Caren v. Providence Health Sys. Or. (In re Caren)

446 P.3d 67, 365 Or. 466
Oregon Supreme Court·Decided August 8, 2019·No. SC S065553·Published·Cited by 11 cases

Opinion

FLYNN, J.

**468The dispute in this workers' compensation case arises from the intersection of overlapping statutory provisions that control the determination of a worker's permanent partial disability. ORS 656.214 obligates employers to provide compensation for a worker's permanent impairment, meaning "loss of use or function" that is "due to the compensable industrial injury." ORS 656.214(1)(a). But another statute limits the employer's liability when the compensable injury combines with a qualifying "preexisting condition" to "cause or prolong" the injured worker's' disability or need for medical treatment, unless the compensable injury is the "major contributing *69cause" of the "combined condition."1 ORS 656.005(7)(a)(B). As part of that liability limit, the legislature has created a process by which the employer issues a denial of the "combined condition" and then pays permanent partial disability compensation only for the estimated portion of the worker's permanent impairment that is attributable to the "current accepted condition." ORS 656.268 (1)(b). The question we must resolve is whether the legislature intended that an employer would obtain the same limited liability when the employer has not followed the process that the legislature has created for estimating a reduced amount of permanent impairment following the denial of a "combined condition." We conclude that the legislature intended that injured workers would be fully compensated for new impairment if it is due in material part to the compensable injury, except where an employer has made use of the statutory process for reducing liability after issuing a combined condition denial.

I. BACKGROUND

A. Overview of the Workers' Compensation Claims Process

We begin with an overview of key terminology and the basic workers' compensation claim process before **469explaining the procedural history of this particular case. "A 'compensable injury' is an accidental injury *** arising out of and in the course of employment requiring medical services or resulting in disability or death[.]" ORS 656.005(7)(a). Traditionally, an injury "arises out of" a worker's employment " 'if the labor being performed in the employment is a material, contributing cause which leads to the unfortunate result.' " Schleiss v. SAIF , 354 Or. 637, 643-44, 317 P.3d 244 (2013) (quoting Olson v. State Ind. Acc. Com. , 222 Or. 407, 414-15, 352 P.2d 1096 (1960) ); see also Hopkins v. SAIF , 349 Or. 348, 351, 245 P.3d 90 (2010) (describing a "compensable injury" as proven by a "material contributing cause" standard). When an injury is compensable, the worker may be entitled to a variety of benefits through the period of recovery, including "medical services for conditions caused in material part by the injury," temporary disability compensation for lost wages, and permanent partial disability compensation. ORS 656.245 ; ORS 656.210 ; ORS 656.214.

The rule for compensation is different when the worker has a "combined condition," which arises when an "otherwise compensable injury combines *** with a preexisting condition to cause or prolong disability or a need for treatment." ORS 656.005(7)(a)(B).2 If the worker has a combined condition, it "is compensable only if, so long as and to the extent that the otherwise compensable injury is the major contributing cause of the disability of the combined condition or the major contributing cause of the need for treatment of the combined condition." Id . However, only certain preexisting causes qualify as a "preexisting condition" that can form a "combined condition"-generally only conditions diagnosed prior to the injury or "arthritis." ORS 656.005(24)(a).3

**470If the worker has a "combined condition," then the claim may be closed when the "accepted injury is no longer the major contributing cause of the worker's combined ***

*70condition." ORS 656.268(1)(b). But, "before the claim may be closed" on that basis, the employer must send the worker a written notice denying the combined condition. ORS 656.262(7)(b).

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Caren v. Providence Health Sys. Or. (In re Caren), 446 P.3d 67, 365 Or. 466 (Or. 2019).

446 P.3d 67 (Caren v. Providence Health Sys. Or. (In re Caren)) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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