Lynn v. STATE DEPT. OF LABOR & INDUSTRIES

125 P.3d 202
CourtCourt of Appeals of Washington
DecidedDecember 19, 2005
Docket55251-1-I
StatusPublished
Cited by41 cases

This text of 125 P.3d 202 (Lynn v. STATE DEPT. OF LABOR & INDUSTRIES) 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
Lynn v. STATE DEPT. OF LABOR & INDUSTRIES, 125 P.3d 202 (Wash. Ct. App. 2005).

Opinion

125 P.3d 202 (2005)
130 Wash.App. 829

Jimmy LYNN, Appellant,
v.
WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES, Respondent.

No. 55251-1-I.

Court of Appeals of Washington, Division One.

December 19, 2005.

*203 Donna L. Mack, Seattle, WA, for Appellant.

Portia Therese C. Guerrero, Office of the Attorney General, Scott Kinney & Fjelstad, Seattle, WA, for Respondent.

ELLINGTON, J.

¶ 1 In 1999, the Department of Labor and Industries entered a final order calculating Jimmy Lynn's compensation benefits. Lynn did not appeal. In 2001, in Cockle v. Department of Labor and Industries,[1] the Washington Supreme Court ruled that the value of health care benefits must be included in calculating workers' compensation. Lynn contends that under RCW 51.28.040, Cockle constituted a change of circumstances justifying recalculation of his benefits. We must disagree, and we therefore affirm summary judgment for L & I.

BACKGROUND

¶ 2 Until he was injured in 1994, Jimmy Lynn worked at Einar Johanson Insulation and Glass, Inc., receiving wages of approximately $125 daily. The company also paid Lynn's monthly health insurance premium of $181.69. Lynn was awarded workers' compensation benefits by the Department of Labor and Industries (L & I).

¶ 3 L & I calculates a time-loss compensation rate based upon the claimant's monthly cash wages, which include "the reasonable value of board, housing, fuel, or other consideration of like nature received from the employer as part of the contract of hire" at "the time of the injury."[2] L & I uses a questionnaire to gain the relevant information from the claimant. Before the decision in Cockle, L & I did not consider employer-paid health benefit premiums to be wages and did not factor the value of the premiums into the compensation rate. The questionnaire Lynn filled out, which was the standard form in use at the time, did not ask about employer-provided health insurance.

¶ 4 On December 29, 1995, Lynn's employer stopped paying Lynn's medical insurance premiums. Lynn did not notify L & I that premium payments ceased.

¶ 5 On March 22, 1999, L & I issued a permanent order setting Lynn's time-loss compensation rate and stating its basis (Lynn's wages, marital status, and dependent status). The order made no reference to health care benefits. The order instructed Lynn to notify his claim manager within 60 days "[i]f marital or dependent status, wage information, or date of injury or disease manifestation *204 is incorrect."[3] The order also included the standard notice of legal rights and instructions for pursuing an appeal: "This order will become final 60 days after you receive it unless you file a written request for reconsideration or an appeal within that time."[4] Lynn did not appeal the order.

¶ 6 In June 1999, Division Two of this court decided Cockle v. Department of Labor and Industries,[5] holding that an injured worker's time-loss benefit rate should take into account the value of health insurance the worker was receiving when injured. In January 2001, the Washington Supreme Court affirmed, holding that health care coverage is "consideration of like nature" and is therefore wages.[6] The Cockle ruling increased benefits for many workers whose claims arose thereafter.

¶ 7 On March 11, 2002, Lynn was declared totally and permanently disabled and was moved to L & I's pension rolls. L & I established Lynn's pension rate based upon the 1999 order.

¶ 8 On May 29, 2002, almost three years after this court's decision and more than one year after the Supreme Court's decision, Lynn requested that L & I adjust both his time-loss compensation rate and his newly established pension rate in light of Cockle. L & I denied the request, and the Board of Industrial Insurance Appeals (BIIA) affirmed. Lynn appealed to King County Superior Court, which granted summary judgment to L & I on three grounds: (1) the change in circumstances statute, RCW 51.28.040, does not apply, (2) res judicata bars Lynn's claim, and (3) equitable estoppel does not overcome res judicata. This appeal followed. The usual standard of review on summary judgment applies.[7]

ANALYSIS

¶ 9 RCW 58.28.040: Change of Circumstances. A recipient's benefit rate is ordinarily final and permanent when the claim is closed by L & I. However, the Industrial Insurance Act provides for adjustment of a closed claim in limited situations:

If change of circumstances warrants an increase or rearrangement of compensation, like application shall be made therefor. Where the application has been granted, compensation and other benefits if in order shall be allowed for periods of time up to sixty days prior to the receipt of such application.[[8]]

¶ 10 Lynn contends his benefit rate should be adjusted under this statute, and proffers two events as changes in circumstances: first, cancellation of his medical benefits after he completed L & I's questionnaire; and second, issuance of the Cockle decision. Essentially this is one argument, raising a single issue: whether judicial interpretation of the governing statute constitutes a change of circumstances under RCW 51.28.040.

¶ 11 RCW 51.28.040 has been applied only where the claimant's situation is altered by events unique to the claimant. For example, In re Margo Schmitz involved a claimant whose benefit rate was adjusted because of a retroactive change in the wages upon which the benefit had been calculated.[9] In In re Charles Stewart, free rent was a part of the claimant's compensation.[10] He continued to receive free rent even after his claim was *205 closed. He later lost the rent-free apartment, and his benefit rate was adjusted under the statute.

¶ 12 In both of these cases, an event changed the claimant's personal circumstances, and the event occurred after the benefits claim was closed. Lynn's health care premiums were terminated before the final order issued. Lynn's position was thus identical to that of the claimant in Cockle; like her, he could have challenged the final order within the 60-day appeal period. He did not do so.

¶ 13 BIIA decisions have consistently held that a change in circumstances under RCW 51.28. 040 "encompasses a change of facts personal to the claimant, not a change in the judicial interpretation in the law."[11] In four decisions since Cockle, the BIIA ruled that res judicata barred recalculation of benefits, noting in each instance that where the claimant was not receiving health care benefits at the time the final order issued, the claimant, "like the claimant in Cockle, could easily have appealed, but did not do so."[12]

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Cite This Page — Counsel Stack

Bluebook (online)
125 P.3d 202, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lynn-v-state-dept-of-labor-industries-washctapp-2005.