Category : Noteworthy Cases
We recently helped a workers’ compensation client receive needed medical services which had been wrongly denied by her employer. In Jeld-Wen v. Cooper, the Oregon Court of Appeals agreed that the Workers’ Compensation Board correctly said that the employer’s denial of medical services was an invalid denial of future treatment, because our client, the injured worker, had not submitted a bill for medical treatment and had not actually required medical services. The employer unlawfully attempted to close the worker’s claim and deny her future care. The Court agreed with the Board that the employer acted wrongly and reinstated Ms. Cooper’s right to treatment. If you have received a denial of medical services or need other assistance with your Oregon workers’ compensation claim, please contact the law office of Philip H. Garrow at 541-382-3736.
In a recent case decided by the Workers’ Compensation Board, an injured worker was awarded additional money for permanent disability because the workers’ compensation insurance company misapplied the law and failed to award the proper amount of disability benefits. The injured worker was also entitled to a penalty (in this case, an additional 25% of her award) because of the insurance company’s claim processing errors.
The injured worker had an on-the-job wrist injury. Her attending physician had restricted her to light duty lifting in her “at-injury” position as a cook/kitchen helper when he released her to return to work. However, the insurance company gave the physician an inaccurate job description, which said that the job the worker was doing at the time of her injury only required light lifting. Based on this incorrect information, the doctor said the worker was released to her regular work, thereby reducing the worker’s disability award. The insurance company closed the claim giving the injured worker some permanent impairment, but no work disability benefits based on her “regular” work release. When the Worker’s Compensation Department reconsidered the closure, the claimant offered an affidavit that explained that her lifting requirements at her “at-injury” job were heavy, rather than light. She was then awarded work disability, as well as a penalty.
The insurer objected to the penalty and argued that it had no reason to question the job description that it gave to the attending physician until after the claimant had given her affidavit during the reconsideration proceeding. The Workers’ Compensation Board affirmed her work disability award and the penalty because if the insurer was uncertain at the time of claim closure exactly what the attending physician had said about the claimant’s disability, it could have simply requested clarification from the physician. The insurer’s “mistake” would have cost the worker a substantial amount of disability benefits if she had not challenged the insurer’s closure of her claim.
It is always a good idea to have an experienced workers’ compensation attorney review your case to look for errors or omissions by the insurance company. There is never any charge for a case evaluation. If you have any questions regarding your Oregon workers’ compensation claim, please contact the law office of Philip H. Garrow at 541-382-3736.
In a recent decision, the Worker’s Compensation Board disagreed with a reduction in an injured worker’s disability award. A Medical Arbiter, appointed to evaluate a worker’s permanent disability, had reduced the injured worker’s award because he thought that 50% of the worker’s reduced range of motion was due to a preexisting condition. Oregon law states that when an injured worker has a preexisting condition that is either arthritis, or another condition that was diagnosed and treated before the work injury, the amount of permanent disability is “apportioned,” or reduced, by the amount of contribution from the preexisting condition. The Board said that the worker’s preexisting spondylosis was not a legally recognized preexisting condition that would allow for a reduction and the State did not accurately apply the law. The Board increased the worker’s disability award accordingly.
The Oregon Workers’ Compensation law has very strict time limits for appealing insurance company denials. Injured workers who do not file timely appeals can lose all their rights and benefits. The insurance companies must also follow the rules. In a recent ruling, the Workers’ Compensation Board said that an injured worker’s request for hearing was timely even though it that was mailed after the 60 day deadline had passed. This was because the insurer had mailed the denial to the wrong address. The Board said that the injured worker had a good reason for the late request for hearing because he did not receive the denial in the way the law requires. When the post office returned the denial to the insurer with notice of the correct address, the insurer did not re-mail the denial as is should have. Therefore, even though the injured worker eventually received the denial one week before the appeal deadline, it was still not properly served on him so that his appeal filed a week after the deadline was accepted.
Thanks to the efforts of the Garrow Law firm, the court has issued a more important decision helping injured workers:
In SAIF v. Camarena, 264 Or App 400 (2014),SAIF claimed the injured worker was not entitled to have his claim reopened for his back strain. The claim had been closed for more than 5 years so there was a requirement that the injured worker must be receiving “curative” treatment order to reopen the claim and pay disability benefits. The court agreed that the medical records showed that the injured worker was not “medically stationary” and that his condition could improve with additional treatment. Therefore, the Court ordered SAIF to reopen the claim and pay benefits.
