Tag Archives: Treatment Authorization

WA Court of Appeals Cites Compensable Consequences Doctrine in Maphet Decision

From the Maphet decision:

“…the compensable consequences doctrine compels coverage of the ninth surgery; and the County conceded that the ninth surgery was proper and necessary. Accordingly, we reverse.”

Clark County, Et Al. v. Jennifer Maphet, (Wa. Ct. App. Div. II, 2019)

Maphet – the Story

The Court of Appeals opinion sets out the chronology of events in the Maphet case, in the most simple and dry manner, as follows:

Jennifer Maphet injured her right knee while at work. Her employer, Clark County, is a self-insured employer. Maphet underwent nine surgeries on her knee. The County contested its responsibility for the ninth surgery to the Department of Labor and Industries (L&I). L&I issued an order for the County to authorize and pay for the surgery. The County appealed. The Board of Industrial Insurance Appeals (BIIA) affirmed L&I’s order. The County appealed to the trial court, and the jury returned a verdict that the industrial injury did not cause the need for the ninth surgery and that the ninth surgery was not proper and necessary.

Undoubtedly, for Ms. Maphet this paragraph represents many years of ordeal, from injury through surgeries, peppered with administrative headaches and legal hassles. The end result, however, is that her set of circumstances has resulted in clarification of the laws, benefiting all injured workers in Washington. From this point forward, claimant attorneys will refer to the “Maphet decision” while representing injured workers.

Key Take-Aways from the Maphet Decision

I encourage you to read the full decision, here. This is a window into the world of legal wrangling in workers’ compensation matters, at the highest level. The Maphet decision also outlines, in detail, one story of one injured worker, with parallels and patterns that will be familiar to any injured worker.

The Maphet case stands for two important rules:

1)      If a self-insured employer (SIE) covers medical treatment, it is legally responsible for the underlying condition; and

2)      The Board’s “compensable consequences doctrine” is a correct statement of the law – if a claim-covered surgery results in some untoward consequence, it is the SIE’s responsibility.

We often litigate cases over the responsibility of the Department of Labor and Industries or self-insured employer for a medical condition or treatment, particularly when surgeries are involved. Like Ms. Maphet’s case, we have seen cases where treatment is authorized, covered by a claim, only later to be retroactively denied as not the responsibility of the Department or SIE.

With the publishing of the Maphet decision, a clear message has been sent that the Department or SIE’s are responsible for both the underlying condition and any untoward consequences arising from a surgery (whether it rises to the level of medical malpractice, or not) once a medical condition has been covered by a claim.

The Appeal Process, Simply Stated

Most workers’ compensation claims are handled administratively, many concluding without conflict or the need for legal representation. Some are more complicated, hard fought, and require litigation. Of these, the majority are resolved through proceedings before the Board of Industrial Insurance Appeals.

Aggrieved parties have the right to appeal from the Board’s decisions to superior court where a judge or, if requested, a jury issue an order on the issues at hand. However, in rare cases where matters of law remain at issue, appeals can be argued to the Court of Appeals and, from there, even more rarely, to the state Supreme Court. Ms. Maphet’s case was recently presented to the Court of Appeals, Division II, and the court opinion was just published.

More Information About Appeals

We have information on our website about appeals to the Board of Industrial Insurance Appeals or higher courts on workers’ compensation issues, here. If you have questions and wish to discuss your case in more detail, please contact our firm for assistance. You may call our office at (206) 292-8627 or email to: reachus @ causeywright.com (remove spaces when entering the email address – they have been added to avoid spam by bots).