Court Opinion

ID: 9898333
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:30:00.988124+00
Date Added: 2024-06-11T09:15:03.078512
License: Public Domain

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

 GEORGE HIGGINS,
                                              No. 85045-8-I
                            Appellant,
                                              DIVISION ONE
                v.
                                              UNPUBLISHED OPINION
 DEPARTMENT OF LABOR AND
 INDUSTRIES,

                             Respondent.

       DÍAZ, J. — George Higgins appeals a trial court’s decision affirming the

Board of Industrial Insurance Appeals’ (board) denial of time loss benefits for the

aggravation of Higgins’ 1989 workplace injury. The director 1 of the Department of

Labor and Industries (L&I or the department) had denied time loss benefits

because it found Higgins voluntarily exited the workforce between 2003 and 2005,

noting he did not provide contemporaneous medical records to support his claim

that he was unable to work during that time due to his industrial injury. Finding no

error, we affirm.

1 We will follow the style of the parties’ briefing, which refers to the director of the

L&I as either “the director” or as “it.”
No. 85045-8-I/2

                                 I. BACKGROUND

       A.     Higgins’ injury and aggravation

       In 1989, Higgins suffered an industrial injury to his back while at work. Dep’t

of Labor & Indus. v. Higgins, 21 Wn. App. 2d 268, 271, 505 P.3d 579 (2022). While

working as an electrician’s helper, he lifted two five-gallon paint cans, causing or

aggravating a left disc herniation at L4-5. Id.

       In 1992, the department closed Higgins’ claim with a category 2 permanent

partial disability award. Higgins, 21 Wn. App 2d at 271. Higgins unsuccessfully

tried to reopen the claim in 1993 and 1994. Id.

       In 2001, Higgins opened an auto repair shop, but closed it in 2003, claiming

he was unable to work due to his back injury. Id. In 2005, more than seven years

after the department closed his claim, Higgins sought to reopen it, requesting time

loss benefits or a pension. 2 Id. After several subsequent appeals and denials, in

January 2017, the director reconsidered and increased his partial permanent

disability benefit rating to a category 4. Id. However, the director declined to award

time loss compensation, stating:

       I am not exercising my discretionary authority to find you eligible for
       time-loss compensation because you stopped working in 2003 and
       there is no contemporaneous medical [sic] to support that you
       stopped working due to your industrial injury.

       However, I am exercising my discretionary authority to find you
       eligible for permanent partial disability benefits in the interest of
       equity and good conscience, because you had a significant increase
       in permanent impairment of your lumbar condition.

2 “Over-seven” time loss benefits also are described as wage replacement benefits

in the parties’ briefing and caselaw. For the purpose of consistency, we will refer
to them as “time loss benefits” or simply “time loss” throughout this opinion.
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No. 85045-8-I/3

Id. at 271-272.

       Following this order, the director again closed Higgins’s claim. Id. at 272.

       B.     Higgins’ first appeal

       Higgins protested the order of the director to the board, which denied the

protest and affirmed the director’s decision. Id. As part of its affirmance, the board

held that it reviewed the director’s order under the preponderance of the evidence

standard, pursuant to Cascade Valley Hospital v. Stach, 152 Wn. App. 502, 508,

215 P.3d 1043 (2009). Id. Under that standard, the board reversed the director’s

decision and ordered the department to pay time loss benefits. Id. The department

appealed the board’s decision to the superior court and argued the proper standard

of review was abuse of discretion. Id. The superior court agreed and remanded

the case to the board to apply that standard. Id. Higgins then appealed the

superior court’s decision, and this court affirmed the superior court, finding that the

proper standard of review is abuse of discretion. Id. at 278.

       C.     Subsequent superior court proceeding

       On August 9, 2021, while the appeal was pending in this court, the board

went forward and reviewed Higgins’ claim under the abuse of discretion standard,

and found the director did not abuse its discretion.        The board affirmed the

director’s January 2017 order, again, granting Higgins’ increased permanent

partial disability benefits and denying Higgins time loss. Higgins appealed that

decision to the superior court.

       The superior court affirmed the board. In its findings of fact, the court found:

       1.2.5 Prior to issuing orders exercising discretionary authority
       regarding additional benefits, the Director considered a 17-page

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No. 85045-8-I/4

       memorandum reviewing the claim file and medical record, including
       the facts that claimant stopped working in 2003 and there was no
       contemporaneous medical record attributing his ceasing work to
       conditions caused by the industrial injury.

