17 NICS App. 12, JOHNS v. TRAVELERS (January 2019)
IN THE PUYALLUP TRIBAL COURT OF APPEALS
PUYALLUP INDIAN RESERVATION
TACOMA, WASHINGTON
Douglas Johns, Petitioner/Appellant,
v.
Travelers St. Paul Fire And Marine Insurance Company, Respondent/Appellee.
NO. PUY-CV-AP-2018-0027 (January 24, 2019)
SYLLABUS*
Trial court denied appellant’s motion for reconsideration of its order dismissing his workers' compensation case. Appellant argued that he was denied an opportunity to be heard because there was not an initial administrative appeal process available as required by the Tribe's workers' compensation ordinance. Court of Appeals agreed with appellant, reversed trial court’s dismissal, and remanded to trial court for a hearing to occur where appellant can present evidence and testimony beyond the original claim file.
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Before: |
Randy A. Doucet, Chief Judge; Ric Kilmer, Judge; Lisa M. Vanderford-Anderson, Judge. |
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Appearances: |
Mark C. Wagner, for Appellant; Robert W. Novasky, for Appellee. |
OPINION
Doucet, C.J.:
Douglas Johns appeals from a tribal court order denying his motion for reconsideration of an order dismissing his case. Mr. Johns argues that he was denied an opportunity to be heard because there was not an initial administrative appeal process as required by the Puyallup Tribe’s workers’ compensation ordinance. We agree with Mr. Johns. The dismissal of his case is REVERSED and the case is REMANDED.
BACKGROUND
This is the second appeal arising from this workers’ compensation case. Douglas Johns was employed as a Puyallup Tribal Police officer. His claim arises from job related Post
17 NICS App. 12, JOHNS v. TRAVELERS (January 2019) p. 13
Traumatic Stress Disorder, panic attacks, depression, and anxiety. Travelers Insurance, the worker’s compensation insurer for the Puyallup Tribe, denied the claim. Mr. Johns then filed his claim in the Puyallup Tribal Court.
In the first appeal, this Court affirmed the tribal court’s interpretation of the Tribe’s workers’ compensation ordinance (“WCO”) to exclude from the definition of “occupational disease” mental conditions or mental disabilities caused by stress.1 The case was remanded.
On January 18, 2018, the tribal court dismissed the case with prejudice. On March 1, 2018, the tribal court denied Mr. Johns’ motion for reconsideration. He filed a notice of appeal on March 14, 2018, appealing the Order Denying Plaintiff’s Motions for Reconsideration.
SCOPE OF APPELLATE REVIEW
A decision of the tribal court will be reversed, modified or remanded only where there has been error as to interpretation and/or application of the law by the judge.2
DISCUSSION
The issue raised on appeal by Mr. Johns is “Whether sua sponte dismissal of Mr. Johns’ case was proper when Travelers failed to provide the required administrative process as proscribed by PTC 14.04.120, and, in any case, Mr. Johns received no opportunity to be heard.”3
The Tribe established a workers' compensation ordinance for the Tribe’s employees injured on the job.4 The WCO is to provide for a system to administer the program and resolve any disputed claims that arise under it.5 The WCO provides for a right to appeal through an administrative process established by the insurer for that purpose.6 Any claimant aggrieved by a decision of the insurer denying eligibility has a right to appeal through the administrative process as set forth in the WCO.7 The insurer shall adopt, and provide to the Tribe and to each claimant, rules and procedures for the conduct of such appeals.8
If the claimant is not satisfied with the determination from the initial administrative appeal they may appeal to the Tribal Court.9 The problem is that no initial administrative appeal process was ever established.10 The administrative appeal is required by law and is a necessary part of the appeal process for denied claims. The tribal court is only allowed to consider those issues addressed during the initial administrative appeal and included in the claimant’s notice of appeal.
17 NICS App. 12, JOHNS v. TRAVELERS (January 2019) p. 14
At this point, it would be futile to require an initial administrative appeal. It has already been ordered with no result, and too much time has passed. Mr. Johns first filed in the tribal court on January 13, 2014. In its October 7, 2016, “Order RE: Workers’ Compensation Claim” the tribal court ordered Traveler’s to process Plaintiff’s claim as an “injury” in accordance with the WCO. The tribal court further ordered that Plaintiff “shall have the right to appeal through the administrative process established by the insurer for that purpose. The insurer shall adopt, and provide to the Tribe and to each claimant, rules and procedures for the conduct of such appeals.” During the first appeal we left undisturbed the tribal court’s order regarding the appeal through the administrative process. Nothing happened. There is still no initial administrative appeal process.
We reject Travelers’ argument that the arbitration provisions in the tribal workers compensation and employers liability insurance policy between the Tribe and Travelers is the administrative appeal process, or a substitute, as required by the WCO. The arbitration provisions are for disputes arising between Travelers and the Tribe regarding the insurance policy. The letter from Travelers to Mr. Johns dated January 2, 2014, refers to an attached copy of Tribal Code Chapter 14.04 for appealing a denial to the Tribal Court. There was nothing in the correspondence from Travelers to Mr. Johns informing him of an arbitration process.
