Blacknall v. Manpower, Inc.

243 P.3d 794, 238 Or. App. 638
CourtCourt of Appeals of Oregon
DecidedNovember 17, 2010
Docket07072H A139376
StatusPublished

This text of 243 P.3d 794 (Blacknall v. Manpower, Inc.) 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
Blacknall v. Manpower, Inc., 243 P.3d 794, 238 Or. App. 638 (Or. Ct. App. 2010).

Opinion

243 P.3d 794 (2010)
238 Or. App. 638

Reese BLACKNALL, Jr., Petitioner,
v.
MANPOWER, INC.; Transportation Insurance Co.; and Department of Consumer and Business Services, Respondents.

07072H; A139376.

Court of Appeals of Oregon.

Argued and Submitted April 21, 2010.
Decided November 17, 2010.

Jodie Anne Phillips Polich argued the cause for petitioner. On the briefs was Jacqueline M. Jacobson.

Jerald P. Keene, Portland, argued the cause and filed the brief for respondent Manpower, Inc.

Judy C. Lucas, Senior Assistant Attorney General, argued the cause for respondent Department of Consumer and Business Services. With her on the brief were John R. Kroger, Attorney General, and Jerome Lidz, Solicitor General.

No appearance for respondent Transportation Insurance Co.

Before LANDAU, Presiding Judge, and ORTEGA, Judge, and SERCOMBE, Judge.

*795 LANDAU, P.J.

Claimant seeks review of an order of the Director of the Department of Consumer and Business Services, contending that the director erred in concluding that claimant, who is not covered by private health insurance, is not entitled to interim medical benefits on his denied claim. We affirm.

This case involves the application and interpretation of statutory and regulatory provisions relating to the payment of medical expenses between the time a workers' compensation claim is filed and the time it is either accepted or denied. We begin with a brief description of those provisions to provide context for the particular dispute at issue in this case.

ORS 656.262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.]" That is to say, except as provided in ORS 656.247, an insurer is not required to pay medical benefits pending the acceptance or denial of a claim. ORS 656.262(6).

Three exceptions to that general rule are stated in ORS 656.247(1):

"[P]ayment for medical services provided to a subject worker in response to an initial claim for a work-related injury or occupational disease from the date of the employer's notice or knowledge of the claim until the date the claim is accepted or denied shall be payable in accordance with subsection (4) of this section if the expenses are for:
"(a) Diagnostic services required to identify appropriate treatment or to prevent disability;
"(b) Medication required to alleviate pain; or
"(c) Services required to stabilize the worker's claimed condition and to prevent further disability."

(Emphasis added.) Thus, three types of expenses incurred pending acceptance or denial of a claim are payable "in accordance with subsection (4)" of the statute: diagnostic services to identify the worker's condition; medication to alleviate pain; and services required to stabilize the worker's condition and prevent disability.

The reference to "subsection (4) of this section" refers to ORS 656.247(4), which provides, in part:

"(a) If the claim in which medical services are provided under subsection (1) of this section is accepted, the insurer or self-insured employer shall make payment for such medical services subject to the limitations and conditions of this chapter.
"(b) If the claim in which medical services are provided under subsection (1) of this section is denied and a health benefit plan provides benefits to the worker, the health benefit plan shall be the first payer of the expenses for medical services according to the terms, conditions and benefits of the plan."

(Emphasis added.) Thus, if the claim is ultimately accepted, the worker's employer or the workers' compensation insurer pays those medical expenses pursuant to ORS chapter 656. ORS 656.247(4)(a). If the claim is ultimately denied, and if the worker has a health care plan, the health care plan is the first payer of those benefits, and the worker's employer or workers' compensation insurer is required to pay the balance. ORS 656.247(4)(b).

Administrative rules have been adopted to implement ORS 656.247. Those rules provide, in part:

"(3) If the medical service provider has knowledge that the worker filed a work related claim, the medical service provider shall not collect health benefit plan co-payment from the worker.
"(4) The medical service provider shall submit a copy of the bill to the workers' compensation insurer in accordance with OAR XXX-XXX-XXXX, and the health benefit plan(s) in accordance with the plan's requirements.
"(5) The insurer shall notify the medical service provider when an initial claim is denied.
"(6) When the claim is denied, the medical service provider shall first bill the health benefit plan(s) with a copy of the workers' compensation denial letter.
*796 "(7) After payment is received from the health benefit plan(s), the medical service provider may bill the workers' compensation insurer, according to OAR XXX-XXX-XXXX, for any remaining balance. The provider shall include a copy of the health benefit plan(s)' explanation of benefits with the bill. If the worker has no health benefit plan, the workers' compensation insurer is not required to pay for interim medical benefits."

OAR XXX-XXX-XXXX (emphasis added). The rule sets out the procedures for the payment of medical bills for interim medical expenses—i.e., expenses incurred pending acceptance or denial of the claim. The italicized text is the subject of the dispute in this case.

With the foregoing statutes and rules in mind, we turn to the facts of this case. Claimant filed a workers' compensation claim for an injury that occurred on July 28, 2005. Transportation Insurance Co. (insurer) denied the claim on September 2, 2005. Between July 28, 2005 and September 2, 2005, claimant had incurred medical bills for treatments related to the injury. It is undisputed that claimant is not covered by a health insurance plan. Insurer paid some of the expenses incurred before its denial, but it denied the remainder, contending that no further payments were due because claimant has no health benefit plan.

The matter came before the director. The director, relying on ORS 656.247

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Related

State v. Gaines
206 P.3d 1042 (Oregon Supreme Court, 2009)
Rodriguez v. the Holland, Inc.
980 P.2d 672 (Oregon Supreme Court, 1999)
Blacknall v. Manpower, Inc.
243 P.3d 794 (Court of Appeals of Oregon, 2010)
Lenon v. Public Employees Retirement Board
206 P.3d 1165 (Court of Appeals of Oregon, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
243 P.3d 794, 238 Or. App. 638, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blacknall-v-manpower-inc-orctapp-2010.