Kelly Elswick Hall Frederick G. Staker, III
Howley & Venezia
Assistant Attorney General Charleston, West Virginia
Attorney for Petitioner Employment Programs Litigation Unit
Attorney for Respondent Commissioner Viewig
Wendy D. Young
Carter & Young
Charleston, West Virginia
Attorney for Respondent
Wal-Mart
JUSTICE DAVIS delivered the Opinion of the Court.
1. A writ of mandamus will not issue unless three elements coexist--(1)
a clear legal right in the petitioner to the relief sought; (2) a legal duty on the part of
respondent to do the thing which the petitioner seeks to compel; and (3) the absence of
another adequate remedy. Syllabus point 2, State ex rel. Kucera v. City of Wheeling, 153
W. Va. 538, 170 S.E.2d 367 (1969).
2. A case is not rendered moot even though a party to the litigation has
had a change in status such that he no longer has a legally cognizable interest in the litigation
or the issues have lost their adversarial vitality, if such issues are capable of repetition and
yet will evade review. Syllabus point 1, State ex rel. M.C.H. v. Kinder, 173 W. Va. 387,
317 S.E.2d 150 (1984).
3. Under W. Va. Code 23-1-13(a) [1995], the Workers' Compensation
Commissioner has a nondiscretionary duty to respond to requests for authorization for
medical treatment within a reasonable period. Under 85 CSR 6 [1985], the rules adopted by
the Commissioner governing time limits, the Commissioner has determined that fifteen (15)
working days from the date of receipt of a request in the Fund is a reasonable period for such
response. CSR 85-6-3.1. [1985].
4. Under W. Va. Code 23-1-13(a) [1995], the Workers' Compensation
Commissioner has a nondiscretionary duty to respond to a compensability request within a
reasonable period. Under 85 CSR 6 [1985], the rules adopted by the Commissioner
governing time limits, the Commissioner has determined that fifteen (15) working days from
the date of receipt of a compensability request in the Fund is a reasonable period for a
response to a compensability claim, other than occupational pneumoconiosis. CSR 85-6-2.1.
[1985].
5. When the Workers' Compensation Commissioner is unable to issue a
protestable order within the time limit set forth in his rules and regulations, the
Commissioner, under 85 CSR 6 [1985], has a nondiscretionary duty to provide the claimant
with notice of good cause for extending the applicable time limit. Such notice of good cause
must be issued to the claimant within a reasonable time after the Commissioner realizes a
time limit cannot be met, and must contain a reasonable date by which a protestable order
will be issued. CSR 85-6-1.1. [1985].
6. When the Court awards reasonable attorney's fees and costs in a case,
which is not subject to remand, any agreement by the parties to such fees and costs is subject
to the Court's approval. If the parties are unable to agree, the parties shall attempt mediation
through the Court's mediation program. If the mediation does not result in an agreement, the
parties and the mediator shall make timely written recommendations to the Court for a
determination of the appropriate award.
The Commissioner conceded that the orders were entered on December 15,
1999, which is approximately 36 days after Mr. Davis' petition was filed with this Court.
Because of the issuance of the protestable orders, the Commissioner seeks to have this case
dismissed as moot. The Commissioner's response also noted that he is willing to discuss
. . . payment of a reasonable attorney's fee, and reasonable costs arising from this
proceeding.
The traditional test for granting mandamus relief is stated in syllabus point 2
of State ex rel. Kucera v. City of Wheeling, 153 W. Va. 538, 170 S.E.2d 367 (1969):
A writ of mandamus will not issue unless three elements
coexist--(1) a clear legal right in the petitioner to the relief
sought; (2) a legal duty on the part of respondent to do the thing
which the petitioner seeks to compel; and (3) the absence of
another adequate remedy.
See Syl. pt. 1, State ex rel. Aaron v. King, 199 W. Va. 533, 485 S.E.2d 702 (1997). Once
these prerequisites are met, this Court's decision whether to issue the writ is largely one of
discretion. Billings, 194 W. Va. at 304, 460 S.E.2d at 439 (footnote omitted). With this
standard in mind, we now address the merits of Mr. Davis' petition.
Although, we agree with the Commissioner that the issue with regard to Mr. Davis is moot, because of the possibility that similar unnecessary delays in responding to legitimate claimant requests may occur in the future, we now address the merits of this case under the Kinder-Israel, exception to the mootness doctrine.
