Did Washington LEOFF medical benefits cover injury to a bridge or filling, and was damage while eating automatically covered in 1985?

Plain-English summary

The Washington Attorney General concluded in 1985 that the LEOFF medical-benefits statute’s phrase “his teeth” included previously installed dental work, such as bridges, false teeth, and fillings. The AG read the statute’s list as minimum covered services and found no sensible basis to limit accidental dental injury coverage to natural teeth.

A separate question concerned dental work that broke while eating. The AG did not decide that every such break was an accident. It said the local disability board had to decide from the facts whether an accidental injury occurred. A footnote added that the board could have discretion to pay dental charges even without a qualifying accidental injury, because the statutory list set a minimum rather than an exclusive set of services.

Currency note

This opinion was issued in 1985. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Did “teeth” include existing bridges and fillings?
Yes. The AG concluded that the term covered prior dental work as well as natural teeth.

Was a dental repair after eating automatically covered as an accident?
No categorical answer was given. The disability board had to decide whether the particular facts showed an accident.

Could the board authorize dental service beyond the listed minimum?
The opinion said the statutory list was a minimum and recognized board discretion to designate other necessary medical services.

Background and statutory framework

A representative asked about LEOFF medical services and a member whose existing dental work broke while eating. The AG interpreted the dental-injury provision in RCW 41.26.030(22) and the employer-payment provision in RCW 41.26.150(1).

Citations and references

• Statutes discussed: RCW 41.26.030(22); RCW 41.26.150(1).

Source

• Landing page: https://www.atg.wa.gov/ago-opinions/scope-medical-services

Original opinion text

Attorney General Ken Eikenberry

PENSIONS ‑- RETIREMENT ‑- DENTISTRY ‑- MEDICAL AID ‑- LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS ‑- SCOPE OF MEDICAL SERVICES

(1) The phrase "his teeth" in RCW 41.26.030 (relating to members of the Washington Law Enforcement Officers and Fire Fighters Retirement System) includes not only natural teeth but also previously installed dental work such as bridges, false teeth, fillings, and the like.

(2) The obligation of an employer, under RCW 41.26.150, to pay for dental repair or replacement for an individual whose previous dental work broke while eating depends on whether, under the facts of the particular case as determined by the disability board having jurisdiction, the damages were the result of an accident.

March 7, 1985

Honorable Michael Patrick
State Representative, 47th District
417 House Office Building
Olympia, Washington 98504

Cite as: AGO 1985 No. 7

Dear Sir:

By recent letter you requested our opinion on two questions regarding medical services for members of the LEOFF Retirement System. We paraphrase your questions as follows:

(1) Does the phrase "his teeth" in RCW 41.26.030(22)(b)(iii)(H) include not only natural teeth but also previously installed dental work such as bridges, false teeth, fillings, etc.?

(2) Do RCW 41.26.150(1) and 41.26.030(22) require an employer to pay for dental repair or replacement for an individual whose previous dental work broke while eating?

We answer your first question in the affirmative and your second question in the manner indicated in our analysis below.

[[Orig. Op. Page 2]]

ANALYSIS

RCW 41.26.150(1), relating to members of the Washington Law Enforcement Officers and Fire Fighters Retirement System (LEOFF), provides in pertinent part:

"Whenever any active member, or any member hereafter retired, on account of service, sickness or disability, not caused or brought on by dissipation or abuse, of which the disability board shall be judge, . . . requires medical services, the employer shall pay for such active or retired member the necessary medical services not payable from some other source as provided for in subsection (2). . . .And provided further, That the disability board shall designate the medical services available to any sick or disabled member."

The term "medical services," as used in that statute, is defined in RCW 41.26.030(22) which provides, in pertinent part:

"'Medical services' . . . shall include the following as minimum services to be provided. Reasonable charges for these services shall be paid in accordance with RCW 41.26.150.

". . .

"(b) Other medical expenses: The following charges are considered 'other medical expenses' . . .

". . .

"(iii) The charges for the following medical services and supplies:

". . .

