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Boise Cascade Corp. v. Huizar12/20/1994
services, or equipment provided for the diagnosis and curative or rehabilitative treatment of an accepted condition will be reimbursed by the department or self-insurer." The lack of a regulatory definition of authorization at the time in question is not determinative because the record clearly establishes as a matter of undisputed fact that Boise Cascade did not in any way approve, authorize or agree to be responsible for the payment of either surgery prior to the time they were performed. They were not, as a matter of law, "authorized" or "approved" for purposes of WAC 296-20-03001(2), (15).
Claim of Mr. Huizar
Mr. Huizar contends the requirements of WAC 296-20 et seq. provide an overall scheme of procedures to be followed in administering open claims. However, when a self-insured is resisting responsibility for administering a claim, it is unrealistic to expect the self-insured to "authorize" or accept responsibility for any medical procedure.
L&I;takes a somewhat similar position. It contends WAC 296-20-097, which governs the reopening of claims, contemplates the factual situation at issue and abrogates or supersedes the prior authorization requirement of WAC 296-20-03001. That regulation specifically states:
Necessary treatment should not be deferred pending a department or self-insurer adjudication decision. However, should reopening be denied treatment costs become the financial responsibility of the worker.
L&I;urges us to adopt a common sense approach because requiring prior authorization under the circumstances of a contested reopening of a claim "would be both meaningless and contrary to the spirit of the Industrial Insurance Act". Brief of Respondent L&I; at 13.
The contentions of Mr. Huizar and L&I;have merit. Rules should be construed to be in harmony with each other and each given effect if possible. See State v. Burke, 92 Wash. 2d 474, 598 P.2d 395 (1979). Rules should also be interpreted in a manner consistent with the legislative purpose of the underlying statute. Moses v. Department of Social & Health Servs., 90 Wash. 2d 271, 274, 581 P.2d 152 (1978). We hold that WAC 296-20-03001 does not apply to a closed claim when a reopening of that claim is contested by a self-insured. WAC 296-20-097 controls. Our holding gives each rule effect. Burke. It also fulfills the purpose of the Industrial Insurance Act, which act is to "be liberally construed for the purpose of reducing to a minimum the suffering and economic loss arising from injuries and/or death occurring in the course of employment." RCW 51.12.010.
As to the timeliness of the billing, Dr. Orvald had been informed that Boise Cascade was asking L&I;not to reopen Mr. Huizar's claim. He did not know who would ultimately be responsible for payment of his services. There was no final adjudication of Mr. Huizar's claim until the Superior Court affirmed the Board's decision requiring that his claim be reopened. The determination was made on July 7, 1989. Boise Cascade received Dr. Orvald's bill on August 2, 1989. RCW 51.36.085 requires payment for allowed claims 60 days after the claim is allowed by final order or judgment.
The trial court did not err in granting summary judgment in favor of Mr. Huizar.
Claim of Mr. Wentz
Mr. Wentz' claim was open at the time his surgery was performed and there is no issue as to the timeliness of the billing. The legal issue is whether payment of a contested op
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