence.

¶ 2 Here, the director has exercised discretion to reopen Lori Stach's over-seven claim for aggravation of a back injury. This is within the director's powers under the statutes, and we affirm.

BACKGROUND

¶ 3 In 1988, Lori Stach injured her lower back while working for her self-insured employer, Cascade Valley Hospital. Her claim was allowed and she underwent back surgery. Her claim was initially closed in 1991 with an award of category 5 low back impairment. The claim was reopened in 1993, and Stach received conservative care but no surgery. The claim was closed in December 1994 with no additional disability award.

¶ 4 In 2004, Stach's physician recommended physical therapy, and on March 3, 2004, the Department reopened Stach's now over-seven claim for medical benefits only.

¶ 5 On June 2, 2005, Stach's physician requested authorization to perform two back surgeries. Cascade did not object. The surgeries were approved and occurred August 19 and 29.

¶ 6 Stach filed a request for time loss compensation. On February 3, 2006, the director wrote to Stach informing her that she was eligible to receive time loss benefits from the day her physician requested authorization for surgery. He also advised Stach she "may" also be eligible to receive a permanent partial disability award and would be contacted by the claims manager regarding that decision.[2] The Department issued an order on February 9, 2006 reopening Stach's back injury claim "for such additional disability benefits as are authorized by law, effective 06/02/05."[3] Cascade appealed.

¶ 7 In a separate set of events, in January 2001, Stach injured her right knee while *1045 working for a State fund employer. She filed a claim for benefits, which was allowed. She had several knee surgeries, and received time loss compensation beginning March 27, 2001. In 2004, she was found to be unable to return to work at the job of injury and to have no transferable skills. She was referred for vocational services. A training course in Las Vegas was considered, but the organizers refused to become a provider for the Department.

¶ 8 On May 9, 2005, apparently on the basis of Stach's worsened back condition and the unavailability of a local provider for vocational training, the Department issued a final order ending Stach's time loss benefits on the knee claim because "vocational services have ended."[4] Stach protested, and on October 7, 2005, the Department changed its May 9 order to a temporary order and resumed time loss benefits on an interlocutory basis pending resolution of Stach's back claim.

¶ 9 The back claim wound its way through the administrative process upon Cascade's appeal, which alleged the director's February 9, 2006 order violated res judicata and was erroneously issued. Eventually the Board of Industrial Insurance Appeals (the Board) affirmed the order, as did the superior court. Cascade now appeals to this court.

ANALYSIS

¶ 10 The Industrial Insurance Act, chapter 51.52 RCW, provides for de novo superior court review of the Board's determination.[5] The party seeking review bears the burden of showing that the Board's decision was improper.[6] The trier of fact applies the standards set forth in RCW 51.52.115:

The Board's decision is prima facie correct under RCW 51.52.115, and a party attacking the decision must support its challenge by a preponderance of the evidence. On review, the superior court may substitute its own findings and decision for the Board's only if it finds from "`a fair preponderance of credible evidence' that the Board's findings and decision are incorrect."[[7]]

This court reviews the superior court's decision to determine whether substantial evidence supports the factual findings and whether the findings support the conclusions of law.[8] On the latter question, our review is de novo.[9] Cascade does not challenge the findings of fact, which are thus verities on appeal.[10]

¶ 11 Cascade first argues the March 3, 2004 order which reopened Stach's over-seven claim for medical benefits only is res judicata and bars the director's February 2006 order reopening the claim for time loss benefits.[11] This is incorrect.

¶ 12 An order determining disability "is res judicata as to any issue before the department at the time it was entered, but is not res judicata as to any aggravation occurring subsequent to that date."[12] Stach's back claim was reopened in 2004 to authorize physical therapy recommended by her physician. The 2004 order did not address time loss compensation. By June of 2005, her *1046 physician had requested approval of two surgeries, and Cascade made no objection. Aggravation of her injury is thus not disputed. Res judicata does not bar consideration of other benefits available under the statute.

¶ 13 Cascade next contends the February 2006 order was erroneously issued because the statute limits the director's authority in over-seven claims to medical benefits only. This also is incorrect.

¶ 14 The statute provides:

If aggravation, diminution, or termination of disability takes place, the director may, upon the application of the beneficiary, made within seven years from the date the first closing order becomes final, or at any time upon his or her own motion, readjust the rate of compensation in accordance with the rules in this section provided for the same, or in a proper case terminate the payment: PROVIDED, That the director may, upon application of the worker made at any time, provide proper and necessary medical and surgical services as authorized under RCW 51.36.010.[[13]]

¶ 15 The statute has been amended several times to change the limitation period for applications, but its general effect has remained the same: to permit readjustment or termination of benefits when workers experience aggravation or improvement of their conditions.[14] With regard to disability

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Bluebook (online)
215 P.3d 1043, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cascade-valley-hosp-v-stach-washctapp-2009.