Farmers Insurance Co. v. Aranda

379 P.3d 552, 279 Or. App. 36
CourtCourt of Appeals of Oregon
DecidedJune 22, 2016
Docket1002175; A153281
StatusPublished
Cited by1 cases

This text of 379 P.3d 552 (Farmers Insurance Co. v. Aranda) 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
Farmers Insurance Co. v. Aranda, 379 P.3d 552, 279 Or. App. 36 (Or. Ct. App. 2016).

Opinion

ORTEGA, P. J.

Employer and its insurer seek judicial review of an order of the Workers’ Compensation Board reversing an administrative law judge’s order and holding that claimant’s new/omitted medical condition claim for cervical radiculop-athy is compensable and that employer had failed to timely move to dismiss the claim regarding the alleged de facto denial of claimant’s new/omitted medical condition claim for cervical radiculopathy. Specifically, the board determined that employer’s motion to dismiss claimant’s de facto denial claim, which employer made during closing arguments, was too late; it should have been made before or during the hearing. The board proceeded to the merits of the claim and determined that the new/omitted medical condition claim for cervical radiculopathy is compensable. Moreover, the board concluded that claimant’s attorney was entitled to a reasonable attorney fee of $25,000 as allowed by ORS 656.386(1). A board member dissented, reasoning that it was claimant’s burden to prove at the hearing the elements of a de facto denial and that he had not done so.

Employer raises four assignments of error, of which the first three concern the establishment of a de facto denial. The first two assignments — contesting the board’s reversal of the ALJ’s consideration of employer’s closing argument motion and the resultant refusal to consider the compensability of the cervical radiculopathy condition — rest primarily on an argument that the requirement, under ORS 656.262(6)(d), that a claimant communicate the belief that a claim had been incorrectly omitted is jurisdictional and, therefore, can be raised at any time. Employer also calls into question the board’s reasoning concerning the untimeliness of its motion to dismiss. The third assignment shares the ALJ’s and dissenting board member’s reasoning that the burden to prove a de facto denial was on claimant and that claimant did not meet that burden. The fourth assignment of error takes issue with the fee assessment. In reviewing the board’s order for substantial evidence and legal error, ORS 656.298(7), ORS 183.482(8)(a), (c), and for substantial reason, Jenkins v. Board of Parole, 356 Or 186, 195-96, 335 P3d 828 (2014), we reject employer’s jurisdictional argument [39]*39and also conclude that the board correctly determined that employer de facto denied claimant’s cervical radiculopathy claim. As to the challenge to the assessment of attorney fees, we conclude that the board did not err in setting a reasonable attorney fee.

In September 2007, claimant was assembling a cabinet for employer, stapling the top of the cabinet with his right hand, when the cabinet began to fall to the left. When claimant attempted to catch the falling cabinet, he felt pain in his neck and left shoulder and arm. Shortly after that injury, employer accepted his claim for a disabling neck and left shoulder strain, then closed that claim in September 2008 without an award of permanent disability. We need not recite a detailed history of claimant’s related medical diagnoses following that closure, except to note that claimant filed a new/omitted condition claim for “left shoulder rotator cuff tendonitis, left cervical facetogenic pain and multilevel degenerative disc disease secondary to left-sided foraminal stenosis,” which employer denied. In April 2010, claimant requested a hearing as to that denial. In June 2010, claimant also requested a hearing as to a de facto denial1 of cervical radiculopathy, as well as a penalty.

A consolidated hearing was held in July 2010. At the outset of the hearing, the ALJ asked employer’s and claimant’s counsel to identify the issues to be addressed, and the following colloquy ensued:

[40]*40“[CLAIMANT]: *** It’s the employer’s March 31, 2010, it’s a partial denial of a left rotator cuff tendonitis and then a cervical facet issue and a cervical foraminal ste-nosis issue.
“Then there’s also a de facto denial of a *** cervical radiculopathy.
[[Image here]]
“THE ALJ: Okay so the conditions are those as listed in the denial, the left shoulder rotator cuff tendonitis, left cervical facetogenic pain and multi-level degenerative disc disease secondary to left-sided foraminal stenosis. Is that correct?
“[CLAIMANT]: Correct.
«* * * * *
“THE ALJ: And then the cervical radiculopathy.
“[CLAIMANT]: Correct.
«* ⅝ * * *
“THE ALJ: *** And then also raised on the Request for Hearing was a penalty issue. Is that still viable?
“[CLAIMANT]: Yeah. I’ll keep the penalty issue in only as regards the cervical radiculopathy.
* * ⅜ *
“THE ALJ: Is that your understanding of the issues, [employer]?
“[EMPLOYER]: It is my understanding of the issues and employer has no cross-issues. Employer also concedes nothing; in other words, employer expects Claimant to prove each element of the issues raised by Claimant.”

After making a brief opening statement regarding the compensability of claimant’s conditions, claimant’s counsel stated that claimant was seeking penalties for cervical radiculopathy because “the only doctors that have really commented on the cervical radiculopathy are the four doctors that [employer] wants to depose. They all support compensa-bility of the cervical radiculopathy. There’s no contrary medical opinion in the record right now.” Employer responded that the medical evidence was not as “one-sided” as claimant [41]*41characterized it. Claimant’s testimony comprised the rest of the hearing, and then claimant rested subject to employer’s request for depositions of four physicians who had treated claimant’s conditions. The ALJ ended the hearing but left the record open to allow for those depositions.

The parties conducted depositions and submitted their closing arguments in writing. Claimant’s closing argument was limited to the assertion that medical evidence from the physicians treating claimant strongly established that he developed cervical radiculopathy as a direct result of the injury, that the facts were uncontroverted, and the “issue boils down to an interpretation of the medical evidence.” Employer responded that, under ORS 656.262(6)(d), to prove a de facto denial, claimant must show (1) that he filed a written claim for that condition; (2) that the claim was received by the employer; and (3) that employer failed to issue an acceptance and denial within 60 days after receiving the written claim for the new and omitted condition. Employer argued that claimant failed to prove that he ever filed such a claim or that employer received a claim for cervical radiculopathy and, thus, failed to prove that employer

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Cite This Page — Counsel Stack

Bluebook (online)
379 P.3d 552, 279 Or. App. 36, Counsel Stack Legal Research, https://law.counselstack.com/opinion/farmers-insurance-co-v-aranda-orctapp-2016.