Without an initial administrative appeal process the tribal court had two options. One option would have been for the tribal court to dismiss Mr. Johns’ civil complaint petition filed in the tribal court for his workers’ compensation claims because he did not follow the initial appeal process required by PTC 14.04.120. However, that would not have been fair to Mr. Johns. He had no choice but to go through the Tribe’s workers’ compensation program. It is no fault of his that the process to appeal a denied claim has not been established. He was denied his right to the initial administrative appeal. If the tribal court chose this first option, there would be no way to appeal a denied claim as set forth in the WCO.
The second option for the tribal court was to allow Mr. Johns’ civil complaint petition to proceed. The Puyallup Tribal Code gives the court some latitude to issue orders to accomplish substantial justice and adopt suitable procedures to carry out and protect its jurisdiction. Where the Puyallup Tribal Code does not expressly address a question, the Court may issue any order to accomplish substantial justice.11 The question not expressly addressed by the code is what happens when the insurer does not provide an initial appeal process as required by the WCO? The code is to be liberally construed to provide a just and equitable result for the parties in civil actions and members of the Puyallup Reservation community generally, and to secure the just, speedy, and inexpensive determination of every civil action.12 If a procedure is not specifically pointed out by the code, the Tribal Court may adopt any suitable procedure consistent with the spirit of the code or take any measures reasonably necessary to carry out and protect its jurisdiction.13 The tribal court is authorized jurisdiction to hear WCO appeals when the claimant is not satisfied with the determination from the initial administrative appeal.14 Therefore, the tribal court may adopt any suitable procedures consistent with the spirit of the WCO and take any measures reasonably necessary to carry out and protect its jurisdiction under the WCO.
17 NICS App. 12, JOHNS v. TRAVELERS (January 2019) p. 15
This second option required the court to balance the interests of justice against the WCO limitations placed on what the court could review without a record from an initial appeal. The initial administrative appeal process as structured by the WCO limits the tribal court to considering only those issues addressed during the initial appeal and included in the claimant’s notice of appeal, and the evidence or testimony from the initial appeal.15 The tribal court eventually dismissed Mr. Johns’ claims with prejudice and denied Mr. Johns’ motions for reconsideration, “Because Travelers does not have an administrative process, the record on review is the original claim record, which was not submitted until the Joint Motion was filed.”16 The tribal court further determined that, “The Court’s dismissal of Johns’ appeal was based on a review of the applicable law, the claim record, and the parties written submissions.”17
It is our opinion that the tribal court’s scope of review upon which it based the decision to dismiss Mr. Johns’ case was too narrow and that Mr. Johns was entitled to a hearing. Had Mr. Johns had an initial administrative appeal, he would have been entitled to present evidence and testimony beyond the original claim file. The WCO does not limit the initial appeal to the original claim file. PTC 14.04.130(d) states that the tribal court hearing shall be de novo, but the “Court shall not receive evidence or testimony other than that submitted during the initial appeal [emphasis added].” The plain language of PTC 14.04.130(d) establishes that there is a hearing to take place for the appeal to the tribal court, which is to be de novo. Therefore, Mr. Johns is entitled to a hearing in the tribal court, but the evidence is limited to only the evidence and testimony that would have been presented during the initial appeal.
In this situation, the tribal court was standing in place of the initial administrative appeal, and also fulfilling its role as a reviewing court of an administrative appeal. Mr. Johns has the right to present evidence and testimony at a hearing before the tribal court the same as if he were at an initial appeal. Therefore, he is entitled to a hearing before the tribal court and have the tribal court consider evidence and testimony that would have been submitted at the initial administrative appeal.
CONCLUSION
We only find error in the tribal court not holding a hearing to allow presentation of evidence and testimony beyond the claim file. We REVERSE the order denying Plaintiff’s motions to reconsider and hold that Mr. Johns had a right to present evidence and testimony for consideration by the tribal court. This places Mr. Johns in the same position that he would have been in had there been an initial administrative appeal. The dismissal of Mr. Johns’ case is REVERSED. The case is REMANDED to have the tribal court hear evidence and testimony from the parties on the issues addressed in the Order on Remand; Order of Dismissal with Prejudice filed on January 18, 2018. The tribal court is then to decide the appeal according to PTC 14.04.130(e).
The syllabus is not a part of the Court’s Opinion. The syllabus is a summary of the Opinion prepared by the publishers of this reporter only for the convenience of the reader. Therefore, the syllabus should not be cited in whole or part as legal authority. Only the Opinion, which follows the syllabus, may be cited as legal authority.
Opinion from first appeal filed 9/21/2017.
PTC 4.16.400(c).
Plaintiff’s Opening Brief, filed 4/18/2018, pg. 5.
PTC 14.04.010
Id.
PTC 14.04.120
Id.
Id.
PTC 14.04.130
Order Denying Plaintiff’s Motions for Reconsideration, filed 3/1/208, pg. 2.
PTC 4.08.320 Rules not announced. [Res. 29-07-87-A (07/29/87); prior code § 4.02.510]
PTC 4.08.030
Id.
PTC 14.04.130
PTC 14.04.130(d).
Order Denying Plaintiff’s Motions for Reconsideration, pg. 2.
Id. at pg. 3.