Carr v. SAIF Corp.

670 P.2d 1037, 65 Or. App. 110, 1983 Ore. App. LEXIS 3692
CourtCourt of Appeals of Oregon
DecidedOctober 12, 1983
DocketWCB 80-00053; CA A23840
StatusPublished
Cited by19 cases

This text of 670 P.2d 1037 (Carr v. SAIF Corp.) 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
Carr v. SAIF Corp., 670 P.2d 1037, 65 Or. App. 110, 1983 Ore. App. LEXIS 3692 (Or. Ct. App. 1983).

Opinions

[112]*112WARREN, J.

Claimant seeks review of an order of the Workers’ Compensation Board, affirming the suspension of his temporary total disability benefits under ORS 656.325 and the administrative rules adopted thereunder, because claimant failed to attend a medical examination scheduled for him by SAIF. Claimant contends that the suspension was unlawful, because he had notified SAIF of a valid reason why he would not be able to attend the scheduled examination. He also contends that the procedures employed by the Workers’ Compensation Department (Department) under ORS 656.325 and OAR 436-54-281 and 436-54-283, which allowed it to suspend his benefits without providing him with notice and an opportunity for a hearing before the suspension, violated his right to due process of law under the United States and Oregon Constitutions. We reverse.

In December, 1979, claimant sustained injuries to his spine in the course and scope of his employment. The claim was accepted, and SAIF began paying him temporary total disability compensation on December 17, 1979. Claimant, a Eugene resident, became a patient of a Eugene orthopedic surgeon, who eventually requested that SAIF refer him to another physician because he had missed several appointments. SAIF scheduled an appointment with another Eugene physician, who reviewed the medical records and informed SAIF that he did not want to treat claimant.

On May 16, 1980, SAIF sent claimant a notice of appointment for the examination at issue. The notice informed him that he was scheduled for an examination by Orthopaedic Consultants in Portland on June 5, 1980, and that his failure to keep the appointment without notifying SAIF before the appointment of a valid reason why he could not attend would result in suspension of compensation under ORS 656.325 and OAR 436-54. The purpose of the examination was to determine the type of treatment claimant required, whether he was medically stationary and when he could return to work.

By letter dated May 19, 1980, claimant’s attorney informed SAIF that'claimant’s wife was due to have a baby on June 5 and requested that the appointment be rescheduled for some time after July 1,1980. SAIF told claimant’s attorney by [113]*113phone on June 2,1980, and by letter dated June 5,1980, that it insisted that claimant keep the appointment.

On June 4,1980, claimant’s attorney called SAIF and reported that claimant’s wife was enroute to the hospital to give birth. SAIF responded that, if the baby was born at a reasonable hour on June 4, claimant must keep the appointment. SAIF’s claims representative attempted to verify that claimant’s wife had been admitted to a hospital. Although the claims representative did not know the wife’s name or her obstetrician’s name, she called all of the hospitals in the Eugene area that she believed had obstetrical departments on June 4 and 5, 1980, and was told that no Mrs. Carr had been admitted. On June 5,1980, she verified that claimant did not keep his appointment. On June 6, 1980, the claims representative called claimant’s attorney, who said that he had been unable to contact claimant to determine what hospital his wife had entered and whether she had given birth. The claims representative told the attorney that SAIF intended to petition the Department for suspension of compensation. Later that day, the claims representative tried unsuccessfully to contact claimant.

On June 6, 1980, SAIF petitioned the Department’s Compliance Division for suspension of benefits in a letter that stated most of the facts discussed above. On June 18, 1980, SAIF’s claims supervisor called the attorney to inquire whether claimant’s wife had given birth. He said that she had not. An assistant claims supervisor of the Division processed the petition. Her inquiry consisted of a call to Orthopaedic Consultants to verify that claimant failed to keep his appointment and a call to SAIF on June 24, 1980, to verify that claimant’s wife had not yet given birth.

On the basis of those two calls and the information contained in the petition, the Division decided to suspend compensation. The assistant claims supervisor informed claimant of the decision by a letter dated June 24,1980, which stated, in part:

“On June 4, 1980 your attorney advised State Accident Insurance Fund that your wife was on the way to the hospital to await delivery of her baby.
“State Accident Insurance Fund advises that upon making a check with all of the hospitals in your area there is no record [114]*114for the admittance of your wife to any of the local hospitals. They also advise that your wife has not yet delivered the baby.
“Therefore I find no valid reason available to me to indicate you could not attend the June 5, 1980 examination with Orthopaedic Consultants.
“The Department, pursuant [to] ORS 656.325 and OAR 436.54, [sic] has no alternative but to give State Accident Insurance Fund authorization to suspend your compensation as of June 5, 1980. The suspension may continue until such time as you have notified them of your agreement to be examined, and in fact, submit to an examination by [a] physician designated by them. * * *” (Emphasis supplied.)

On June 27, 1980, claimant requested a hearing on the suspension. On September 5, 1980, a hearing began concerning three issues relevant to claimant’s compensation, including whether the suspension was reasonable. On February 20, 1981, another hearing was held, and by May 8, 1981, the parties filed written arguments on the three issues. On May 22, 1981, the referee issued his opinion and order. He affirmed the Division’s decision to suspend compensation and refused to consider claimant’s constitutional challenge.1 The Board affirmed the referee, and claimant filed this appeal.

The first question is whether the Division’s decision to suspend compensation under ORS 656.325 and OAR 436-54-281 and 436-54-283 was arbitrary or unreasonable. It is clear from the record that SAIF and the Division followed the applicable statutory and regulatory procedures. We do not address the reasonableness of those procedures. The narrow focus of our inquiry is whether, on the basis of the facts the Division had before it through those procedures, the substance of its decision that claimant had no valid reason for missing his appointment was arbitrary or unreasonable. We have reviewed the record and conclude that the Division’s decision was not arbitrary or unreasonable.

The other and quite different issue is whether the procedure used by the Division under ORS 656.325 and OAR 436-54-281 and 436-54-283, which allowed it to suspend claimant’s benefits without providing him with notice and an [115]*115opportunity to be heard before

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Bluebook (online)
670 P.2d 1037, 65 Or. App. 110, 1983 Ore. App. LEXIS 3692, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carr-v-saif-corp-orctapp-1983.