       1.2.6 The Director also considered a second 18-page
       memorandum addressing Mr. Higgins’ protest and additional
       information provided by Mr. Higgins in response to the Director’s
       initial determination . . . [i]nformation provided by Mr. Higgins
       included his declaration regarding his withdrawal from the workforce
       in 2003 and why there are no contemporaneous medical records
       relating the withdrawal from the workforce to his industrial injury . . .

       1.2.7 The decision reached by the Director was based on
       information contained in the Department’s claim file as it existed on
       June 1, 2017 and June 20, 2020.

       1.2.8 The Director’s discretion was not unreasonable and did not
       reflect an abuse of discretion.

       The court further ordered Higgins to pay a statutory fee of $200, and

awarded the department interest from the date of entry of the judgment under RCW

4.56.110. Higgins timely appealed to Division II of this court, which transferred the

matter to this division.

                                    II. ANALYSIS

       A. Background on the applicable substantive law

       When a worker is injured on the job, the department gives them “proper and

necessary” medical treatment until the condition(s) caused by the injury have

reached “maximum medical improvement.” RCW 51.36.010(2)(a); WAC 296-20-

01002. While the worker’s claim is open, they are eligible for a number of benefits,

including time loss compensation. RCW 51.32.090. Time loss is meant to replace

lost wages while the worker is temporarily unable to work. Id. Once the worker’s

injury reaches a “fixed” condition (where no further improvement is expected), the

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No. 85045-8-I/5

department closes the claim. Franks v. Dep’t of Labor & Indus., 35 Wn.2d 763,

766-67, 215 P.2d 416 (1950).

       Upon closing the claim, the department determines if the worker has a

permanent disability from their workplace injury, and whether such injury is total or

partial. See, e.g., RCW 51.32.060(1), (3), & (6); and see RCW 51.32.080. The

department requires medical evidence to show the industrial injury proximately

caused the disability. Loushin v. ITT Rayonier, 84 Wn. App. 113, 122-23, 924 P.2d

953 (1996).

       The department approves a permanent partial disability award when the

worker is capable of employment after the injury but loses a permanent bodily

function, RCW 51.08.150; RCW 51.32.080.             The department awards total

permanent disability benefits when the worker’s industrial injury proximately

renders them permanently incapable of employment.           RCW 51.08.160; RCW

51.32.060.

       Following these determinations, “[t]he director may readjust a beneficiary’s

disability benefits under two circumstances (1) by the beneficiary’s application if

submitted within seven years of their claim closing or (2) at any time upon the

director’s own motion.” Higgins, 21 Wn. App 2d at 274-75. As to the latter, i.e.,

“over-seven” claims, the director’s decision whether to reopen such a claim at all,

and whether to consider benefit eligibility in aggravation cases is discretionary.

Stach, 152 Wn. App. at 512. Further, a director may reopen an over-seven claim

sua sponte “at any time.” Id. at 509.

       Moreover, we have held that the director has significant discretion regarding

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No. 85045-8-I/6

the information it considers when considering whether to open an over-seven

claim, stating that “[t]he statute makes no distinction, for purposes of the director’s

discretion, between aggravation and diminution or termination of injury. Nor does

the statute specify or limit the sources of the director’s information.” Id. at 510-

511. In other words, the director has broad authority to reopen a claim for various

reasons because “[i]t is unlikely the legislature expected the director to learn of

aggravated injuries by way of personal investigation or serendipitous encounters.”

Id. at 511.

       B. Standard of Review

       The director’s decision whether to reopen a claim is reviewed for an abuse

of discretion. Higgins, 21 Wn. App. 2d at 270. When evaluating whether the

director abused its discretion, “[t]he key is not the source of the director’s

information [informing their decision to reopen an over-seven claim].” Stach, 152

Wn. App. at 510. “Rather, the key is the director’s discretion,” to reopen or decline

to reopen an over-seven claim. Id.

       An agency abuses its discretion if its decision is arbitrary and capricious.

State ex rel. Carroll v. Junker, 79 Wn.2d 12, 26, 482 P.2d 775 (1971). A decision

is arbitrary and capricious where it is “willful and unreasoning and taken without

regard to the attending facts or circumstances.” Whidbey Envt’l Action Network v.

