Washington Court of Appeals Upholds HTTC and Clarifies What Constitutes a Protest to a Department Order
by John Klor
The Washington Court of Appeals, Division II issued two significant decisions today.
In Murray v. Dept. of L & I, the court affirmed the Board’s decision to uphold the Department’s decision that based on the Health Technology Clinical Committee’s (HTTC) decision, the proposed hip surgery was not a covered procedure under state health care law. Self Insured Employers in Washington are included in HTTC decisions.
Essentially, the Court affirmed that individualized challenges to HTTC decisions will not be allowed. It denied claimant’s constitutional challenges to the HTCC.
Murray upheld a prior decision on this issue in Joy v. Dept. of L & I, 170 Wn. App. 614, 285 P.2d 187 (2012). At the time the WA Supreme Court declined review in Joy. However, it is anticipated that Supreme Court review will again be requested in the Murray case. Stay tuned.
To review the court’s decision, see: //www.courts.wa.gov/opinions/?fa=opinions.disp&filename=488701MAJ
In Boyd v. City of Olympia and Dept of L & I, the Court affirmed summary judgment in the City and Department’s favor. The Boyd case involved a situation where the injured worker did not protest an order closing his claim. But within the protest period one of his doctors sent a chart note and bill to the City that was not construed as a protest.
Several months later, Boyd appealed the Department’s final order to the Board. In his appeal he argued that the receipt of the chart note by the City constituted a timely protest. The Board ruled that the chart note and bill in question did not put the City or the Department on notice that Boyd was protesting the closure of his claim. The Court of Appeals agreed.
The Court adopted the Board’s standard review as articulated in re Lambert, 91 0107(1991). This standard generally requires that to be considered a protest, the communication in question must be one that reasonably puts the Department on notice that the worker is taking issue with some Department action.
These kinds of cases are necessarily very fact driven. In this case, the main thrust of the chart note that recommended treatment and bill in question were addressing conditions not allowed under the claim. There was an indirect reference to the allowed low back injury. But that was not sufficient in the Court’s opinion to put a self-insured employer or a Department adjudicator reasonably on notice that the claimant was protesting closure of his claim.
Bill Masters of Wallace, Klor, Mann, Capener & Bishop, P.C. briefed and argued this case on appeal. Bill can be reached at [email protected].
To review the court’s decision see:
Please feel free to contact John at [email protected] or any of the lawyers at WKMC&B at 503-224-8949 if you have any questions