Matthews v. Department of Labor & Industries

288 P.3d 630, 171 Wash. App. 477
CourtCourt of Appeals of Washington
DecidedJuly 17, 2012
DocketNo. 41369-8-II
StatusPublished
Cited by7 cases

This text of 288 P.3d 630 (Matthews v. Department 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
Matthews v. Department of Labor & Industries, 288 P.3d 630, 171 Wash. App. 477 (Wash. Ct. App. 2012).

Opinion

Hunt, J.

¶1 Elaine Matthews appeals the superior court’s order affirming the Board of Industrial Insurance’s final order that she repay the Department of Labor and Industries’ overpaid time-loss compensation benefits for twelve work periods during which she had received benefits while she was earning wages from three sequential jobs. She argues that the superior court and the Board (1) lacked subject matter jurisdiction to enter their respective orders because the Department had not decided whether she was still “entitle [d] to time-loss compensation” benefits, despite her temporary work, or whether she had induced her over-payments by a means other than the unproved “willful misrepresentation” alleged in the Department’s order; and (2) erred in concluding that she had been overpaid time-loss [481]*481compensation benefits where the Department had determined her overpayments based on only the alleged and unproved willful misrepresentation, without considering whether she had engaged in innocent misrepresentation or some other statutory ground justifying recoupment of the overpayment. Br. of Appellant at 9-10.

¶2 We hold that, after finding insufficient proof of willful misrepresentation to support the Department’s imposition of a statutory 50 percent penalty (which the Board vacated), the Board and the superior court had jurisdiction and did not exceed their respective scopes of review in affirming (1) the Department’s finding of overpayment of time-loss compensation benefits to Matthews while she was employed and (2) the Department’s order that Matthews reimburse such overpayments to the Department in an amount to be recalculated on remand. We affirm the Board and the superior court’s upholding the Department’s overpayment finding; and we remand to determine the amount of overpayment that Matthews must reimburse the Department.1

FACTS

¶3 Elaine Matthews immigrated to the United States from Sierra Leone 15 years ago, learned to speak English, obtained her GED (general education development) certificate, and earned a four-year nursing degree from Walla Walla Community College. When limited English skills hindered her ability to pass the state licensing exam, she began working as a licensed practical nurse for a nursing agency.

[482]*482I. Overpayment of Benefits

A. Work Injury; Commencement of Time-Loss Benefits

¶4 Around May 18,2006, Matthews slipped, fell, and was injured while working at Puget Sound Health Care Center. The fall caused a broken tooth and head and back injuries, resulting in persistent numbness and tingling sensations in her feet and partial loss of eyesight in her left eye. She filed an industrial insurance claim with the Department, which allowed her claim and began sending her time-loss compensation, or “wage replacement,” benefits on June 21. Administrative Record (AR) at 331.

¶5 Matthews was eligible to continue receiving these time-loss compensation benefits as long as she was “unable to work.” AR at 331. But as a condition of receiving these benefits, the Department required Matthews (1) to submit monthly worker verification forms certifying that she had not performed “any work, paid or unpaid” during the previous payment period and that she was seeking continued time-loss compensation benefits; (2) to confer regularly with vocational rehabilitation counselor Michelle Barré to assess whether she (Matthews) was able to work; and (3) to have a medical provider certify that she remained unable to work. AR at 447. To enforce this condition, each of Matthews’ time-loss compensation payment orders, which the Department mailed with her benefit checks, included the following admonishment:

DO NOT CASH THIS WARRANT IF YOU WERE RELEASED FOR WORK OR RETURNED TO ANY TYPE OF WORK DURING THE PERIOD PAID BY THIS ORDER OF PAYMENT.

AR at 473 (emphasis added).

¶6 When Matthews first began receiving time-loss compensation benefits, she “consistently and regularly” returned the Department’s required worker verification forms, certi[483]*483fying that she had not performed any work during the previous payment period. AR at 340. About a year later, she began feeling “depressed”; feared losing her nursing skills; asked her doctor about trying to return to work gradually; and, in summer 2007, attempted to reenter the workforce as a licensed practical nurse.

B. Unreported Earnings while Receiving Time-Loss Benefits

¶7 In May 2007, Matthews stopped returning her worker verification forms to the Department; within two months, she began working again. From July 6,2007, to January 20, 2008, she received wages from three different employers while simultaneously receiving time-loss compensation benefits from the Department. She failed to report any of her employment or her wages to the Department; and she did not notify her claims manager or her vocational rehabilitation counselor (Barré) that she had returned to work.

¶8 From July 6 until August 26, 2007,2 Matthews worked for and received $6,075.20 in wages from Avalon Care Center, while also receiving $4,551.04 in time-loss compensation benefits from the Department. From September 16 through October 22, 2007, she worked for and received $4,530.16 in wages (including a $300.00 bonus) from Bel Air Health & Rehab, while also receiving $3,238.24 in time-loss compensation benefits from the Department.3 From November 28, 2007, through January 20, 2008, she worked for and received $4,774.07 in wages from Faithful Nurses Inc., while also receiving $4,726.08 in time-loss compensation benefits from the Department.

¶9 While working these three jobs, Matthews received a total of twelve department payment orders and time-loss [484]*484compensation benefit checks. She signed and cashed each check, despite the payment orders’ admonishment that she should not cash the checks if she had “returned to any type of work.” AR at 246 (emphasis added). On six occasions between July 17, 2007, and January 28, 2008, the Department sent Matthews worker verification forms, none of which she returned as required.4

II. Procedure

¶10 Through a “cross-match” of Matthews’ employment security and workers’ compensation records in January 2008, the Department discovered that she had been working and earning wages while also receiving time-loss compensation benefits. After conducting an investigation, the Department determined that (1) it had overpaid Matthews time-loss compensation benefits during the periods that she had worked, from July 6, 2007, to January 20,2008; and (2) she would have to reimburse the Department for these payments.

A. Department’s June 30, 2008 Order

¶11 On June 30, 2008, the Department issued an order (1) finding that Matthews had been overpaid time-loss compensation benefits during her three periods of unreported employment; and (2) demanding that she repay the actual amount of overpaid benefits, plus a statutory 50 percent penalty based on her “willful misrepresentation” of her employment status. The Department’s order stated:

WHEREAS, [Matthews] sustained an injury on 05/18/2006 while engaged in employment subject to the provisions of the Industrial Insurance laws, and

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Bluebook (online)
288 P.3d 630, 171 Wash. App. 477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/matthews-v-department-of-labor-industries-washctapp-2012.