Growth Mgmt. Hr’gs Bd., 14 Wn. App. 2d 514, 526, 471 P.3d 960 (2020) (quoting

PacifiCorp v. Wash. Utils. & Transp. Comm’n, 194 Wn. App. 571, 587, 376 P.3d

389 (2016)). “[W]here there is room for two opinions, an action taken after due

consideration is not arbitrary and capricious even though a reviewing court may

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No. 85045-8-I/7

believe it to be erroneous.” ITT Rayonier, Inc. v. Dalman, 122 Wn.2d 801, 809,

863 P.2d 64 (1993) (quoting Kendall v. Douglas, Grant, Lincoln, & Okanogan Cys.

Pub. Hosp. Dist. 6, 118 Wn.2d 1, 14, 820 P.2d 497 (1991)).

       “Once the director reopens a claim on grounds of aggravation, he or she

may grant additional benefits only ‘in accordance with the rules in this section

provided for the same.’” Stach, 152 Wn. App. at 512 (quoting RCW 51.32.160).

And this court has held “that the director’s grant or denial of specific benefits is to

be reviewed under the preponderance standard.” Id. (emphasis added).

       In such findings and decisions, the “Board’s decision is prima facie correct

under RCW 51.52.115.” Ruse v. Dep’t of Labor & Indus., 138 Wn.2d 1, 5, 977

P.2d 570 (1999). Further, the appellate court views the evidence “in the light most

favorable” to the party who prevailed at the superior court. Street v. Weyerhaeuser

Co., 189 Wn.2d 187, 205, 399 P.3d 1156 (2017) (quoting Bennett v. Dep’t of Labor

& Indus., 95 Wn.2d 531, 534, 627 P.2d 104 (1981)). The party seeking review

bears the burden of showing that the Board’s decision was improper. Stach, 152

Wn. App. at 506 (citing RCW 51.52.115).

       An appellate court’s review of a decision by the department “is limited to

examination of the record to see whether substantial evidence supports the

findings made after the superior court’s de novo review, and whether the [superior]

court’s conclusions of law flow from the findings.’” Ruse, 138 Wn.2d at 5 (quoting

Young v. Dep’t of Labor & Indus., 81 Wn. App. 123, 128, 913 P.2d 402 (1996)).

“Substantial evidence exists if it ‘convince[s] an unprejudiced, thinking mind of the

truth of that to which the evidence is directed.’” Street, 189 Wn.2d at 205 (quoting

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No. 85045-8-I/8

Ehman v. Dep’t of Labor & Indus., 33 Wn.2d 584, 597, 206 P.2d 787 (1949)).

       Unchallenged facts of an agency’s final decision are verities on appeal.

Energy Nw. v. Hartje, 148 Wn. App. 454, 459, 199 P.3d 1043 (2009).

       C. Discussion

       We conclude the director did not abuse its significant discretion or lack

substantial evidence when it reopened Higgins’ over-seven claim and found him

eligible for permanent partial disability, but ineligible for time loss benefits.

       In a nutshell, the director determined Higgins was ineligible for time loss

because he voluntarily severed himself from the workforce after the closure of his

auto shop in approximately 2003, noting that he did not provide contemporaneous

medical evidence showing he was unable to work due to his prior industrial injury.

       Higgins contends that the director’s denial was an abuse of discretion, 3 first,

because there is no statutory basis for finding a voluntary severance and, second,

because RCW 51.32.090(3)(b) does not require contemporaneous medical

evidence.

            1. Further background on severance from the workforce

       Time loss is paid to an injured worker to help them cover costs while seeking

employment. Hartje, 148 Wn. App. at 466. If, while a worker is temporarily totally

disabled, but the director considers them “voluntarily retired and . . . no longer

3 The parties do not appear to distinguish between the standard of review for the

director’s decision to reopen an over-seven claim (abuse), the decision to
determine the scope of that review (abuse), and the decision on the specific type
of benefit to be awarded (substantial evidence). We will present the arguments as
they were made, but attempt to apply the appropriate standard consistently.
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No. 85045-8-I/9

attached to the workforce, benefits shall not be paid.” RCW 51.32.090(10).

       An injured worker is considered “voluntarily retired” and therefore severed

from the workforce if both of these conditions are met:

       (a) The worker is not receiving income, salary or wages from any gainful
       employment; and

       (b) The worker has provided no evidence to show a bonafide attempt to
       return to work after retirement.

