Michael E. Murray v. Dept. Of L & I, State Of Wa, 48870-1

Background

Michael E. Murray injured his right hip at work in 2009 and sought authorization in 2013 for surgery to treat femoral acetabular impingement (FAI); the Department had previously denied coverage based on a 2011 HTCC determination that the surgery is not a covered benefit.
The Health Technology Clinical Committee (HTCC) is a rulemaking body created by statute to determine which health technologies are covered by state health programs and to set criteria for medical necessity; HTCC decisions bind participating agencies, including the Department.
RCW 70.14.120(3) bars individualized determinations for technologies the HTCC has deemed not covered; RCW 70.14.120(4) preserves an individual’s right to appeal a participating agency’s decision.
Murray appealed the Department’s denial to the Board of Industrial Insurance Appeals, which affirmed based on the HTCC determination; the superior court granted the Department’s summary judgment, and Murray appealed.
Murray argued the HTCC delegation is an unconstitutional legislative delegation (insufficient procedural safeguards), that Joy v. DLI should be overruled, and that denial violated his procedural and substantive due process rights by preventing individualized review.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
1. Constitutionality of legislative delegation to HTCC	Murray: delegation unconstitutional because safeguards (esp. avenues for individualized review) are inadequate and certiorari is too narrow	Dept.: delegation constitutional; constitutional writ of certiorari plus statutory safeguards (public comment, open meetings, periodic review) suffice	Delegation constitutional; procedural safeguards (certiorari + statutory protections) control arbitrary action and prevent abuse
2. Whether Joy should be overruled	Murray: Joy wrongly precludes individualized review; legislative intent supports individual application	Dept.: Joy controls; no basis to overturn precedent	Court declines to overrule Joy; HTCC noncoverage precludes individualized determinations
3. Due process (vested right to surgery)	Murray: denial of individualized review and reliance on HTCC violated procedural and substantive due process; he had a right to the surgery	Dept.: claimant has no vested right to a particular treatment—only to proper and necessary treatment as defined by statute and HTCC rules	Murray lacks a vested property interest in the specific surgery; due process claim fails
4. Merits of HTCC determination / individualized “proper and necessary” inquiry	Murray: even if HTCC rule exists, Board/courts should be able to decide medical necessity for his individual case	Dept.: statutory scheme prohibits individualized override where HTCC deemed technology not covered; merits not properly before court	Court refuses to conduct individualized merits review because RCW 70.14.120 bars it; does not address whether HTCC decision was correct

Key Cases Cited

Joy v. Dep’t of Labor & Industries, 170 Wn. App. 614 (HTCC noncoverage means technology is not proper/necessary in any case)
Barry & Barry, Inc. v. Dep’t of Motor Vehicles, 81 Wn.2d 155 (legislative delegation valid when standards + procedural safeguards exist)
Auto. United Trades Org. v. State, 183 Wn.2d 842 (discussion of safeguards for delegation and examples of review mechanisms)
Stelter v. Dep’t of Labor & Industries, 147 Wn.2d 702 (standards for appellate review of board decisions)
Coballes v. Spokane County, 167 Wn. App. 857 (scope of constitutional writ of certiorari; review for arbitrary, capricious, or illegal action)
Dellen Wood Prods., Inc. v. Dep’t of Labor & Indus., 179 Wn. App. 601 (analysis of vested property interests for due process claims)