Michael L. Sims v. Dept Of Labor & Industries Of The State Of Washington

Filed
Washington State
Court of Appeals
Division Two
July 26, 2016
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II
MICHAEL L. SIMS, No. 47604-5-II
Appellant,
v. PUBLISHED OPINION
DEPARTMENT OF LABOR AND
INDUSTRIES OF THE STATE OF
WASHINGTON,
Respondent.
MAXA, J. – Michael Sims appeals a superior court order affirming a Board of Industrial
Insurance Appeals (Board) ruling denying permanent partial disability benefits. The Board ruled
that Sims was unable to receive a permanent partial disability award for his March 2012
industrial injury because that injury occurred after the September 2010 effective date of a
permanent total disability determination relating to a 2003 injury. Sims argues that the Board
and the superior court erred because the Department of Labor & Industries (DLI) did not enter its
decision regarding his permanent total disability until after his March 2012 injury.
A worker who has a permanent partial disability (PPD) because of an industrial injury
receives a one-time award of benefits based on his or her loss of function. RCW 51.32.080. A
worker who has a permanent total disability (PTD) receives a certain percentage of his or her
wages as a monthly pension. RCW 51.32.060. Under settled Washington law, an injured worker
who has been classified as being permanently and totally disabled and subsequently is injured
No. 47604-5-II
again cannot receive a PPD award for the second injury. E.g., Harrington v. Dep’t of Labor &
Indus., 9 Wn.2d 1, 7-8, 113 P.2d 518 (1941). However, a worker who suffers one injury and
later is classified as being permanently and totally disabled because of another injury can receive
a PPD award for the first injury. McIndoe v. Dep’t of Labor & Indus., 144 Wn.2d 252, 266, 25
P.3d 903 (2001).
Sims argues that under McIndoe he is entitled to a PPD award for the March 2012 injury
because that injury occurred before DLI entered the decision that he was permanently and totally
disabled. DLI argues that Sims is not entitled to a PPD award for the March 2012 injury because
that injury occurred after the September 24, 2010 effective date of his permanent and total
disability.
We agree with DLI. We hold that Sims is not entitled to a PPD award for the March
2012 injury because that injury occurred after the effective date of his PTD, as determined by the
Board and DLI. Accordingly, we affirm the superior court’s order.
FACTS
In 2003, Sims injured his left arm at work. He filed a workers’ compensation claim,
which DLI allowed. DLI provided Sims with time-loss benefits until October 2009.
In April 2010, DLI closed Sims’s claim and determined that Sims was permanently and
partially disabled because of the 2003 injury. After Sims protested, DLI affirmed its disability
determination in a decision dated September 24, 2010. Sims appealed to the Board, claiming
that he was permanently and totally disabled rather than partially disabled because of the 2003
injury.
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While this appeal was pending before the Board, Sims was injured at work in March
2012. Sims filed another workers’ compensation claim. DLI allowed the claim and determined
that Sims was entitled to receive medical treatment and other benefits under this claim.
In August 2012, the Board reversed DLI’s decision on Sims’s appeal for the 2003 injury.
The Board found that Sims was “unable to perform or obtain gainful employment on a
reasonably continuous basis . . . as of September 24, 2010.” Clerk’s Papers (CP) at 76. The
Board concluded that Sims “was a permanently totally disabled worker within the meaning of
RCW 51.08.160, as of September 24, 2010.” CP at 76. Finally, the Board remanded the matter
to DLI to determine that Sims was totally and permanently disabled.
In September 2012, DLI issued a notice of decision correcting and superseding its
September 24, 2010 order. The decision stated, “This worker is totally and permanently disabled
and is placed on pension effective 9/24/2010.” CP at 80.
In February 2013, DLI closed Sims’s claim for the March 2012 injury without a PPD
award. Sims protested the decision. DLI affirmed its decision and issued a letter stating that
Sims was not entitled to a PPD award for the March 2012 injury because he was pensioned in
2010.
Sims appealed to the Board. Sims filed a motion for summary judgment and DLI filed a
cross motion for summary judgment. An industrial appeals judge (IAJ) issued a proposed
decision and order granting summary judgment to DLI. The proposed decision and order ruled
that Sims was not entitled to consideration of a PPD award for his March 2012 injury because he
was permanently and totally disabled as of September 2010.
