Evans v. SAIF Corp.

396 P.3d 952, 285 Or. App. 402, 2017 Ore. App. LEXIS 599
CourtCourt of Appeals of Oregon
DecidedMay 10, 2017
Docket1304105; A159666
StatusPublished

This text of 396 P.3d 952 (Evans 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
Evans v. SAIF Corp., 396 P.3d 952, 285 Or. App. 402, 2017 Ore. App. LEXIS 599 (Or. Ct. App. 2017).

Opinion

LAGESEN, J.

Claimant petitions for review of a final order of the Workers’ Compensation Board. In that order, the board upheld insurer SAIF Corporation’s denial of claimant’s “combined condition” claim, which SAIF issued after determining that claimant’s accepted workplace injury was no longer the major contributing cause of claimant’s disability or need for treatment. See ORS 656.005(7)(a)(B); ORS 656.262(6)(c); Brown v. SAIF, 361 Or 241, 243, 391 P3d 773 (2017) (explaining the nature of a “combined condition” claim for workers’ compensation benefits). We review under ORS 183.482(8), ORS 656.298(7), and affirm.

On February 11, 2013, claimant injured his low back at work, and claimed workers’ compensation benefits in connection with the injury. SAIF accepted the claim, designating the accepted condition as a “lumbar strain.” Later, SAIF modified its acceptance to accept a combined condition beginning on the date of claimant’s workplace injury. SAIF identified the combined condition as the lumbar strain that claimant suffered at work combined with claimant’s preexisting lumbar spondylosis. SAIF subsequently denied the continued compensability of claimant’s combined condition, finding that, as of August 7, 2013, claimant’s workplace injury was no longer the major contributing cause of his disability or need for treatment. Thereafter, SAIF closed the claim, awarding time loss but no permanent disability.

Claimant requested a hearing on the denial before an administrative law judge (ALJ) and the ALJ affirmed. Claimant then sought review before the board, and the board, over the dissent of one board member, adopted and affirmed the ALJ’s order, with supplementary analysis addressing whether SAIF’s denial was permissible under our decision in Brown v. SAIF, 262 Or App 640, 325 P3d 834 (2014), reversed, 361 Or 241, 391 P3d 773 (2017).1

Before us, claimant again challenges the board’s August 2013 denial of the compensability of his combined [405]*405condition. In his first assignment of error, he asserts that the wording of the board’s order reflects that, in upholding SAIF’s denial, the board erroneously analyzed whether claimant’s “accepted condition” (i.e., lumbar strain) remained the major contributing cause of his combined condition, rather than analyzing whether claimant’s “work-related injury incident” remained the major contributing cause of his combined condition, as required by our decision in Brown. See 262 Or App at 656 (holding that correct test to determine if a combined condition remains compensable is “whether claimant’s work-related injury incident is the major contributing cause of the combined condition”). Relatedly, in his third assignment of error, claimant asserts that even if the board applied the correct legal standard under our decision in Brown, the board’s determination that claimant’s work-related injury incident was no longer the major contributing cause of his combined condition is not supported by substantial evidence. That is because, in claimant’s view, the medical opinions in the record show only that claimant’s accepted lumbar strain was no longer the major contributing cause of claimant’s combined condition, and do not support the inference that claimant’s “work-related injury incident” was no longer the major contributing cause of the combined condition.

In addition, apart from the Brown issues, claimant asserts in his second assignment of error that the board’s order is not supported by substantial evidence for a different reason. He points out that our case law requires an insurer to present “evidence at the hearing that persuades the board that the claimant’s condition has changed since the [insurer] accepted the combined condition” in order to carry its burden of proving that an accepted condition is no longer the major contributing cause of a combined condition. Washington County v. Jansen, 248 Or App 335, 345, 273 P3d 278 (2012) (emphasis added); Wal-Mart Stores, Inc. v. Young, 219 Or App 410, 418, 182 P3d 298 (2008) (explaining that medical evidence must demonstrate a change in the claimant’s condition in order to support a finding that claimant’s combined condition is no longer compensable). Claimant then asserts that the record does not contain substantial evidence that his condition changed between the date his accepted combined condition started and August 7, 2013, [406]*406the date as of which SAIF determined claimant’s combined condition was no longer compensable.

Whatever the merits of claimant’s first and third assignments of error under our decision in Brown, they have been foreclosed by the Supreme Court’s recent reversal of that decision. Brown, 361 Or at 283. There, the court held that “an employer is entitled to deny a combined condition claim when the accepted injury is no longer the major contributing cause of that combined condition,” rejecting our contrary conclusion that an employer has to prove that the “work-related injury incident” no longer remained a major contributing cause of any combined condition in order to deny compensability. Id. Here, regardless of any causal role that the “work-related injury incident” continues to play in claimant’s combined condition, it is undisputed that, at the time of SAIF’s denial of the compensability of claimant’s combined condition, claimant’s accepted lumbar strain was no longer the major contributing cause of claimant’s combined condition. Accordingly, under the Supreme Court’s decision in Brown, we reject claimant’s first and third assignments of error.

As to claimant’s second assignment of error, the question is whether substantial evidence supports the finding that claimant’s medical condition changed between the date of SAIF’s effective acceptance of claimant’s combined condition and August 7, 2013, the date that, according to SAIF, claimant’s combined condition became no longer com-pensable. See Oregon Drywall Systems, Inc. v. Bacon, 208 Or App 205, 210, 144 P3d 987 (2006) (holding that “the effective date of acceptance provides a baseline for determining whether a worker’s condition has changed so that” the accepted condition no longer remains the major contributing cause of a combined condition). “Substantial evidence supports a finding when the record, viewed as a whole, permits a reasonable person to make the finding.” Garcia v. Boise Cascade Corp., 309 Or 292, 294, 787 P2d 884 (1990).

We conclude that substantial evidence supports the finding that the requisite change occurred. In particular, substantial evidence supports the finding that claimant’s accepted lumbar strain had improved by August 7, 2013. [407]*407The evidence includes an independent medical evaluation performed by Dr. Rosenbaum on March 26, 2013. At that time, Rosenbaum opined that claimant’s accepted lumbar strain remained the major contributing cause of claimant’s need for treatment, and anticipated that the lumbar strain would persist for another 30 days:

“The work injury continues to be the major contributing cause of the need for treatment.

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Related

Garcia v. Boise Cascade Corp.
787 P.2d 884 (Oregon Supreme Court, 1990)
Washington County - Risk v. Jansen
273 P.3d 278 (Court of Appeals of Oregon, 2012)
Wal-Mart Stores, Inc. v. Young
182 P.3d 298 (Court of Appeals of Oregon, 2008)
Oregon Drywall Systems, Inc. v. Bacon
144 P.3d 987 (Court of Appeals of Oregon, 2006)
Brown v. SAIF Corp.
391 P.3d 773 (Oregon Supreme Court, 2017)
Brown v. SAIF Corp.
325 P.3d 834 (Court of Appeals of Oregon, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
396 P.3d 952, 285 Or. App. 402, 2017 Ore. App. LEXIS 599, Counsel Stack Legal Research, https://law.counselstack.com/opinion/evans-v-saif-corp-orctapp-2017.