EBI Companies v. Thomas

672 P.2d 1241, 66 Or. App. 105, 1983 Ore. App. LEXIS 4024
CourtCourt of Appeals of Oregon
DecidedDecember 7, 1983
Docket81-07043 and 81-07044; CA A27118
StatusPublished
Cited by4 cases

This text of 672 P.2d 1241 (EBI Companies v. Thomas) 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
EBI Companies v. Thomas, 672 P.2d 1241, 66 Or. App. 105, 1983 Ore. App. LEXIS 4024 (Or. Ct. App. 1983).

Opinion

*107 NEWMAN, J.

Petitioner (EBI) seeks review of an order of the Workers’ Compensation Board (Board). EBI assigns as error that the Board awarded claimant penalties and attorney fees. We reverse.

Claimant was employed by O.K. Delivery Systems. He suffered a compensable injury to his back on October 31, 1977. At that time EBI insured the employer. Claimant was released to return to his job on February 19, 1979. On March 5, 1981, claimant again injured his back. At that time, Argonaut Insurance Company (Argonaut) insured employer.

On March 13, 1981, claimant filed an aggravation claim with EBI for the second injury. On June 10, 1981, EBI denied the aggravation claim on the ground that the 1981 injury was a new injury for which Argonaut was responsible:

“We have reviewed the medical reports and the request for reopening of your claim which was closed by Determination Order dated February 8, 1979. Our investigation indicates that you have not been under active medical treatment since February 19, 1979, and have continued to work at your regular job until March 5, 1981, when you had a definite new incident while lifting a 300 pound pipe. It is therefore, necessary for us to deny the reopening of your claim for aggravation.
“By copy of this letter to Dan Zahn of the Workers’ Compensation Board and to Argonaut Insurance Company, we are requesting the appointment of a designated paying agency [under ORS 656.307] to process your claim until the responsibility for your present condition can be determined.”

On the same date, EBI informed the Compliance Division that (1) it was sending Argonaut all the medical reports with a notice of EBI’s request and (2) it had reinstated temporary total disability benefits for the period from March 5,1981, and had paid them through June 11,1981.

On July 20, 1981, Argonaut denied responsibility. It claimed that the 1981 injury was an aggravation of claimant’s 1977 injury and that EBI was the responsible insurer. On July 23, 1981, EBI again requested the Compliance Division to *108 issue an order pursuant to ORS 656.307 1 designating a paying agent, pending final determination of responsibility. On August 19, 1981, the Compliance Division issued a “.307 order” designating EBI as the paying agent.

Claimant requested a hearing on both claims. Each request for hearing named as an issue “Failure to meet requirements of ORS 656.307 and OAR 436-54-332.” 2 The referee held a hearing and concluded that EBI was the responsible insurer, because claimant had suffered an aggravation of his 1977 injury. The referee’s decision also stated:

“Counsel for claimant labored to show that claimant suffered a new injury rather than an aggravation but was unsuccessful. In view of the court’s ruling and comments in HANNA vs. McGREW BROS. SAWMILL (45 Or App 757) claimant is not entitled to an attorney fee where responsibility, but not compensability, is the issue.
“However, claimant’s counsel claims that if he is not otherwise entitled to an attorney fee, claimant is entitled to penalties and attorneys fees for the insurers’ failure to meet the requirements of ORS 656.307 and OAR 436-54-332.
*109 “There is no specific failure to meet the requirements of the statute or rule pointed out. ORS 656.307 and OAR 436-54-332 do not spell out any definite time period for obtaining a ‘307’ Order from the Compliance Division or provide a penalty for delay in the issuance of a ‘307’ Order.
“Presumably claimant refers to delays. Claimant’s doctor notified EBI of the aggravation claim by letter dated March 11, 1981. Acceptance or denial was due within 60 days (ORS 656.273(6); ORS 656.262(6). EBI’s denial was not issued until June 10, 1981. This late denial is presumed to be unreasonable, there being no explanation advanced by EBI. A penalty on this basis would be assessable. However, penalties are based on ‘amounts then due’ (ORS 656.262(9)) and there is no proof of any unpaid compensation due at any point in time and there is uncontradicted evidence that claimant’s time loss had been reinstated (EBI’s letter of June 10, 1981).
“There was delay in the issuance of the ‘307’ Order and the delay was occassioned [sic] by EBI. Although EBI requested the ‘307’ Order on the same day that it denied the aggravation claim, the denial itself was unreasonably delayed. Without this unreasonable delay, it is presumed that the request for the ‘307’ Order would have been more promptly made and the unreasonable delay in asking for the ‘307’ Order justifies an award of an attorney fee payable by EBI, pursuant to ORS 656.262(9).”

The Board concluded, and it is not challenged here, that Argonaut was the responsible insurer, because the 1981 incident contributed to claimant’s subsequent disability. The Board then took up the issues of penalties and attorney fees:

“* * * Although claimant’s aggravation claim was dated March 11,1981 and received by EBI on March 13,1981, EBI neither denied the claim nor requested an order pursuant to ORS 656.307 until June 10, 1981, about 90 days later. We believe that all denials, whether of compensability or responsibility, have to be issued within 60 days. ORS 656.262(6). In addition, when insurer responsibility issues arise, OAR 436-54-332 requires all involved insurers to ‘expedite’ claim processing by ‘immediate priority investigation.’ The 90 day period between EBI’s receipt of claimant’s aggravation claim and action on that claim does not conform to the letter or spirit of the statute or administrative rule.
“* * * Also, * * * assessment of an attorney fee pursuant to ORS 656.382(1) is appropriate in this case.
*110

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Cite This Page — Counsel Stack

Bluebook (online)
672 P.2d 1241, 66 Or. App. 105, 1983 Ore. App. LEXIS 4024, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ebi-companies-v-thomas-orctapp-1983.