The court held that the medical record easily would permit a reasonable person to find that the attending physician had prescribed treatment to bring about recovery from the injured worker’s back strain and the worker should have had his claim reopened. The Court specifically disagreed with SAIF’s argument that it was up to the insurance company to decide if the proposed medical treatment was necessary to “cure” the injured worker’s condition
If you have questions or need help with your workers’ compensation claim, please contact the office of Philip H. Garrow at 541-382-3736.
There has been some good news for workers from the Court of Appeals this year:
In Brown v. SAIF, 262 Or App 640 (2014), the Court held that an “otherwise compensable injury” is not defined by what conditions the insurer has accepted, but is rather “the work injury resulting from the work accident that caused the disability or need for treatment.” The Court applied this principle in SAIF v. Carlos-Macias, 262 Or App 629 (2014). In Carlos-Macias, the Court said that the terms “compensable injury” and “accepted condition” are not interchangeable. The insurer had refused to pay for a proposed diagnostic medical service, arguing that it was not needed for the “accepted conditions.” Because the law says that injured workers are to receive medical services for the compensable injury, this includes diagnostic procedures for conditions not yet discovered.
If you have question regarding your workers’ compensation claim, please contact the Law Office of Philip H. Garrow at 541-382-3736.
In a recent case, the Workers’ Compensation Board held that, because the insurance company had reopened the injured worker’s claim for both a new medical condition and an aggravation of a previously accepted condition, the worker was entitled to have both conditions rated for permanent disability when the claim was closed. This resulted in a greater disability award for the injured worker. If you have questions about your on-the-job injury claim, including your possible entitlement to permanent disability benefits, contact the law office of Philip H. Garrow at 541-382-3736.
The Workers’ Compensation Board held recently that when a home-care worker told her employer that she was in the motor vehicle accident (MVA) on her way home, after finishing work, her claim was not compensable. She told her boss some 6 months later that she had actually been in the MVA on her way to a client’s home. Finding insufficient evidence regarding when the MVA occurred, the Board held that the worker’s claim was barred since the worker had not reported the injury withing the statutorily required 90 days.
A note to home-care workers: Be sure to advise your employer if you get in a motor vehicle accident while coming or going from a client’s home. All workers would be well-advised to notify your employer or supervisor of an injury or accident immediately, even if you don’t seek medical treatment right away. Failure to promptly report a claim may defeat your right to benefits under the Oregon Workers’ Compensation Act.
If you have questions regarding your workers’ compensation claim, please contact the law office of Philip H. Garrow at 541-382-3736.
The Oregon Workers’ Compensation Act is a very complex piece of legislation. The law restricts which doctors may act as “Attending Physicians.” In a recent case, the Workers’ Compensation Board held that an injured worker’s aggravation claim was invalid because it was signed by a chiropractor, who was not authorized to serve as the “attending physician.” The Board noted that a chiropractor can serve as an “attending physician” for a cumulative total of 60 days from the first visit on the initial claim or for a cumulative total of 18 visits, whichever occurs first. In this case the Board found that since more than 60 days had expired from the injured worker’s first visit to the chiropractor, the chiropractor was not statutorily authorized to serve as an “attending physician.” As a consequence the chiropractor’s determination that his patient had a worsened condition was not considered valid. If you have questions about your attending physician or chiropractic care for a work-related injury, contact the law office of Philip H. Garrow at 541-382-3736.
In a case decided last year, a worker was awarded benefits for his hearing loss that was partially due to diabetes brought on by exposure to Agent Orange while in the military service. Under Oregon workers’ compensation law, the percentage of hearing loss due to military service may be considered a work-related factor. This is based on a court case, Wallowa County v. Fordice, 181 Or pp 222, 225 (2002), rev den 334 Or 492 (2003).
In the Fordice case, the court agree with the Workers’ Compensation Board that military service is employment for the purposes of the workers’ compensation law. If you have questions regarding hearing loss related to your employment, or other on-the-job injuries, contact the Law Office of Philip H. Garrow at 541-382-3736.