Arreola v. Scentsy, Inc.
| Docket Number | Docket No. 49511 |
| Decision Date | 23 June 2023 |
| Parties | Veronica ARREOLA, Claimant-Appellant, v. SCENTSY, INC., Employer; and Granite State Insurance Co., Surety, Defendants-Respondents. |
| Court | Idaho Supreme Court |
Goicoechea Law Offices, Chtd., Boise, for Appellant. Justin Aylsworth argued.
Bowen & Bailey, LLP, Boise, for Respondents. Rachael O’ Bar argued.
This appeal arises out of the Idaho Industrial Commission's order denying Veronica Arreola's petition for a declaratory ruling and motion for reinstatement of compensation. Arreola brought her petition and motion against the Granite State Insurance Co. ("the Surety"), when the Surety, without an order from the Commission—as permitted by our interpretation of Idaho Code section 72-434 in Brewer v. La Crosse Health & Rehab , 138 Idaho 859, 71 P.3d 458 (2003) —invoked section 72-434 to suspend Arreola's compensation payments. In the Surety's unilateral and private determination, suspending Arreola's compensation payments was appropriate because the Surety had purportedly scheduled Arreola's Independent Medical Exam ("IME") with its physician at a "reasonable" time, I.C. § 72-433(1), and Arreola had "unreasonably" failed to submit to or had obstructed the scheduled IME by not appearing, I.C. § 72-434. Arreola's petition and motion disputed these private conclusions by the Surety. Arreola also maintained that only the Commission has the authority to adjudicate the underlying medical exam dispute and determine whether there is a factual basis to execute the enforcement mechanisms in Idaho Code section 72-434. The Commission denied the petition and motion, instructing Arreola to instead proceed through a complaint for relief.
For the reasons discussed below, we conclude that our decision in Brewer Idaho Code section 72-434 was manifestly wrong. Only the Commission has the authority to adjudicate medical exam disputes, and to enforce that adjudication through the enforcement mechanisms in section 72-434 by ordering the suspension of both the injured employee's compensation payments and "right to take or prosecute any proceedings" under the Worker's Compensation Law ("the Law") until the failure or obstruction by the injured employee related to the requested medical exam ceases.
In light of this, Arreola's concern that the Surety's unilateral execution of the enforcement mechanisms in section 72-434 also suspended her right to file a "complaint" to seek relief is now abated. With Brewer overruled and the authority of the Commission clarified, there is no legal impediment to filing a "complaint" below, as initially preferred by the Commission. Nevertheless, we do not affirm. Given the shift in the legal landscape with Brewer overruled, we vacate the Commission's order denying the petition and motion, and remand with instructions that the Commission: (1) order payment of prospective compensation payments that might be owed until such time as the Commission determines that payments are not required under section 72-434 ; (2) reconsider the appropriate procedural mechanism for adjudicating the underlying factual dispute; and (3) instruct the Surety what procedural mechanism it must use to obtain an order authorizing it to lawfully suspend compensation payments.
In May 2021, Arreola experienced an industrial accident, and injured her right shoulder while using a mallet in the course of her employment with Scentsy, Inc. Arreola timely made a worker's compensation claim for benefits. Two weeks later, her claim was "accepted" as "compensable" by the Surety and benefits later commenced. A few weeks after that, Arreola underwent an MRI and, one week later, visited a treating orthopedic physician. After reviewing the MRI and examining Arreola, the treating physician diagnosed Arreola with a "traumatic" right rotator cuff tear
, recommended that her injury "requires surgical intervention[,]" and thereafter sought authorization from the Surety to perform surgery on Arreola's shoulder. The physician also noted that Arreola had "an acute rotator cuff tear [that] needs to be repaired sooner [rather] than later," and emphasized that "time is of the essence."
The Surety did not immediately authorize surgery; instead, it placed the request from the treating physician "under review[.]" Three weeks into review, the Surety sent Arreola a notice instructing her to submit to an IME with Dr. Jeffrey Hessing twenty days after the notice date. The Surety had apparently scheduled the IME without coordinating with Arreola. Six days before the scheduled IME, Arreola's attorney responded to the notice, and informed the Surety that Arreola could not attend the IME at the scheduled time because it was in "direct conflict" with Arreola's "long-standing" obligations to care for a relative. Arreola's attorney also requested that the Surety coordinate the scheduling of all IMEs with his office.