WAC 296-14-100 (emphasis added). But of course, “[a] worker is not voluntarily

retired when the industrial injury or occupational disease is a proximate cause for

the retirement. Id.

       Moreover, if the worker voluntarily removes themselves from the workforce,

and then their condition becomes aggravated, the original industrial injury is not a

proximate cause of subsequent lost wages. Hartje, 148 Wn. App. at 466-469

(emphasis added). In such case, the claimant is ineligible for time loss benefits.

Id.

       Thus, under WAC 296-14-100(1)(b), Higgins would need to present bona

fide evidence he attempted to return to work between 2003 and 2005. If he does

not, and is also not receiving income, the department considers him voluntarily

retired, and thus severed from the workforce. WAC 296-14-100. 4

          2. Basis for severance from the workforce

4 This court accords deference to the administrative rules promulgated by the

agency: “we give substantial weight to an agency’s interpretation of the law it
administers, especially when the issue falls within the agency’s expertise.”
Southwick, Inc. v. Dep’t of Licensing Bus. & Professions Div., 191 Wn.2d 689, 695,
426 P.3d 693 (2018); see also Scott R. Sonners, Inc. v. Dep’t of Labor & Indus.,
101 Wn. App. 350, 354-55, 3 P.3d 756 (2000). Higgins does not challenge the
agency’s expertise or any regulation cited in the parties’ briefing.
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No. 85045-8-I/10

       Higgins contends that the record shows he did not voluntarily sever himself

from the workforce because there was no evidence Higgins was not seeking work.

Specifically, Higgins’ argument rests on distinguishing Hartje, which is similar to

this matter. Id.

       In Hartje, the claimant injured her back while working for Energy Northwest.

Hartje 148 Wn. App. at 459. She applied for department benefits in 1994 and

received permanent partial disability and time loss compensation.          Id.      The

department then closed her claim, noting her condition was stable and she would

be employable as of October 2, 1996.           Id.   Her subsequent appeal was

unsuccessful as the department found she was capable of obtaining and

performing gainful employment that was more sedentary. Id. at 459-460. In 1999,

she petitioned to reopen her claim for aggravation of her 1994 injury. Id. at 460.

Hartje testified she attempted to return to work at Energy Northwest but was unable

to due to her injury:

       [ ] After my on-the-job injury, I attempted to return to work on two
           occasions and retained ties with my employer;

       [ ] I have not been able to return to work since the 1996 time frame due
             to the residuals from my industrial injury. I have not voluntarily
             withdrawn from the work force at any time.

       [ ] Had I been able to return to work, I would have done so. It has always
            been my intent to return to work, if possible.

Id. at 461.

        On appeal, Energy Northwest argued, among other things, that Hartje was

barred from receiving time loss because she voluntarily retired under RCW

51.32.090(8). Id. at 463. This court agreed, concluding that Hartje voluntarily

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No. 85045-8-I/11

retired and noting that there was no evidence that she sought employment before

the aggravation of her injury. Id. at 468. Because “Ms. Hartje was capable of

obtaining gainful employment as of October 2, 1996, her industrial injury was not

a proximate cause for her failure to return to the work force.” Id. at 469. Thus, her

intent to return to work itself was insufficient to show she did not voluntarily sever

her employment. Id.

       According to Higgins, because there is no evidence he was cleared to return

to work nor was there evidence he voluntarily retired, the director abused its

discretion by concluding Higgins voluntarily retired.          Furthermore, Higgins

contends he was unable to return to work due to the residuals of his 1989 industrial

injury. Id. at 15. We disagree.

       Again, the director has broad discretion to consider any source of

information when deciding to open or determine the scope of an over-seven claim.

Stach, 152 Wn. App. at 510-511. There is no authority restricting the director from

considering the lack of evidence as it forms its decision. As we stated in Stach,

the key is not the source of information, rather it is the director’s discretion. Id. at

510.

       In the same way, we must determine, on the one hand, whether Higgins

met this burden to show that he did not voluntarily retire and whether, on the other

hand, “an unprejudiced, thinking mind” would be convinced “of the truth of that to

which the evidence is directed.’” Street, 189 Wn.2d at 205 (quoting Ehman, 33

Wn.2d at 597).

