Eldina Novalic, V. Peacehealth Sw Wa Medical Center

Court of Appeals of Washington·Decided July 16, 2024·No. 58451-4·Unpublished

Opinion

Filed

Washington State

Court of Appeals

Division Two

July 16, 2024

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION II

ELDINA NOVALIC, No. 58451-4-II

Appellant,

v.

UNPUBLISHED OPINION

PEACEHEALTH AND THE DEPARTMENT OF LABOR AND INDUSTRIES,

Respondents.

PRICE, J. — Eldina Novalic was injured while working as a nurse for PeaceHealth Southwest Washington Medical Center (PeaceHealth). She applied for workers’ compensation benefits pursuant to the Industrial Insurance Act (IIA), Title 51 RCW. As part of the administration of Novalic’s claim, PeaceHealth requested that Novalic attend an independent medical examination (IME). Because of the COVID-19 pandemic and related travel restrictions, PeaceHealth notified Novalic shortly before the examination that it would be conducted remotely by telehealth. Novalic’s counsel objected, and Novalic did not attend.

As a result of Novalic’s failure to attend the exam, the Department of Labor and Industries (Department) suspended her benefits. Both the Board of Industrial Insurance Appeals (BIIA) and the superior court affirmed the suspension of benefits.

Novalic appeals the superior court’s order affirming the decision of the BIIA. Novalic argues that the superior court erred because (1) she was given inadequate notice that the exam

would be by telehealth and (2) PeaceHealth violated the Department’s telehealth policy when it shifted the exam to telehealth without her consent. Novalic also requests attorney fees.

We affirm.

FACTS

I. BACKGROUND In 2019, Novalic injured her back while employed by PeaceHealth, a self-insured employer.1 Novalic opened a claim with the Department and sought benefits under the IIA. The Department initially allowed the claim.

Some time later, one of Novalic’s evaluating doctors believed that as a consequence of her back injury, Novalic was suffering from anxiety. As a result, CorVel Corporation (CorVel), the claims administrator handling Novalic’s claim on behalf of PeaceHealth, scheduled an IME with a psychiatrist. Initially, the examination was scheduled for February 2020, but it was canceled before it could take place. II. THE DEPARTMENT’S TEMPORARY TELEHEALTH POLICY The next month, in response to the onset of the COVID-19 pandemic, the Department issued a new payment policy called the “Temporary Record Review & Telehealth Independent Medical Exams Policy.”2 Administrative Record (AR) at 18. One portion of the policy was

1 Self-insured employers “pay directly to workers any disability and medical benefits.” Dep’t of Lab. & Indus. v. Ortiz, 194 Wn. App. 146, 152, 374 P.3d 258 (2016). The IIA defines a “self insurer” as an “employer . . . which has been authorized under [the IIA] to carry its own liability to its employees covered by this title.” RCW 51.08.173. 2 On the first page of the policy, immediately above the title, the document carries the description “Payment Policies for Healthcare Services Provided to Injured Workers and Crime Victims.” AR at 18.

entitled “Payment [P]olicy: Temporary Telehealth IME and Record Review.” AR at 20. In that portion, the policy explained that it was designed to limit the spread of COVID-19 while allowing IMEs to continue. The policy provided that the Department was temporarily “allowing the delivery of independent medical exams . . . via telehealth.” AR at 20. The policy further instructed providers on how to conduct telehealth exams to be able to bill for them and how to bill and document telehealth exams.

However, the payment-related provisions also contained several clauses that purported to limit the provider’s ability to conduct telehealth exams. For example, the policy stated that the provider was responsible for assessing “a worker’s ability and willingness to participate in an exam via telehealth, as well as ensuring telehealth is the appropriate method of service delivery for safe and effective care.” AR at 20. The policy also provided that the “claims manager, worker, representative, employer, or any other party to the claim[] must also agree a telehealth IME is appropriate.” AR at 20 (emphasis added). III. MAY EXAM NOTICES, NOVALIC’S RESPONSE, AND THE DEPARTMENT’S ORDER On May 7, 2020, nearly two months after the issuance of the Department’s telehealth policy, CorVel provided 14 days’ advanced notice to Novalic’s counsel that a psychiatrist would conduct an IME of Novalic. CorVel communicated the date, time, and that the location of the exam would be in Vancouver. The notice stated that Novalic’s attendance of the examination was mandatory and advised that failure to attend the exam may result in the suspension of benefits.

On May 19, 2020, three days before the exam was scheduled to take place, Novalic was informed that the exam would be shifted from being in person to a telehealth appointment. Novalic was told that she had the option of attending the exam at the Vancouver office where staff could

assist Novalic in connecting with the psychiatrist on an office computer or she could attend the telehealth appointment using any smartphone, tablet, or computer.

The next day, Novalic’s attorney objected and advised PeaceHealth that Novalic would not attend the IME because it was not going to be conducted in person. Novalic’s attorney explained:

The mental status examination, which is the most important part of the psychiatric evaluation, needs to be based on personal observations.

AR at 186. As a result of Novalic’s refusal to attend, the exam was cancelled.

Several months later, Novalic’s attorney sent a series of letters to the Department in response to correspondence from PeaceHealth. Novalic’s attorney further explained his objection to using telehealth as a way to administer a mental status examination, claiming that

[t]he use of teleconferencing produces substantial visual distortions, as evidenced by national video productions, such as witnessed on PBS NewsHour, broadcast[ed]

nightly.

AR at 188. Novalic’s attorney also argued that PeaceHealth did not provide Novalic with the required 14 days of notice that the exam would be held by telehealth. Novalic’s attorney later claimed that the exam could not be conducted remotely because “[t]he appearance, body gestures and manner of speech are distorted by teleconferencing.” AR at 189.

The Department rejected these arguments and issued an order on July 31, 2020, suspending Novalic’s benefits based on her refusal to “submit to, and/or cooperate with a medical examination.” AR at 219. IV. PROCEDURAL HISTORY Novalic appealed the Department’s order to the BIIA. Both Novalic and PeaceHealth filed cross motions for summary judgment. Novalic claimed that PeaceHealth did not have the authority

to require her to attend the exam by telehealth and, as a result, the Department did not have the authority to suspend her benefits. Novalic did not provide any declarations from medical experts supporting her position that in-person observations were necessary for psychiatric examinations.

PeaceHealth argued that the Department’s order should be affirmed because Novalic failed to establish good cause for her failure to attend the exam. Unlike Novalic, PeaceHealth supported its motion for summary judgment with declarations from three licensed and board-certified psychiatrists. Dr. Jean Dalpe, the provider who was assigned to Novalic’s examination, explained that the IME was converted to a telehealth exam due to COVID-19 travel restrictions. All three psychiatrists stated that they regularly used telehealth to conduct IMEs and in their regular practices due to the pandemic. They all opined that telehealth was an appropriate alternative to in- person exams for evaluating psychiatric conditions.

In a proposed decision and order, the industrial appeals judge (IAJ) rejected Novalic’s argument that conducting an IME by telehealth was unauthorized and affirmed the suspension of her benefits. The IAJ concluded that PeaceHealth’s notice satisfied WAC 296-14-410(3) and that Novalic failed to establish good cause for failing to attend the exam.

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