Murray v. Dep’t of Labor & Indus.

In 2006, the Washington legislature enacted legislation establishing a state health technology assessment program. Part of that legislation formed the Health Technology Clinical Committee ("HTCC") as an independent committee to judge selected medical technology and procedures by their safety, efficacy, cost-effectiveness, and health outcomes. In 2010, the HTCC began its review of a controversial procedure - femoroacetabular impingement (FAI) syndrome hip surgery. Michael Murray sustained a hip injury while at work in August 2009. L&I allowed his claim and provided medical treatment. Murray's physician, Dr. James Bruckner, asked the Washington Department of Labor and Industries ("L&I") to authorize surgery regarding Murray's hip condition, FAI syndrome. L&I denied payment for FAI surgery because the HTCC disallowed coverage for that procedure. Dr. Bruckner performed the surgery on Murray without authorization from L&I. The FAI surgery purportedly successfully rehabilitated Murray's hip injury. Murray appealed L&I's decision denying payment for the surgery to the Board of Industrial Insurance Appeals (Board or BIIA), which affirmed L&I. Murray appealed to the superior court, which affirmed the Board. Murray appealed to the Court of Appeals, which affirmed the superior court. Murray then petitioned the Washington Supreme Court, which reversed. The Supreme Court "harmonized" the HTCC legislation with the Industrial Insurance Act, and in doing so, determined that applying L&I's Medical Aid Rules, HTCC determinations were one of several sources of information L&I used to make medical coverage decisions. "While HTCC determinations are given considerable weight, the Medical Aid Rules do not afford such determinations preclusive effect. Under 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." Murray's reimbursement claim to L&I was remanded for further proceedings. View "Murray v. Dep't of Labor & Indus." on Justia Law