       Here, the director reviewed the record, including a report of Higgins’ entire

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No. 85045-8-I/12

administrative record by a claim manager, showing that there was no evidence of

Higgins attempting to return to work from 2003-2005 after Higgins’ auto shop

closed. Furthermore, Higgins’ claim was closed in 1992, at which time the director

determined Higgins was able to obtain and perform some type of work. The

director further noted that Higgins was asked multiple times to provide further

information about his medical needs between 2003 and 2005.              The director

reviewed all these reports including Higgins and his son’s testimony regarding his

inability to work due to his injury.

       When viewing this evidence “in the light most favorable” to the party who

prevailed at the superior court (the respondent), we do not find the director’s order

to reopen the over-seven claim in the way it did was arbitrary and capricious, i.e.,

“willful and unreasoning and taken without regard to the attending facts or

circumstances.” Whidbey Envtl. Action Network, 14 Wn. App. 2d at 526 (quoting

PacifiCorp, 194 Wn. App. at 587. Nor do we find that Higgins carried his burden

that no substantial evidence supported the director’s decision as to the specific

type of benefit granted.

       And, as in Hartje, the director may find Higgins’ intent to return to work

insufficient to show he made bona fide attempts to seek work. 148 Wn. App at

468. Whether or not we agree that Higgins provided some evidence of his desire

or inability to work, “where there is room for two opinions, an action taken after due

consideration is not arbitrary and capricious even though a reviewing court may

believe it to be erroneous.” Kendall,118 Wn.2d at 14 (quoting Abbenhaus v.

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No. 85045-8-I/13

Yakima, 89 Wn.2d 855, 858-59, 576 P.2d 888 (1978)).

          3. Contemporaneous medical records

       Second, Higgins contends that the director erred by noting the lack of

contemporaneous medical records. Under RCW 51.32.090(3)(b), an employee

deemed unable to work due to a temporary total disability is supposed to receive

a statement from the employer describing the work available to the claimant

consistent with their physical ability. If the worker’s existing industrial injury is

aggravated and a medical professional judges the worker unable to continue the

work, the worker’s temporary total disability payments are resumed while the

worker ceases working. Id.

       Higgins contends this statute does not require contemporaneous evidence

that he was unable to work between 2003 and 2005. To Higgins, “[c]onjuring

requirements that do not exist” is an abuse of discretion inconsistent with the

remedial nature of the statute.

       As a preliminary matter, an agency may abuse its discretion if it relies upon

conjecture, or ignores evidence presented at proceedings. In re Det. of Dyer, 157

Wn.2d 358, 369, 139 P.3d 320 (2006). Conversely, the director holds broad

discretion in weighing the facts before it when finding a worker eligible or ineligible

for benefits, especially in over-seven claims. Stach, 152 Wn. App. at 510-511.

Even considering the remedial nature of the statute, the law vests the director with

discretion to award or deny to fulfill the intent behind the act. RCW 51.12.010.

Nothing in the statutes Higgins cites says otherwise.

       More substantively, as reviewed above, the director’s order did not base the

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No. 85045-8-I/14

entirety of its reasoning on Higgins’ lack of contemporaneous medical records from

2003-2005, but rather mentioned them in passing. Mere reference to a particular

piece of evidence (or lack thereof) is not an act that is “willful and unreasoning and

taken without regard to the attending facts or circumstances,” under the abuse of

discretion standard. Whidbey Envt’l Action Network, 14 Wn. App. 2d at 526.

       Similarly, Higgins provides no authority for the proposition that merely

noting the absence of some information can be fatal to the director’s decision

and/or allows him to carry his heavy burden here. Where a party fails to provide

citation to support a legal argument, we assume counsel, like the court, has found

none. State v. Loos, 14 Wn. App. 2d 748, 758, 473 P.3d 1229 (2020) (citing State

v. Arredondo, 188 Wn.2d 244, 262, 394 P.3d 348 (2017)).

       Moreover, it is not unreasonable for the director to note that there were no

records before it of Higgins seeking employment or even medical care. It is within

the director’s discretion in this context to note the lack of contemporaneous

evidence of Higgins’ aggravated injury, regardless of whether the director is

expressly permitted to do so in any statute or regulation. Again, no authority

Higgins cites says otherwise.

                                   III. CONCLUSION

   We affirm the superior court.

WE CONCUR:

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