Paulsen v. Department of Social & Health Services

78 Wash. App. 665
CourtCourt of Appeals of Washington
DecidedJuly 24, 1995
DocketNo. 35736-1-I
StatusPublished
Cited by9 cases

This text of 78 Wash. App. 665 (Paulsen v. Department of Social & Health Services) 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
Paulsen v. Department of Social & Health Services, 78 Wash. App. 665 (Wash. Ct. App. 1995).

Opinion

Coleman, J.

In this case, this court is asked to decide whether the State’s statutory right to recover medical payments made under RCW 74.09.180 and 43.20B.060 is subject to equitable subrogation principles, which allow recovery only after the injured party is fully compensated for his injuries by the tortfeasor. In Department of Labor & Indus. v. Dillon, 28 Wn. App. 853, 626 P.2d 1004 (1981), the court addressed a similar statute and found that a statutory lien securing reimbursement evidences legislative intent to displace equitable principles. We find similar legislative intent expressed in the language of the statutes at issue here and affirm.

In 1990, Scott Paulsen was severely injured while working at a construction site. He filed a lawsuit against the subcontractor and the owner of the construction site, which the parties settled for the defendants’ policy limits, $2.1 million. Paulsen had received $46,346 in medical care payments from the Department of Social and Health Ser[667]*667vices. The Department asserted a lien on the recovery in the amount of $30,938 for payments made less a proportionate share of attorney fees. Paulsen brought the present action, arguing that (1) RCW 74.09.180 and 43.20B.060 allow application of the equitable principle that an injured party must be fully compensated before an insurer may assert its right to recovery and (2) the settlement had not made him whole. The parties each moved for summary judgment. The trial court found legislative intent in the statutes to displace equitable subrogation principles and entered judgment in favor of the Department. The Washington Supreme Court declined direct review.

The sole issue to be determined is whether the Department’s statutory right to assert a lien on a medical assistance recipient’s recovery is governed by equitable subrogation principles. Under RCW 74.09, DSHS generally pays for medical care services provided to eligible persons. The Department is not obligated to pay for these services, however, when the individual’s injuries are caused by the negligence or wrong of another. When the Department elects to pay in these circumstances, the agency becomes "subrogated to the recipient’s rights against the recovery had from any tortfeasor or the tort-feasor’s insurer, or both, and shall have a lien thereupon to the extent of the value of the assistance furnished by the department”. (Italics ours.) RCW 74.09.180. To secure reimbursement, the statute additionally allows the Department to pursue its remedies under RCW 43.20B.060, which provides:

(1) To secure reimbursement of any assistance paid under chapter 74.09 . . . the department shall be subrogated to the recipient’s rights against a tort feasor or the tort feasor’s insurer, or both.
(2) The department shall have a lien upon any recovery by or on behalf of the recipient from such tort feasor or the tort feasor’s insurer, or both to the extent of the value of the assistance paid[.]
(3) The lien of the department shall be upon any claim, [668]*668right of action, settlement proceeds, money, or benefits arising from an insurance program to which the recipient might be entitled!.]

Paulsen contends that the statutes, by use of the term "subrogated,” incorporate equitable subrogation principles. These principles developed to prevent the unjust enrichment of either the tortfeasor whose debt is paid by the insurer or the tort victim who recovers from both the insurer and the tortfeasor. Generally, subrogation allows the insurer to be substituted to the rights of the insured and pursue recovery directly from the tortfeasor or, when the insured recovers from the tortfeasor, to be reimbursed from that recovery. United States v. Greene, 266 F. Supp. 976, 979 (N.D. Ill. 1967); 1 George E. Palmer, Law of Restitution § 1.5, at 23-24 (1978). In equity, the insurer’s right to recover its subrogation interest is limited, however, to "the excess which the insured has received from the wrongdoer, remaining after the insured is fully compensated for his loss”. Thiringer v. American Motors Ins. Co., 91 Wn.2d 215, 219, 588 P.2d 191 (1978).

The State argues that RCW 74.09.180 and 43.20B.060 are similar to other statutes that have been held to supplant common law subrogation principles, citing Department of Labor & Indus. v. Dillon, 28 Wn. App. at 855 and Rhoad v. McLean Trucking Co., 102 Wn.2d 422, 426, 686 P.2d 483 (1984). In Dillon, the Court of Appeals considered whether the victims’ compensation act supplanted the same equitable principle advanced by Paulsen. The statute at issue in that case provided that the Department of Labor and Industries "shall be subrogated to and have a lien upon any recovery [by the victim from the tortfeasor] to the extent of the payments made by the department”. Dillon, 28 Wn. App. at 855 (quoting former RCW 7.68.050). Creation of a lien against recovery in addition to a right of subrogation, the court found, signaled legislative intent to replace equitable subrogation principles.

A statutory right to reimbursement (i.e. the Department’s lien on recovery) is not to be diminished absent an express [669]*669statutory provision. We may not do so under the guise of statutory construction. Courtright v. Sahlberg Equip., Inc., 88 Wn.2d 541, 544-45, 563 P.2d 1257 (1977). Equitable principles cannot be asserted to establish equitable relief in derogation of statutory mandates. Norlin v. Montgomery, 59 Wn.2d 268, 273, 367 P.2d 621 (1961). This is recognized by the Thiringer case relied upon by Dillon, where it was stated:
Subrogation is an equitable doctrine, and an examination of the cases cited by both parties shows that courts, unless otherwise directed by statutory requirements, attempt to resolve each case upon a consideration of the equitable factors involved, guided by the principle that a party suffering compensable injury is entitled to be made whole but should not be allowed to duplicate his recovery.
(Italics ours.) Thiringer, ... at 220. Therefore, statutory interpretation and not the equitable doctrine of subrogation is determinative. The statute is clear and unambiguous.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Polygon Northwest Co. v. American Nat. Fire Ins. Co.
189 P.3d 777 (Court of Appeals of Washington, 2008)
Blankenship v. Estate of Bain
5 S.W.3d 647 (Tennessee Supreme Court, 1999)
British Columbia Ministry of Health v. Homewood
970 P.2d 381 (Court of Appeals of Washington, 1999)
Copeland v. Toyota Motor Sales U.S.A., Inc.
136 F.3d 1249 (Tenth Circuit, 1998)
Kohfeld v. United Pacific Ins. Co.
931 P.2d 911 (Court of Appeals of Washington, 1997)
Leingang v. PIERCE CO. MED. BUREAU, INC.
930 P.2d 288 (Washington Supreme Court, 1997)
Kohfeld v. United Pacific Insurance
931 P.2d 911 (Court of Appeals of Washington, 1997)
Patterson v. Horton
929 P.2d 1125 (Court of Appeals of Washington, 1997)
Paulsen v. DEP'T OF SOC. & HEALTH
898 P.2d 353 (Court of Appeals of Washington, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
78 Wash. App. 665, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paulsen-v-department-of-social-health-services-washctapp-1995.