Arcadia L. Tapia, Petitioner Employee,
The Industrial Commission of Arizona, Respondent, Banner University Medical Center Tucson, Respondent Employer, Banner Health Workers Compensation, Respondent Insurer.
Special Action - Industrial Commission ICA Claim No.
20152330156 Insurer No. ST15003230 Gary M. Israel,
Administrative Law Judge
Clymer Attorney at Law, Tucson By Laura Clymer Counsel for
Industrial Commission of Arizona, Phoenix By Jason M. Porter
Counsel for Respondent
Jardine, Baker, Hickman & Houston, PLLC, Phoenix By
Charles G. Rehling and Janet S. Weinstein, P.C., Phoenix By
Janet S. Weinstein Counsel for Respondents Employer and
Judge Eckerstrom authored the opinion of the Court, in which
Presiding Judge Staring and Judge Eppich concurred.
ECKERSTROM, CHIEF JUDGE:
In this statutory special action, Arcadia Tapia petitions
this court to set aside the Industrial Commission's award
denying her complaint for unfair claim processing practices
against Banner University Medical Center Tucson and Banner
Health Workers Compensation (collectively,
"Banner"). For the reasons that follow, we set the
and Procedural History
"We consider the evidence in a light most favorable to
upholding the administrative law judge's award."
Aguayo v. Indus. Comm'n, 235 Ariz. 413, ¶ 2
(App. 2014). On July 31, 2015, while Tapia was working as a
housekeeper for Banner's environmental services
department, she bent down to clean the floor and felt a
tearing sensation in her right knee. Tapia's supervisor
helped her fill out an incident form and walked her to the
emergency room. Banner's medical staff examined her and,
pursuant to doctor's orders, Tapia did not return to work
for four days.
Tapia filed a claim for workers' compensation benefits
with the Industrial Commission and, on August 25, Banner, a
self-insured employer, received notification thereof. On
September 11, Banner issued a notice of claim status denying
Tapia's claim on the ground the incident had not been
reported to the organization. Tapia sought review from the
Industrial Commission and obtained an award in her favor.
Tapia then filed a "complaint of bad faith and/or unfair
claim processing practice" alleging that when Banner
initially denied her claim, it had done so without a
"reasonable basis and [had] failed to conduct an
adequate investigation," among other allegations. After
a hearing, the administrative law judge (ALJ) found that
Banner had acted reasonably when it initially denied
Tapia's claim. Tapia requested review, and the ALJ
affirmed its award. Tapia petitioned this court for special
action; we have jurisdiction. A.R.S. §§
Faith and Unfair Claim Processing
Tapia argues the ALJ erroneously considered the
twenty-one-day deadline specified in § 23-1061(M),
A.R.S., in a manner that lessened Banner's obligation to
properly investigate her claim. Our review is limited to
"determining whether or not the commission acted without
or in excess of its power" and whether the findings of
fact support the award. A.R.S. § 23-483(B); see
Special Events Serv. Inc. v. Indus. Comm'n, 228
Ariz. 332, ¶ 6 (App. 2011). Whether Banner reasonably
denied Tapia's claim is a mixed question of fact and law;
accordingly, we defer to the ALJ's determination of
disputed facts but review questions of law de novo. See
Miller v. Indus. Comm'n, 240 Ariz. 257, ¶ 9
Section 23-930(B), A.R.S., states that if an ALJ "finds
that unfair claim processing . . . has occurred in the
handling of a particular claim, it shall award the claimant .
. . a benefit penalty." A self-insured employer commits
unfair claim processing when it "[unreasonably issues a
notice of claim status without adequate supporting
information in its possession or available to it." Ariz.
Admin. Code R20-5-163(B)(1); see Hayes v. Cont'l Ins.
Co.,178 Ariz. 264, 268 (1994) (§ 23-930(E) directs
Industrial Commission to adopt definition of unfair claim
processing). Although this language suggests self-insured
employers generally should not issue a notice of claim status
"without adequate supporting information,"
see Ariz. Admin. Code R20-5-163(B)(1), a
self-insured employer may reasonably deny a claim when a lack
of adequate supporting information results ...