Breaking News: Washington State Supreme Court Upholds Injured Workers’ Right to Appeal Medical Coverage Decisions

Workers Compensation Supreme Court Decision

This morning the Washington State Supreme Court issued a historic decision in Murray v. Dep’t of Labor and Industries (No. 95251-5) unanimously holding that HTCC coverage determinations are not binding on the Department of Labor and Industries under the Industrial Insurance Act and that injured workers retain the right to appeal coverage decisions based on HTCC determinations to the Board of Industrial Insurance Appeals for consideration of whether the proposed medical treatment is necessary and proper under the Industrial Insurance Act. HTCC coverage determinations may still be afforded considerable weight, but injured workers still retain the right to appeal the determination, which is significant. In its decision, the Court concluded that:

 “applying L&I’s Medical Aid Rules, HTCC determinations are one of several sources of information that L&I uses to make medical coverage decisions. While HTCC determinations are given considerable weight, the Medical Aid Rules do not afford such determinations preclusive effect. Under the Medical Aid Rules, L&I, not the HTCC, remains responsible for medical treatment coverage decisions. Accordingly, such Department medical coverage decisions are then subject to review before the BIIA and in superior court, pursuant to chapter 51.52 RCW.”

Congratulations to Mr. Murray and all the attorneys who fought this difficult fight, and congratulations to Washington State injured workers’ who retain the right to argue the necessary and proper nature of treatment being recommended by their providers!

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