Five days after Arreola's attorney responded, the Surety sent another notice, instructing Arreola to submit to an IME with Dr. Hessing at a rescheduled date and time. Apparently, the Surety had again unilaterally scheduled the IME. Four days after the second notice was sent, Arreola's attorney responded and informed the Surety that Arreola could not attend the rescheduled IME for the same reason as before: Arreola had a prior, "unavoidable obligation" during the rescheduled day and time to care for her relative. Arreola's attorney again requested that the Surety coordinate the scheduling of all IMEs with his office. One day before the rescheduled IME, the Surety responded to Arreola's attorney that the IME would not be rescheduled a second time:
Arreola did not attend the rescheduled IME. Three days later, the Surety issued a "Notice of Claim Status" to Arreola, and explained that due to Arreola's "failure to attend the medical examination[,] [the Surety was] suspending [Arreola's] temporary total disability benefits under Idaho Code [section] 72-434." The Surety added that Arreola's benefits "will be suspended until [Arreola] attend[s] an independent medical examination with Dr. Hessing's office." In the meantime, Arreola's treating physician still had not received authorization from the Surety to perform the recommended surgery.
Subsequently, Arreola sought intervention from the Commission. Instead of filing a complaint with a motion for an emergency hearing, Arreola filed a motion for reinstatement of compensation, or in the alternative, a petition for a declaratory ruling from the Commission to reinstate her compensation based on the Surety's unlawful execution of section 72-434. Arreola also sought "sanctions" and attorney fees against the Surety for its "punitive" use of section 72-434 to arbitrarily "penalize" Arreola for missing the IME that the Surety had unilaterally scheduled, and allegedly knew Arreola could not attend due to a preexisting conflict.
The Commission did not reach the merits of Arreola's request for relief. Instead, the Commission denied Arreola's motion and petition as procedurally improper and declined to hold a hearing on the underlying factual dispute or to issue a declaratory ruling reinstating compensation payment. The Commission explained that because Arreola had not yet filed a complaint, Arreola's motion was not properly before the Commission. Thus, it could not be ruled upon. As for Arreola's petition for a declaratory ruling, the Commission declined to use this procedural mechanism to resolve the underlying dispute even though the Commission's Judicial Rules of Practice and Procedure specifically authorize it to issue a declaratory ruling. Instead, the Commission instructed Arreola that the preferred procedural path was for her to pursue relief through administrative litigation, by filing a complaint and a motion for an emergency hearing before an assigned referee.
Arreola timely appealed from the denial of her petition for a declaratory ruling and motion for reinstatement of benefits.
"In reviewing a decision of the Commission, this Court exercises free review over the Commission's legal conclusions." Clark v. Shari's Mgmt. Corp. , 155 Idaho 576, 579, 314 P.3d 631, 634 (2013). "The interpretation of a statute is a question of law over which this Court exercises de novo review." Kelly v. TRC Fabrication, LLC , 168 Idaho 788, 791, 487 P.3d 723, 726 (2021) (quoting Robison v. Bateman-Hall, Inc. , 139 Idaho 207, 210, 76 P.3d 951, 954 (2003) ). "When doing so, this Court ‘must liberally construe the provisions of the worker's compensation law in favor of the employee, in order to serve the humane purposes for which the law was promulgated.’ " Clark , 155 Idaho at 579, 314 P.3d at 634 (quoting Jensen v. City of Pocatello, 135 Idaho 406, 413, 18 P.3d 211, 218 (2000) ).
On appeal, Arreola first focuses on the underlying factual dispute. Arreola alleges that the Surety refused to coordinate with Arreola in scheduling the IME on the dates and times she was available. Thus, according to Arreola, there is no factual basis to execute Idaho Code section 72-434 and suspend her compensation payments because the Surety did not schedule an IME for a "reasonable" time, see I.C. § 72-433(1), and Arreola did not "unreasonably" fail to submit to or otherwise obstruct the IME, see I.C. § 72-434. However, we do not reach this underlying factual dispute that the Commission never addressed in denying Arreola's petition and motion below. Instead, Arreola's appeal turns on questions of law raised by Arreola related to the proper interpretation and operation of Idaho Code section 72-434.
Citing to case law from this Court interpreting the Idaho Worker's Compensation Law, along with Idaho Code section 72-707, Arreola maintains that only the...
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