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Boise Cascade Corp. v. Huizar12/20/1994
entz sought evaluation and treatment from Dr. Todd Orvald on December 23, 1988 for bilateral hand numbness and lumbar and cervical spine problems. Dr. Orvald thought Mr. Wentz had a degenerative process in his cervical spine for years and the degeneration was not caused by the industrial accident.
On February 28, 1989, Mr. Wentz was evaluated by Dr. James Haven, a partner of Dr. Orvald. He concluded that Mr. Wentz probably had cervical disc disease, but did not know if it was related to the industrial accident.
In a chart note dated April 14, 1989, Dr. Orvald stated he told Mr. Wentz he should consider surgery and recommended a second opinion, and sent this note to Boise Cascade. Boise Cascade wrote Mr. Wentz on April 14, 1989, confirming his statement that he was going to have surgery and explaining it could not be authorized without a second opinion by an independent medical examiner. Mr. Wentz was also advised that if surgery were performed before that examination, Boise Cascade would not be responsible for payment. Boise Cascade also wrote Dr. Orvald a letter stating no payment would be made for the surgery without a second surgical consultation and asking him to respond to a prior request for information regarding Mr. Wentz' condition and its relationship to the industrial accident.
Without receiving authorization from Boise Cascade or L&I; Dr. Orvald performed cervical spine surgery on May 18, 1989. It was admittedly nonemergent and elective. L&I;directed Boise Cascade to deny responsibility for the surgery and any residual effects arising from it on the basis of failure to show a causal relationship between the industrial injury and the surgery and failure to comply with WAC 296-20-03001(2).
Mr. Wentz protested L&I;s decision. L&I;affirmed and Mr. Wentz appealed to the Board. The Board reversed and Boise Cascade appealed to Superior Court after unsuccessfully petitioning for review.
Mr. Huizar, Mr. Wentz, and Boise Cascade filed motions for summary judgment. Boise Cascade's motion was denied. The motions of Mr. Huizar and Mr. Wentz were granted. Boise Cascade timely filed this appeal.
STANDARD OF REVIEW
Boise Cascade appeals the denial of its motion for summary judgment and the granting of summary judgment in favor of Mr. Huizar and Mr. Wentz. Since the Board's findings are not contested, the sole issues are questions of law. See Risher v. Department of Labor & Indus., 55 Wash. 2d 830, 837, 350 P.2d 645 (1960). Questions of law are reviewed de novo. Mains Farm Homeowners Ass'n v. Worthington, 121 Wash. 2d 810, 813, 854 P.2d 1072 (1993).
PRIOR AUTHORIZATION
Boise Cascade contends it is not responsible for the costs of either surgery because the claimants and their attending physicians did not obtain prior authorization as required by WAC 296-20-03001. That rule states:
(2) The department may designate those inpatient hospital admissions that require prior authorization.
(15) The department may designate those diagnostic and surgical procedures which can be performed in other than a hospital inpatient setting. Where a worker has a medical condition which necessitates a hospital admission, prior approval of the department or self-insurer must be obtained.
The term "authorization" was not defined by regulation at the time either claimant underwent the surgical procedures at issue. It is now defined in WAC 296-20-01002 as "notification by a qualified representative of the department or self-insurer that specific medically necessary treatment,
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