In our seminal case of Meadows v. Lewis, we addressed the duty of the
Commissioner to respond timely to the rights of Workers' Compensation claimants. In
Meadows, the petitioners sought to have the Commissioner timely process temporary total
disability and permanent partial disability claims. One of the pertinent legal issues in
Meadows was the petitioners' request that the Commissioner be compelled to promulgate
rules and regulations governing 'the time within which adjudications and awards shall be
made' as required by W. Va. Code § 23-1-13. Meadows, 172 W. Va. at 473, 307 S.E.2d at
641. Based on W. Va. Code 23-1-13, this Court recognized that the Commissioner had a
nondiscretionary duty to promulgate rules and regulations. Syllabus point 6 of Meadows
states:
The commissioner is required by W. Va. Code § 23-1-13
(1981 Replacement Vol.) to promulgate regulations specifying,
inter alia, internal procedural time limits through which
adjudications and awards are made.See footnote 5
5
On May 23, 1985, the Commissioner responded to our ruling in Meadows, by
promulgating Time Limits For The Administrative Processing Of Adjudications And
Awards. See generally, 85 CSR 6 [1985]. These rules were promulgated for the purpose
of promoting and facilitating the prompt processing of claims with the operation of the
Workers' Compensation Fund. CSR 85-6-1.1. [1985]. The disposition of this issue is
controlled by the rules promulgated by the Commissioner. Given that the Commissioner
promulgated the rules, he must consider them reasonable and must believe that the Fund is
capable of complying with them.
(1) Request to pay for medications and pain management treatment. Mr.
Davis made an initial request for the payment of certain medications on September 3, 1998.
Subsequently, on January 22, 1999, Mr. Davis made a request for authorization to receive
pain management treatment. After these initial requests, Mr. Davis followed up with
additional demands that the Commissioner respond to his requests. The Commissioner
ignored Mr. Davis' requests until he sought extraordinary relief from this Court. In fact, the
Commissioner did not respond to Mr. Davis' requests until December 15, 1999.
The Commissioner's rule addressing the time limit for responding to requests
for medical treatment is found at CSR 85-6-3.1. [1985], which provides:
Medical Treatment. --Requests for authorization of medical
treatment shall be ruled upon within fifteen (15) working days
from the date of receipt in the Fund.
(Emphasis added.) The need for a rapid response to a request of medical treatment is self
evident. An injured worker, who needs medical treatment, should not suffer because of
bureaucratic delay. The Commissioner recognized the need for a timely response and he
imposed a nondiscretionary duty to respond to such requests within fifteen (15) working days
of the receipt of such requests in the Fund.
We find that under W. Va. Code 23-1-13(a) [1995], the Workers'
Compensation Commissioner has a nondiscretionary duty to respond to requests for
authorization for medical treatment within a reasonable period. Under 85 CSR 6 [1985], the
rules adopted by the Commissioner governing time limits, the Commissioner has determined
that fifteen (15) working days from the date receipt of a request in the Fund is a reasonable
period for such response. CSR 85-6-3.1. [1985].
In the instant proceeding, the Commissioner not only failed to comply; but, he
did not even come reasonably close to complying with his own time limit. Mr. Davis had
to wait almost a year for approval for prescription medications and for denial of certain
treatment. In both cases, the injured worker has a grave potential for harm - harm because
of lack of proper treatment or harm because of delay in the appeal/protest process.
(2) Request to find right ankle fracture compensable. On December 23,
1998. Mr. Davis submitted a request to the Commissioner that his ankle injury be added as
part of his compensable back injury claim. Again, Mr. Davis followed up with additional
requests that the Commissioner respond to his initial inquiry. Again, Mr. Davis' requests
were ignored by the Commissioner until he sought extraordinary relief from this Court.
Again, no order was entered by the Commissioner until December 15, 1999.
The Commissioner's rule addressing the time limit for responding to requests
for finding an injury compensable is found at CSR 85-6-2.1. [1985], which provides, in
pertinent part:
Injury and occupational disease claims. --Those claims based
upon injuries and occupational diseases other than occupational
pneumoconiosis that are filed in the Fund upon properly
executed, prescribed forms ... shall be ruled upon within fifteen
(15) working days from the date of receipt in the Fund.See footnote 6
6
(Emphasis added.) The need for a timely response to a compensability request is apparent.
An injured worker needs immediate treatment. The Commissioner recognized the need for
a timely response. Thus, he imposed a nondiscretionary duty to respond to a compensability
claim, other than occupational pneumoconiosis, within fifteen (15) working days from the
date of receipt of the request in the Fund.
We find under W. Va. Code 23-1-13(a) [1995], the Workers' Compensation
Commissioner has a nondiscretionary duty to respond to a compensability request within a
reasonable period. Under 85 CSR 6 [1985], the rules adopted by the Commissioner
governing time limits, the Commissioner has determined that fifteen (15) working days from
the date of receipt of a compensability request in the Fund is a reasonable period for a
response to a compensability claim, other than occupational pneumoconiosis. CSR 85-6-2.1.