"(H) Dental charges incurred by a member who sustains an accidental injury to his teeth and who commences treatment by a legally licensed dentist within ninety days after the accident;

". . ." (Emphasis added)

As we explained in AGO 1980 No. 18, copy enclosed, this definition of "medical services" is not inclusive but, instead, [[Orig. Op. Page 3]] only lists the minimum medical services to be provided and paid for by the member's employer or former employer. Services other than those listed in the statute may also be "necessary medical services" and thus may be designated by the LEOFF disability board under the authority of the last proviso of RCW 41.26.150(1) as quoted above. Stegmeier v. Everett, 21 Wn.App. 290, 584 P.2d 488 (1978).

Question (1):

Your first question concerns those minimum medical services covered by the phrase "[d]ental charges incurred by a member who sustains an accidental injury to his teeth" in RCW 41.26.030(22)(b)(iii)(H). You have asked whether the term "teeth" includes both natural teeth and, as well, previously installed dental work.

The word "teeth" is not defined by the statute and, therefore, its meaning depends on common usage and the context in which it appears. Childers v. Childers, 89 Wn.2d 592, 575 P.2d 201 (1978); Graffell v. Honeysuckle, 30 Wn.2d 390, 191 P.2d 858 (1948). In the context of chapter 41.26 RCW, we do not view the term as limited to natural teeth.

Statutes should receive a reasonable and sensible construction to effect the legislative intent and, if possible, to avoid unjust or absurd consequences. Crown Zellerbach v. Labor & Industries, 98 Wn.2d 102, 653 P.2d 626 (1982). If an act is subject to two interpretations that interpretation which best advances the legislative purpose should be adopted. In re R, 97 Wn.2d 182, 641 P.2d 704 (1982). In view of the apparent purpose behind RCW 41.26.150 and 41.26.030(22), we can conceive of no sensible reason why the legislature would have intended to limit the minimum medical services provided under those statutes only to dental charges incurred through accidental injury to an individual's natural teeth.

Accordingly, we conclude that the phrase "his teeth," as used in the above quoted statutory provision, does include previously installed bridges, false teeth, fillings, or the like.

Question (2):

Your second question concerns the meaning of the phrase "accidental injury" in RCW 41.26.030(22)(b)(iii)(H). You have [[Orig. Op. Page 4]] asked whether this phrase would encompass the case of an individual whose previous dental work broke while eating.

Neither the phrase "accidental injury" nor the term "accident," as used in RCW 41.26.030(22)(b)(iii)(H), is defined in chapter 41.26 RCW. Therefore, once again, in the absence of a statutory definition such statutory phrases or terms should be given their ordinary, commonly understood meaning in the context in which they are used in the statute. See also,Dillard v. Public Employees' Retirement System, 93 Wn.2d 677, 611 P.2d 1231 (1980).

The use of the term "accident" in RCW 41.26.030(22)(b)(iii)(H) indicates that the legislature intended "accidental injury" in the same statute to mean an injury caused by an accident. An "accident" is commonly understood to mean an undesigned and unexpected occurrence, identifiable at some reasonably definite time and place, which produces an undesirable result. Dillard,supra at 680.

It is not possible for us to express a categorical opinion on whether the general situation described in your letter would constitute an "accident." Depending on the total facts and circumstances of any particular case, however, we believe a local disability board could justifiably resolve such a question either way. Accordingly, this is best viewed as a question of fact to be determined by the local disability board. Cf.Grosche v. Washington State Employees' Retirement Board, 69 Wn.2d 337, 418 P.2d 476 (1966).1/

We trust the foregoing will be of assistance to you.

Very truly yours,
KENNETH O. EIKENBERRY
Attorney General

DONALD COFER
Assistant Attorney General

*** FOOTNOTES ***

1/Of course, a local disability board would have the discretion to order payment for dental charges even if the board found no accidental injury, since RCW 41.26.030(22) lists only the minimum medical services that must be provided. A court generally would not interfere with such a discretionary decision. Stegmeier v. Everett, supra at 294-95.