Fleming v. SAIF

461 P.3d 261, 302 Or. App. 543
Court of Appeals of Oregon·Decided March 4, 2020·No. A165693·Published·Cited by 2 cases

Opinion

Argued and submitted April 5, 2019, reversed and remanded March 4, 2020

In the Matter of the Compensation of Lloyd R. Fleming, Claimant.

Lloyd R. FLEMING,

Petitioner,

v.

SAIF CORPORATION

and Treske Precision Machining, Respondents.

Workers’ Compensation Board 1504074; A165693

461 P3d 261

Claimant seeks judicial review of an order of the Workers’ Compensation Board affirming respondent SAIF’s denial of claimant’s occupational disease claim for a right shoulder condition. The board concluded that claimant’s prior disputed claim settlement (DCS) under ORS 656.289(4) with his previous employer, in which he stipulated that his shoulder condition was not compensably related to his work for that employer, precluded him from contending, against the employer in this case, that that employment contributed to his claimed occupational disease. Claimant argues that his DCS with a previous employer does not preclude him from asserting, in the context of a claim against his subsequent employer, that that employment contributed to his claimed occupational disease. Held: ORS 656.289(4) does not state or imply that a DCS with a previous employer, as a matter of law, precludes a claimant from litigating the role that previous employment may have played in determining the compensability of a subsequent claim against an employer not bound by a DCS with that claimant. The board erred in concluding otherwise.

Reversed and remanded.

Julene M. Quinn argued the cause and filed the briefs for petitioner.

Julie Masters argued the cause and filed the brief for respondents.

Before Lagesen, Presiding Judge, and DeVore, Judge, and James, Judge.

LAGESEN, P. J. Reversed and remanded. DeVore, J., dissenting.

544 Fleming v. SAIF

LAGESEN, P. J. Claimant seeks judicial review of an order of the Workers’ Compensation Board. In that order, the board affirmed respondent SAIF’s denial of his occupational disease claim for a right shoulder condition. The board concluded , applying Gilkey v. SAIF, 113 Or App 314, 832 P2d 1252, rev den, 314 Or 573 (1992), that claimant’s prior disputed claim settlement (DCS) under ORS 656.289(4) with his previous employer, in which he stipulated that his shoulder condition was not compensably related to his work for that employer, precluded him from contending, in this proceeding involving an occupational disease claim against a different employer, that that employment contributed to his claimed occupational disease. On review, claimant argues that the board’s interpretation of Gilkey is incorrect and that the board erred when it concluded that claimant’s DCS with respect to the claim against his prior employer precluded him from asserting, in this proceeding, that his previous work contributed to his claimed occupational disease in his right shoulder. We agree with claimant and, therefore , reverse and remand to the board.

The dispositive facts in this case are not in dispute.

Claimant worked as a saw fitter for Simonds International from 2010 to 2013. His primary responsibilities included grinding large band saws and rolling out welds, all of which put considerable pressure on his arms. In 2012, claimant began experiencing significant pain whenever he would raise or lower his right arm. He visited his doctor, who diagnosed him with a full thickness partial tear of his right rotator cuff. Claimant filed for workers’ compensation and Simonds’s insurer, Liberty Northwest Insurance Company, accepted the claim. Claimant underwent several weeks of treatment during which the condition improved significantly . In February 2013, claimant was released back to regular full duty with no permanent limitations.

In November 2013, claimant left his job with Simonds to work for Treske Precision Machining. He worked at this job without difficulty until July 2014, when the pain in his shoulder returned. Claimant returned to see his doctor again, who discovered that his condition had worsened to

Cite as 302 Or App 543 (2020) 545

a full thickness rotator cuff tear. Claimant requested that Liberty, as Simonds’s insurer, accept the full thickness tear as a worsening of the rotator cuff tear accepted by Liberty in 2012. In evaluating claimant’s request, Liberty scheduled an insurer-arranged medical examination (IME) of claimant . After examining claimant, the IME doctor concluded that claimant’s current rotator cuff tear was the result of a condition that was preexisting at the time of his 2012 rotator cuff injury. For that reason, Liberty denied claimant’s claim for a worsening of the 2012 condition.

Claimant nonetheless underwent surgery to repair his rotator cuff and sought review of Liberty’s denial. However, before a hearing was held in claimant’s case, claimant and Simonds, acting through Liberty, agreed to settle the case by DCS under the authority of ORS 656.289. The DCS recited the competing contentions of claimant and Liberty regarding claimant’s rotator cuff tear that “[e]ach party has substantial evidence to support its factual allegations,” that there was a “bona fide dispute between the claimant and [Liberty],” and that “[t]he parties have agreed to compromise and settle the denied claim under the provisions of ORS 656.289(4).” Under the terms of the DCS, claimant received $25,000 in exchange for allowing Liberty’s denial of his worsening claim to remain in force. The DCS also provided that claimant agrees that the “legal effect” of the settlement would be “the same as if the claimant admitted and agreed to the accuracy of the contentions of [Liberty]” recited in the agreement.

Shortly after entering into the DCS, claimant initiated the occupational disease claim at issue in this case against his current employer, Treske, insured by SAIF. Claimant asserted that, although working conditions at Treske were not the major contributing cause of his injury, Treske was still liable for his current rotator cuff condition by virtue of the “last injurious exposure rule” (LIER), applicable to occupational disease claims under Inkley v. Forest Fiber Products Co., 288 Or 337, 605 P2d 1175 (1980). As had Liberty, SAIF scheduled an IME of claimant. Just as before, the examining doctor concluded that claimant’s work conditions were not the major cause of his full thickness rotator cuff tear. As a result, SAIF too denied claimant’s claim.

546 Fleming v. SAIF

Claimant requested a hearing before an administrative law judge (ALJ), who upheld SAIF’s denial of the claim. The ALJ held that, under Gilkey, 113 Or App 314, claimant’s DCS with Liberty as a matter of law operated to preclude him from contending that his employment with Simonds was a cause of his current rotator cuff condition. That, according to the ALJ, meant that claimant’s right shoulder condition had to be treated as a preexisting condition for purposes of his claim and that claimant had to “prove that his work at Treske was the major contributing cause of the combined condition and pathological worsening of his right shoulder condition.” Because the medical evidence submitted by claimant did not address that point at all, the ALJ concluded that claimant had not met his burden of proof and affirmed SAIF’s denial.

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Fleming v. SAIF, 461 P.3d 261, 302 Or. App. 543 (Or. Ct. App. 2020).

461 P.3d 261 (Fleming v. SAIF) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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