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Sims filed a petition for review of the proposed decision and order with the Board. The
Board considered and denied the petition, adopting the IAJ’s proposed decision and order as the
Board’s decision and order.
Sims appealed the Board’s order to the superior court. The superior court affirmed the
Board’s order adopting the IAJ’s proposed decision and order.
Sims appeals.
ANALYSIS
A. STANDARD OF REVIEW
Under the Industrial Insurance Act (IIA), the superior court’s review of a Board order is
de novo and based solely on the evidence and testimony presented to the Board. Butson v. Dep’t
of Labor & Indus., 189 Wn. App. 288, 295, 354 P.3d 924 (2015); RCW 51.52.115. In the
superior court, the Board’s decision is prima facie correct and the party challenging the Board’s
decision must support its challenge by a preponderance of the evidence. Butson, 189 Wn. App.
at 296; RCW 51.52.115.
In an industrial insurance case, we review the superior court’s decision, not the Board’s
decision. Butson, 189 Wn. App. at 296; RCW 51.52.140. DLI is charged with administering the
IIA, so we afford substantial weight to its interpretation of the act when the subject area falls
within the agency’s area of expertise. Birrueta v. Dep’t of Labor & Indus., 188 Wn. App. 831,
844, 355 P.3d 320 (2015), review granted, 184 Wn.2d 1033 (2016). However, we are not bound
by DLI’s interpretation. Id.The superior court held that the Board correctly granted summary judgment to DLI. We
review summary judgment orders de novo. Rickman v. Premera Blue Cross, 184 Wn.2d 300,
311, 358 P.3d 1153 (2015). Summary judgment is appropriate if there are no genuine issues of
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material fact and the moving party is entitled to judgment as a matter of law. Lakey v. Puget
Sound Energy, Inc., 176 Wn.2d 909, 922, 296 P.3d 860 (2013); CR 56(c).
B. PERMANENT DISABILITY UNDER THE IIA
The right to workers’ compensation benefits is statutory, and we look to the provisions of
the IIA to determine whether a particular worker is entitled to compensation. Clauson v. Dep’t
of Labor & Indus., 130 Wn.2d 580, 584, 925 P.2d 624 (1996). When construing the IIA, we
must liberally construe the act “for the purpose of reducing to a minimum the suffering and
economic loss arising from injuries . . . occurring in the course of employment.” RCW
51.12.010; see also Harry v. Buse Timber & Sales, Inc., 166 Wn.2d 1, 8, 201 P.3d 1011 (2009).
Therefore, doubts as to the meaning of the IIA are resolved in favor of the injured worker.
McIndoe, 144 Wn.2d at 257.
The IIA provides two types of classifications for a permanent disability: permanent
partial disability and permanent total disability. Permanent partial disability involves a
permanent injury or disease that does not prevent the worker from working. See id. Once DLI
determines that the worker is permanently partially disabled, he or she is entitled to receive a
specific amount as compensation, calculated under guidelines stated in RCW 51.32.080 and
related administrative regulations. Id. PPD benefits are often referred to as “lump-sum” benefits
because the benefit is a one-time award. Stone v. Dep’t of Labor & Indus., 172 Wn. App. 256,
262, 289 P.3d 720 (2012).
Permanent total disability involves certain specific injuries and an injury or disease that
“permanently incapacita[tes] the worker from performing any work at any gainful occupation.”
RCW 51.08.160; see also McIndoe, 144 Wn.2d at 257. Once DLI determines that the worker is
permanently and totally disabled, the worker is entitled to receive a monthly payment in an
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amount based on a percentage of his or her wages. RCW 51.32.060; Boeing Co. v. Doss, 183
Wn.2d 54, 58, 347 P.3d 1083 (2015). PTD benefits are often referred to as “pension” benefits
because the benefit represents a monthly wage replacement. Stone, 172 Wn. App. at 262.
