DCBS v. Muliro

CourtOregon Supreme Court
DecidedJune 16, 2016
DocketS062922
StatusPublished

This text of DCBS v. Muliro (DCBS v. Muliro) is published on Counsel Stack Legal Research, covering Oregon Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
DCBS v. Muliro, (Or. 2016).

Opinion

736 June 16, 2016 No. 39

IN THE SUPREME COURT OF THE STATE OF OREGON

In the Matter of the Compensation of Rebecca M. Muliro, Claimant. DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, Workers’ Compensation Division; and ComPro, Inc., Respondents on Review, v. Rebecca M. MULIRO, Petitioner on Review, and LIBERTY NORTHWEST INSURANCE CORPORATION; Adams & Gray Home Care - Marquis Home Health; and Assured at Home, Respondents. (WCB 103496, 1102720; CA A152594; SC S062922)

En Banc On review from the Court of Appeals.* Submitted on the record on January 12, 2016. R. Adian Martin, Portland, filed the brief for petitioner on review. Greg Rios, Assistant Attorney General, Salem, filed the brief for respondent on review. With him on the brief were Ellen F. Rosenblum, Attorney General, and Paul L. Smith, Deputy Solicitor General. NAKAMOTO, J. The decision of the Court of Appeals is affirmed. The order of the Workers’ Compensation Board is reversed, and the case is remanded to the board for further proceedings. ______________ * Review from Workers’ Compensation Board. 267 Or App 526, 341 P3d 131 (2014). Cite as 359 Or 736 (2016) 737

Case Summary: The Department of Consumer and Business Services (DCBS) sought judicial review of the Workers’ Compensation Board’s order providing that, under ORS 656.210(2)(b), the employer’s preexisting knowledge of claim- ant’s secondary employment was imputed to the insurer. DCBS argued that, under the express terms of ORS 656.210(2)(b)(A), what a claimant must provide, and the insurer must receive, is actual notice. The Court of Appeals agreed that, under ORS 656.210(2)(b)(A), the insurer must receive actual notice. Held: ORS 656.210(2)(b)(A) requires a claimant to prove that the insurer received actual notice of the claimant’s secondary employment within 30 days of the insurer’s receipt of the initial claim. The decision of the Court of Appeals is affirmed. The order of the board is reversed, and the case is remanded to the board for further proceedings. 738 DCBS v. Muliro

NAKAMOTO, J. Under the Workers’ Compensation Act, an injured worker with more than one employer may be entitled to receive supplemental temporary disability benefits from the Workers’ Benefit Fund, in addition to the disability benefits the worker receives from the employer’s insurer. The injured worker cannot qualify “unless the insurer * * * receives,” within 30 days of receipt of an initial claim, “notice that the worker was employed in more than one job” at the time of injury. ORS 656.210(2)(b)(A). The question in this case is whether an injured worker must provide actual notice of the worker’s secondary employment in connection with the claims process or whether the employer’s preexisting knowl- edge of that employment may be imputed to the insurer to satisfy the notice requirement of ORS 656.210(2)(b)(A). We hold that the correct interpretation of ORS 656.210(2)(b)(A) requires a claimant to prove that the insurer received actual notice of the claimant’s secondary employment within 30 days of the insurer’s receipt of the initial claim. I. BACKGROUND We take the historical facts, which are undisputed, from the findings of the Workers’ Compensation Board in its order on review. While claimant was employed by Adams & Gray Home Care-Marquis Home Health (Adams & Gray) as a certified nursing assistant, she sustained a workplace injury. At that time, claimant also worked for two other home health employers, and Adams & Gray was aware of that fact. Two coordinators at Adams & Gray responsible for scheduling claimant’s work hours, claimant’s supervisors, knew of her secondary employment because claimant would at various times let a supervisor know, when asked to han- dle a placement, that she was already scheduled by another agency. Claimant promptly sought workers’ compensation benefits for her injury. She filed a workers’ compensation claim, which Adams & Gray’s insurer, Liberty Northwest Insurance Corporation (Liberty), received less than a week Cite as 359 Or 736 (2016) 739

later. As part of her claim, claimant filled out and signed several workers’ compensation benefits forms that were sub- mitted to Liberty—a Liberty claim form (Form 801) and a Department of Consumer and Business Services (DCBS) “Worker’s and Physician’s Report for Workers’ Compensation Claims” form (Form 827). On each form, there was a box above the signature line labeled either “Check here if you are employed w/more than one employer” or “Check here if you have more than one employer.” Claimant did not check the boxes on those forms that would have indicated that she had more than one employer. Form 801 contained Liberty’s mailing address, telephone number, and fax number, and Form 827 provided a telephone number to call in case the claimant did not “know the name and address of the insurer.” Claimant gave a recorded statement to a claims investigator less than two weeks after she had filed her claim. Claimant told the investigator that Adams & Gray usually gave her 40 hours of work per week. The investiga- tor did not ask claimant whether she had other employers while working for Adams & Gray, and claimant did not vol- unteer that information. Within 30 days of filing her claim, neither claimant nor Adams & Gray had informed Liberty that claimant had secondary employment, and Liberty was unaware of that fact. Approximately nine months after her injury, claim- ant informed Liberty through counsel that she had had multiple employers at the time of her injury and requested supplemental temporary disability benefits. Liberty elected not to process the claim for supplemental disability benefits, so DCBS, through its assigned processing administrator, ComPro, Inc., did so.1 ComPro denied claimant’s request on the ground that claimant was ineligible for those benefits because Liberty had not received timely notice of claimant’s secondary employment, as required by ORS 656.210(2)(b)(A).

1 If an insurer elects to transfer responsibility to process and pay supple- mental disability benefits, DCBS will “administer and pay the supplemental benefits directly or shall assign responsibility to administer and process the payment to a paying agent selected by the director.” ORS 656.210(5)(b); OAR 436-060-0035(1)(a). In that event, ComPro acts as assigned administrator for supplemental disability benefits on behalf of DCBS. 740 DCBS v. Muliro

Subsequently, claimant requested a hearing before the board’s Hearings Division. Based on Adams & Gray’s knowledge of claimant’s secondary employment and the reasoning of an earlier board decision, the administrative law judge (ALJ) concluded that Liberty had received timely notice of claimant’s secondary employment. The ALJ deter- mined that claimant was eligible for supplemental disability benefits and ordered ComPro to process claimant’s claim. DCBS and ComPro sought board review of that decision, and the board affirmed the ALJ’s order.

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DCBS v. Muliro, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dcbs-v-muliro-or-2016.