Bentley v. State Accident Insurance Fund

590 P.2d 746, 38 Or. App. 473, 1979 Ore. App. LEXIS 2471
CourtCourt of Appeals of Oregon
DecidedFebruary 20, 1979
Docket76-5766, CA 9877
StatusPublished
Cited by18 cases

This text of 590 P.2d 746 (Bentley v. State Accident Insurance Fund) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bentley v. State Accident Insurance Fund, 590 P.2d 746, 38 Or. App. 473, 1979 Ore. App. LEXIS 2471 (Or. Ct. App. 1979).

Opinion

*475 RICHARDSON, J.

The State Accident Insurance Fund (Fund) appeals an order of the Workers’ Compensation Board (Board) affirming the referee’s decision that claimant’s 1972 award of unscheduled permanent total disability should not be changed. The Fund contends claimant’s condition has materially improved and her award should be reduced to 35 percent permanent partial disability. The Fund also contends the referee and Board erred in concluding that the Fund had followed the incorrect procedure in seeking reduction of claimant’s disability award and that the award of attorney fees was improper.

Claimant, then 47 years old, suffered a compensable injury while lifting a patient in the nursing home where she worked. Her doctor treated the injury conservatively at first but when her symptoms of pain persisted he performed a myelogram and subsequently a laminectomy and excision of a ruptured disc.

Following surgery she still experienced pain associated with her back and was referred to the Physical Rehabilitation Center for intensive back exercise and physical therapy. A psychologist at the center evaluated her as a person who was functionally illiterate and below average intelligence. He concluded she had limited intellectual, verbal and manual skills and her prognosis for vocational retraining was poor. She had followed the same occupation as a nurse’s aide for the past 30 years and had developed no other marketable skills. Attempts at vocational retraining proved unsuccessful.

Her claim was closed by the Closing and Evaluation Division 1 in 1972 with an award of 15 percent unscheduled disability. She appealed and the hearings referee found her to be permanently and totally disabled. The Fund did not appeal this decision. The *476 referee’s decision was based in large measure on claimant’s severely limited intellectual and manual skills and the fact she was unable, because of pain in her back, to do any lifting.

There was no further activity respecting her claim until 1976 when she requested authorization for chiropractic treatment. In response to this request the Fund sent her to Orthopedic Consultants with a request they submit an opinion on certain questions:

"* * * i jg there any causal relationship existing between the claimant’s present complaints and her injury of September 8, 1970. 2. If related, is any further treatment recommended. 3. If not, is the claimant permanently and totally disabled as a direct result of her injury at this time. 4. If not, please evaluate any impairment existing as a result of the injury.”

The report of Orthopedic Consultants contained a diagnosis respecting claimant’s physical injury which was essentially the same as the diagnosis submitted in the 1972 hearing. They concluded chiropractic treatment would be of little benefit. Respecting her employ-ability the report continued:

"We feel that this woman is capable of doing sedentary to light activities. She could be a sales woman, do clerk work, cashier work, etc., that do not tax her back. She states that actually being on her feet and walking is helpful. It is our opinion that this woman does not represent a permanent total disability case, secondary to her injury.”

Based on this report the Fund sought redetermination of claimant’s disability from the Closing and Evaluation Division. This division issued a redetermination order terminating claimant’s permanent total disability benefits and awarding her 112 degrees for 35 percent unscheduled disability. Claimant appealed. The referee concluded she was still permanently and totally disabled and reversed the redetermination order. In addition, the referee awarded claimant $500 attorney fees. In his opinion and order the referee said he was "troubled” by the procedure utilized by the *477 Fund in seeking redetermination from the Closing and Evaluation Division rather than requesting a hearing.

The Board affirmed the referee including the comments respecting the procedure used. The Board awarded claimant $100 attorney fees for services in connection with the appeal to the Board.

We first approach the Fund’s claim that the referee and Board erred in concluding an improper procedure had been followed. We first note this case does not involve an exercise of the Board’s own motion jurisdiction under ORS 656.278. The question is what rights does an employer or insurer have to seek redetermination of an award after the appeal time has expired. ORS 656.325(3) provides:

"A worker who has received an award for unscheduled permanent total or unscheduled partial disability should be encouraged to make a reasonable effort to reduce his disability; and his award shall be subject to periodic examination and adjustment in conformity with ORS 656.268.”

ORS 656.268 provides an employer or insurer is to submit medical reports to the Closing and Evaluation Division to seek determination of an award. Reading these two statutes together we conclude an employer or insurer may seek redetermination of an award from the Closing and Evaluation Division when there is available medical or other evidence that the injured worker’s condition has improved. The thrust of ORS 656.325(3) is that a worker’s compensation should be reduced in the event his disability has reduced. This procedure does not, however, allow a reduction in the award unless there has been a decrease in disability. It is not simply an additional appeal right from the original award. The Fund followed the proper procedure by seeking redetermination of claimant’s disability from the Closing and Evaluation Division. Since the injured worker has a continuing obligation to reduce his disability and the award is subject to periodic examination and adjustment there is no time *478 limit on the insurer’s or employer’s right to seek reduction of the award based on improvement in the worker’s condition. If the appeal period following an award has not run the Fund may seek a hearing pursuant to ORS 656.283 and 656.319(2). If the appeal time has run there is no right of the Fund to request a hearing and it must proceed under ORS 656.325 by seeking redetermination of the award.

The threshold issues in resolving this case are; what must be established for an adjustment of the previously granted award and where the burden of proof lies.

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Bluebook (online)
590 P.2d 746, 38 Or. App. 473, 1979 Ore. App. LEXIS 2471, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bentley-v-state-accident-insurance-fund-orctapp-1979.