[1985].
In the instant proceeding, the Commissioner failed to comply with his own
time requirements. Mr. Davis waited almost a year for a ruling on the compensability of his
fractured ankle. Such delay frustrates not only the injured worker and his/her family, but
also affects medical providers, employers and others. Delay also postpones a prompt
adjudication of disputed matters.
(3) Procedure to follow when time limits cannot be met. The rules also provide a
procedure when time limits cannot be met. CSR 85-6-1.1. [1985] provides in pertinent part:
Compliance with non-statutory time limits may be extended for good cause. In the instant
proceeding, no cause, good or otherwise, was given for the delay in responding to Mr. Davis'
requests. Under the Commissioner's rules, he was required to communicate with Mr. Davis,
within a reasonable time, detailing his good cause for extending the time limits involved.
We hold that when the Workers' Compensation Commissioner is unable to
issue a protestable order within the time limit set forth in his rules and regulations, the
Commissioner, under 85 CSR 6 [1985], has a nondiscretionary duty to provide the claimant
with notice of good cause for extending the applicable time limit. Such notice of good cause
must be issued to the claimant within a reasonable time after the Commissioner realizes a
time limit cannot be met, and must contain a reasonable date by which a protestable order
will be issued. CSR 85-6-1.1. [1985].
We further stated in syllabus point 9 of Meadows:
Where a claimant for workers' compensation benefits is
required to hire an attorney to contest unlawful acts of the
commissioner, the claimant should be reimbursed for reasonable
attorney fees incurred in vindicating his statutory entitlement to
benefits. Reasonable attorney fees are to be paid by the
commissioner who fails to comply with statutory duties.
Mr. Davis should not be forced to expend his resources to have the
Commissioner perform his nondiscretionary duty. Mr. Davis was entitled to prompt rulings
on his requests. Unfortunately, before he could secure any action from the Commissioner,
he had to seek a writ of mandamus from this Court. The Commissioner's response
acknowledges that the Workers' Compensation Division should reimburse Mr. Davis for his
reasonable attorney's fees and costs. Based on the undisputed facts of this case, we find that
Mr. Davis is entitled to reasonable attorney's fees and costs associated with prosecuting this
petition.
During oral argument, the parties indicated that they were negotiating payment
of the reasonable attorney's fees and costs incurred by Mr. Davis in this matter, but no
agreement had been reached. Because the case cannot be remanded for a judicial
determination, we are concerned that another long and unnecessary delay may occur in
settling the issue of reasonable attorney's fees and costs.
We hold that when the Court awards reasonable attorney's fees and costs in a
case, which is not subject to remand, any agreement by the parties to such fees and costs is
subject to the Court's approval. If the parties are unable to agree, the parties shall attempt
mediation through the Court's mediation program. If the mediation does not result in an
agreement, the parties and the mediator shall make timely written recommendations to the
Court for a determination of the appropriate award.
In the instant proceeding, if the parties are unable to agree within 15 days of
the issuance of the mandate in this case, the matter shall be submitted to this Court's
mediation program, which was instituted in 1998 to assist parties in Workers' Compensation
cases to reach a mutually acceptable agreement.See footnote 7
7
Although the mediation proceedings in the
Court's program are confidential, in cases involving a Court referral concerning the award
of reasonable attorney's fees and costs, any agreement is subject to Court approval. If the
parties are unable to agree, the parties and the mediator shall timely submit written
recommendations to the Court for a determination of any award.
1Wal-Mart Stores, Inc., Mr. Davis' employer, was named as a nominal respondent in this matter.
(1) A December 15, 1999 order titled: Authorization for
medication;
(2) A December 15, 1999 order titled: Authorization for
medication;
(3) A December 15, 1999 order titled: Notice to include
secondary conditions;
(4) A December 15, 1999 order titled: Denial to Dr. Lilly; and
(5) A January 6, 2000 order titled: Correction to Denial to Dr.
Lilly.
The Commissioner also attached two orders, dated December 22, 1999 and December
31, 1999, which address matters extraneous to this opinion and therefore, are not discussed.
The workers' compensation division shall adopt
reasonable and proper rules of procedure, regulate and provide
for the kind and character of notices, and the service thereof, in
cases of accident and injury to employees, the nature and extent
of the proofs and evidence, the method of taking and furnishing
the same to establish the rights to benefits or compensation from
the fund hereinafter provided for, or directly from employers as
hereinafter provided, as the case may require, and the method of
making investigations, physical examinations and inspections,
and prescribe the time within which adjudications and awards
shall be made.