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Boise Cascade Corp. v. Huizar12/20/1994
THOMPSON, C.J.-- Boise Cascade Corporation, a self-insured employer, appeals summary judgment orders entered in favor of two employees, Richard Huizar, Jr., and Dewayne L. Wentz. The orders affirmed decisions by the Board of Industrial Insurance Appeals (Board) requiring Boise Cascade to pay the employees' surgical bills. Boise Cascade contends it was not responsible for payment because the surgeries were elective, nonemergent procedures completed without its prior authorization or the prior authorization of the Department of Labor and Industries (L&I; and, in the case of Mr. Huizar, billings were not submitted within 90 days of service. We affirm.
FACTS AND PROCEDURAL HISTORY
Richard Huizar, Jr., Claim
This claim has a 14-year history. Only the salient facts are summarized here.
On August 26, 1980, while employed by Boise Cascade, Mr. Huizar sustained an industrial injury involving his lower back. He timely filed an accident report. His attending orthopedic surgeon, Dr. Jack C. Irwin, saw him in consultation with another orthopedic surgeon, Dr. Max Bocek. Later, Mr. Huizar was treated by Dr. Todd Orvald, Dr. Irwin's partner. Although surgical fusion was recommended by Dr. Orvald, his initial treatment was conservative, not surgical, in nature. Dr. Orvald completed a closing examination of Mr. Huizar on October 17, 1983, and sent a follow-up letter rating impairment to Boise Cascade on March 6, 1984.
On April 18, 1984, L&I;closed Mr. Huizar's claim with time loss compensation paid to December 2, 1982 and an award of permanent partial disability.
On January 23, 1986, Mr. Huizar signed an application to reopen his claim for aggravation of condition. The application was signed at Dr. Orvald's office. On that portion of the application which asked if the claimant had been examined since his claim was closed, Dr. Orvald's office typed "see attached sheet". The attached sheet was a copy of a letter written by Dr. Orvald to Dr. Bocek referring Mr. Huizar to him for consultation and requesting a second opinion as to whether a 1-level fusion would help the patient's condition.
Boise Cascade received Mr. Huizar's application to reopen on January 29, 1986. On January 31, his application was denied. Copies of the denial form were sent to Dr. Orvald, Dr. Bocek and Mr. Huizar's attorney.
Mr. Huizar was seen by Dr. Bocek on February 6, 1986. Dr. Bocek agreed that surgical fusion was appropriate. On March 26, 1986, Mr. Huizar was admitted to the hospital with a diagnosis of spondylolisthesis L5-S1, symptomatic, grade I. Dr. Orvald performed a posterolateral spinal fusion at L5-S1 without the prior authorization of L&I;or Boise Cascade.
In June 1986, Mr. Huizar's attorney called the Boise Cascade claims administrator, stating the original of Mr. Huizar's application to reopen claim had been misplaced by L&I; Boise Cascade was asked to resubmit the reopening application. It did so on June 3.
On July 7, 1986, L&I;entered an order denying reopening of Mr. Huizar's claim and directing closure. Mr. Huizar appealed to the Board. On July 31, 1986, L&I;entered an order assuming jurisdiction over Mr. Huizar's claim and holding the July 7th order in abeyance pending medical examination and such further order as may be indicated. On July 31, the Board returned the claim to L&I;for further action.
On December 18, 1986, L&I;ordered Mr. Huizar's claim reopened effective June 5, 1986 for authorized treatment and benefits. On January 8, 1987, Boise Cascade sent a letter to Dr. Orvald notifying him it was challenging L&I;s decision to reopen the claim and acknowl
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