Ziegler v. Department of Labor & Industries

708 P.2d 1212, 42 Wash. App. 39
Court of Appeals of Washington·Decided October 24, 1985·No. No. 6546-4-III·Published·Cited by 4 cases

Opinion

Thompson, J.

—The Department of Labor and Industries appeals a holding that the Department is not entitled to reimbursement for costs of medical examinations it scheduled for Mr. Ziegler. We affirm.

On March 16, 1979, Paul Ziegler, a truck driver, sustained industrial injuries in an auto accident involving a third party. Because of the nature of the third party's violent death, Mr. Ziegler also developed a psychological condition labeled posttraumatic stress syndrome. The Department informed Mr. Ziegler that he could elect to seek recovery from the estate of the third party or assign his rights to the Department. He was informed that in either case he was entitled to receive benefits under the Industrial Insurance Act, RCW Title 51, but that the [41] Department would have a lien on any recovery or settlement for benefits paid to him or in his behalf by the Department.

The Department authorized medical treatment by Mr. Ziegler's attending physician, Dr. Roland Carlill, a general practitioner. Mr. Ziegler was also referred to a psychiatrist, Dr. James Kilgore, who diagnosed an anxiety neurosis and requested and obtained Department authorization for psychotherapy in July 1979. On October 11, 1979, Dr. Carlill advised the Department that although the physical injuries were resolved, further psychiatric treatment was recommended.

Between May 1980 and August 1981, the Department required Mr. Ziegler to undergo at least four additional examinations, two of which were conducted by its own panel of medical specialists. The individual examiners and panels concurred with the diagnoses of the treating physician and psychiatrist, recommended physical therapy and continued psychotherapy for extendable 6-month periods, and determined Mr. Ziegler was eligible for certain permanent partial disability benefits.

In September 1981, a settlement was reached between Mr. Ziegler and the estate of the third party. Shortly thereafter, the Department claimed a lien for $9,740.66, including $1,755.22 costs and expenditures for the ordered evaluations. On stipulated facts, the Superior Court ruled the costs of the examinations were not benefits paid as contemplated by RCW 51.24.060.

RCW 51.24.060 provides in relevant part:

(1) If the injured worker or beneficiary elects to seek damages from the third person, any recovery made shall be distributed as follows:
(c) The department and/or self-insurer shall be paid the balance of the recovery made, but only to the extent necessary to reimburse the department and/or self-insurer for compensation and benefits paid;
(2) The recovery made shall be subject to a lien by the [42] department and/or self-insurer for its share under this section.

(Italics ours.) The dispositive issue is whether the costs of the RCW 51.36.0701 ordered medical examinations are reimbursable to the Department as "compensation and benefits paid". We agree with the trial court that these costs are not reimbursable.

The parties do not dispute the wide discretion granted the director in ordering examinations under RCW 51.36.070, but the reason for requesting these examinations arguably differs from the purpose of providing the injured worker with proper and necessary medical and surgical services.2 See Buell v. Aetna Cas. & Sur. Co., 14 Wn. App. 742, 746-47, 544 P.2d 759 (1976). RCW 51.36.070 medical examinations are scheduled in order to resolve medical issues and not to provide treatment. It is a cost that ordinarily would not be incurred by a worker if it were not for the fact the Department has a duty to properly administer the funds. See Alcina v. Days Inn of Am., Inc., 430 So. 2d 775 (La. Ct. App. 1983); IGA Food Fair v. Martin, 584 P.2d 828 (Utah 1978).

The Department argues and the trial court agreed the worker did receive some benefit from the ordered medical examinations. However, again, the principal reason for the [43] examination is to allow the Department to properly administer the program and any benefit to Mr. Ziegler was incidental to that purpose. The word benefits as used in RCW 51.24.060 refers to costs incurred for "proper and necessary medical and surgical services" authorized the worker under RCW 51.36.010. Buell, at 746. The medical examinations do not fit within that description. Moreover, it should be noted RCW 51.36.070 authorizes the director when ordering such examinations to charge the cost to a self-insurer or the medical aid fund. We find the costs of the ordered examinations were administrative expenses, not benefits.

Since we have affirmed the trial court's decision as noted above, we do not reach Mr. Ziegler's issue on cross appeal regarding an accord and satisfaction.

Finally, we consider whether the trial court erred in disallowing attorney fees and costs to Mr. Ziegler. RCW 51.52.130 provides in relevant part:

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

Ziegler v. Department of Labor & Industries, 708 P.2d 1212, 42 Wash. App. 39 (Wash. Ct. App. 1985).

708 P.2d 1212 (Ziegler v. Department of Labor & Industries) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Timothy Nelson, V Department Of L&i State Of Wa
Court of Appeals of Washington, 2017
Nelson v. Department of Labor & Industries
392 P.3d 1138 (Court of Appeals of Washington, 2017)
Rowland v. Great States Insurance
20 P.3d 1158 (Court of Appeals of Arizona, 2001)
Cole v. Byrd
656 N.E.2d 1068 (Illinois Supreme Court, 1995)