A worker who receives a PPD award before being classified as permanently and totally
disabled based on an unrelated injury is entitled to a full pension for the subsequent PTD,
“notwithstanding the payment of a lump sum for his or her prior injury.” RCW 51.32.060(4);
see also McIndoe, 144 Wn.2d at 257-58. However, if the worker receives a PPD award for an
injury and then is classified as permanently and totally disabled for the same injury, the amount
of the PPD award is deducted from the PTD benefits. RCW 51.32.080(4).
C. RECOVERY OF BOTH PPD AND PTD BENEFITS
In Harrington, the Supreme Court held that a worker who has been classified as
permanently and totally disabled for an industrial injury and has been awarded a PTD pension
cannot recover disability benefits for a second injury that occurred after being classified as
permanently and totally disabled. 9 Wn.2d at 7-8. The court stated, “[h]aving been classified as
permanently and totally disabled, [the worker] could not, in law, be further disabled.” Id. at 7.
The court further stated,
[The worker] has already received all the benefits that may be allowed for
permanent and total disability. A subsequent lesser disability cannot be
superimposed upon the maximum disability recognized by the law. A contrary
conclusion would result in an overlapping of classifications and in the allowance
of double payment.
Id. at 8.
The Supreme Court acknowledged this rule in two cases decided shortly after
Harrington. See Peterson v. Dep’t of Labor & Indus., 22 Wn.2d 647, 651-52, 157 P.2d 298(1945); Sorenson v. Dep’t of Labor & Indus., 19 Wn.2d 571, 577-78, 143 P.2d 844 (1943). The
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court also has confirmed the Harrington rule in more recent cases. See McIndoe, 144 Wn.2d at
259-60; Clauson, 130 Wn.2d at 585.
However, a worker can recover PPD benefits for an injury that occurred before he or she
was classified as permanently and totally disabled because of a different injury, even if the PPD
award had not yet been made at the time of the PTD classification. McIndoe, 144 Wn.2d at 266;
Clauson, 130 Wn.2d at 586.
In Clauson, the worker injured his right hip in 1974 and injured his lower back and left
hip in 1983. 130 Wn.2d at 582. DLI determined that the worker was permanently and totally
disabled because of the 1983 back injury and awarded him a PTD pension. Id. Later, DLI
determined that Clauson was permanently partially disabled because of the 1974 hip injury, but
denied the worker PPD benefits because he already had been classified as permanently and
totally disabled. Id. at 582-83. The Supreme Court held that Clauson was entitled to PPD
benefits under the particular circumstances of that case. Id. at 586. The court distinguished
Harrington because Clauson’s injury resulting in the PPD occurred before the injury resulting in
the PTD, the PPD was considered under a separate claim, and the PPD claim was pending at the
time Clauson was classified as permanently and totally disabled. Id.
In McIndoe, three workers in consolidated cases suffered injuries for which they were
classified as permanently and totally disabled, but also sought PPD awards for unrelated hearing
loss that developed before the PTD classification. 144 Wn.2d at 254-56. The Supreme Court
stated that unlike in Harrington, the workers were not seeking disability benefits for an injury
suffered after they had been classified as permanently totally disabled. Id. at 259-60. Instead,
the workers were seeking PPD awards for an occupational disease that occurred before their
pension awards. Id. at 260. The court stated that “[a]s in Clauson, the workers in this case had
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valid, preexisting, compensable claims for occupational disease suffered before their totally
disabling injuries.” Id. at 265. The court concluded:
Based on the holding of Clauson, the principle that provisions of the IIA be
liberally construed in favor of injured workers, and that workers should not be
penalized for the sequencing of the filing of claims, we hold that a worker may
receive permanent partial disability benefits for a valid occupational injury or
disease claim that preexisted and is unrelated to the worker’s permanent total
disability condition if the permanent partial disability claim is filed within the
statute of limitations.
Id. at 266.
In both Clauson and McIndoe, it was not material whether the date of DLI’s decision and
the effective date of the PTD were different; the injuries for which the workers were seeking a
PPD award all occurred before the effective date of the PTD. Here, however, Sims’s March
2012 injury occurred after the effective date of the PTD (September 24, 2010) but before the date
of DLI’s decision stating that Sims was permanently and totally disabled (September 11, 2012).
The issue here is whether the relevant date for determining Sims’s entitlement to PPD benefits
for his March 2012 injury is the effective date on which he became permanently and totally
disabled (2010) or the date of DLI’s decision stating that he became permanently and totally
disabled (2012).
