Joy v. Department of Labor & Industries
170 Wash. App. 614
| Wash. Ct. App. | 2012Background
- Cheryl Joy injured her neck at work in 2006, resulting in chronic cervical neuropathic pain and ongoing treatment under L&I.
- HTCC determined spinal cord stimulation was not a covered benefit, based on safety concerns and lack of net benefit.
- Joy appealed to the Board; an IAJ concluded she was not a good candidate and the Board denied review.
- Joy then challenged in superior court whether L&I must authorize spinal cord stimulation as a necessary and proper treatment.
- HTCC issued a blanket noncoverage determination affecting all state health care programs, including L&I.
- Trial court granted L&I judgment as a matter of law under RCW 70.14.120(3), holding individualized determinations were precluded; Joy appeals.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether RCW 70.14.120(3) precludes courts from ordering coverage. | Joy argues courts may order L&I to authorize treatment. | L&I contends HTCC noncoverage bars individualized determinations. | Precludes individualized medical-necessity determinations and court orders. |
| Whether HTCC noncoverage determinations bind reviewing bodies and courts. | Joy seeks relief despite HTCC noncoverage. | L&I must comply with HTCC determinations. | Yes; HTCC determinations bind reviewing bodies and courts. |
| Relation between RCW 70.14.120(3) and RCW 70.14.120(4) on appeals. | Joy believes she may appeal coverage denial to Board/courts. | Statutes conflict; 3 controls over 4 to ensure uniformity. | RCW 70.14.120(3) controls over 70.14.120(4). |
| Retroactivity and due process concerns of applying RCW 70.14.120(3). | Joy claims retroactive application violated vested rights. | Responds that statute is remedial or nonretroactive. | No remedy issues; retroactivity discussion not resolved in light of preclusion. |
| Attorney fees for prevailing party. | Joy seeks fees as prevailing party. | L&I accordingly prevails; fees denied. | Denied; Joy’s claims fail. |
Key Cases Cited
- Davis v. Microsoft Corp., 149 Wn.2d 521 (Wash. 2003) (judgment as a matter of law standard when viewing evidence)
- Glaubach v. Regence BlueShield, 149 Wn.2d 827 (Wash. 2003) (avoidance of unlikely or absurd consequences in construction)
- Flight Options, LLC v. Dep’t of Revenue, 172 Wn.2d 487 (Wash. 2011) (specific statutes prevail over general ones when in conflict)
- New Castle Invs. v. City of LaCenter, 98 Wn. App. 224 (Wash. App. 1999) (legislative intent/interpretation of veto and open remedies)
- State v. J.P., 149 Wn.2d 444 (Wash. 2003) (statutory interpretation and plain meaning principles)