D. DATE OF DISABILITY VS. DATE OF DLI DECISION
Sims argues that Clauson and McIndoe control and he is entitled to a PPD award because
the March 2012 injury occurred and his claim was pending before DLI’s decision that he was
permanently and totally disabled. DLI argues that the Harrington rule controls and Sims is not
entitled to a PPD award because the March 2012 injury occurred after the effective date of
Sims’s PTD and receipt of pension benefits. We agree with DLI.
Sims’s argument finds some support in the language of McIndoe and Clauson. Both
cases focus on when the worker was “classified” as permanently and totally disabled. McIndoe,
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144 Wn.2d at 260; Clauson 130 Wn.2d at 585. As in those cases, DLI had not classified Sims as
permanently and totally disabled when his March 2012 injury occurred. However, neither
Clauson nor McIndoe involved the situation here, where DLI’s PTD decision stated that the date
on which Sims had become permanently and totally disabled was approximately two years
earlier.
Focusing on the effective date of the PTD rather than the date of DLI’s PTD decision is
consistent with the reasoning in Harrington. As the Board and DLI determined, Sims actually
became permanently and totally disabled on September 24, 2010. Once he became totally
disabled, he could not become further disabled by another injury. Harrington, 9 Wn.2d at 7.
Focusing on the effective date of the PTD also is consistent with the purpose of the rule
that a permanently and totally disabled worker cannot receive a PPD award for a subsequent
injury: to avoid double recovery. Id. at 8. DLI’s decision stated that Sims was entitled to a
pension retroactive to September 24, 2010. A pension is the maximum benefits allowed for a
permanent total disability. See id. at 7. Giving Sims a PPD award in addition to maximum PTD
benefits would result in double recovery.
Sims argues that as in Clauson, he is entitled to a PPD award because the claim for his
March 2012 injury was pending when the Board and DLI determined that he was permanently
and totally disabled effective September 24, 2010. However, the proper question is whether the
claim for the March 2012 injury was pending at the time Sims actually became disabled, not
when DLI made its decision. Sims’s March 2012 claim was not pending on the effective date of
his disability and pension.
Sims also argues that he is being penalized because of DLI’s erroneous initial decision
that he was only partially disabled because of his 2003 injury and that denying a PPD award for
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the 2012 injury would be unfair. But Sims does not explain why denying him a PPD award
would be unfair. If DLI had correctly decided in September 2010 that Sims was permanently
and totally disabled, he would have begun receiving a pension at that time and there would be no
question under Harrington, Clauson and McIndoe that he could not recover a PPD award for the
2012 injury. DLI’s corrected decision established the same result retroactively.
Finally, Sims argues that if DLI actually had awarded him PPD benefits for the March
2012 injury before the Board’s August 2012 ruling, he would be able to retain those benefits.
Although we need not decide this issue, it is not clear that Sims would be able to retain the PPD
benefits in this situation. Because under DLI’s corrected decision Sims received a PTD pension
effective September 24, 2010, a reasonable argument may be made that allowing him to retain a
PPD award in this situation would result in double recovery.
We hold that because Sims became permanently and totally disabled as of September 24,
2010 and received pension benefits retroactive to that date, he cannot obtain PPD benefits for an
injury that occurred after that date.
E. ATTORNEY FEES
Sims requests an award of reasonable attorney fees pursuant to RCW 51.52.130. RCW
51.52.130(1) provides for an award of attorney fees to workers or beneficiaries when the superior
court “decision and order is reversed or modified and additional relief is granted to a worker or
beneficiary.” Because we affirm the superior court’s order, we do not award Sims attorney fees
under RCW 51.52.130.
CONCLUSION
After the Board’s decision on Sims’s appeal, DLI determined that Sims was permanently
and totally disabled as of September 24, 2010. Sims received a monthly wage-replacement
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pension effective on that date. Sims’s March 2012 injury occurred after he was permanently and
totally disabled. Therefore, under settled law Sims was not entitled to a PPD award for the
March 2012 injury. We affirm the superior court’s order.
MAXA, J.
We concur:
BJORGEN, C.J.
LEE, J.
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