Hopper v. SAIF Corp.

336 P.3d 530, 265 Or. App. 465
CourtCourt of Appeals of Oregon
DecidedSeptember 10, 2014
Docket1200309; A152765
StatusPublished
Cited by2 cases

This text of 336 P.3d 530 (Hopper 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
Hopper v. SAIF Corp., 336 P.3d 530, 265 Or. App. 465 (Or. Ct. App. 2014).

Opinion

LAGESEN, J.

SAIF Corporation (SAIF) denied claimant’s claim for workers’ compensation benefits for failure to cooperate with its investigation of her claim after claimant did not comply with SAIF’s multiple requests that she complete an interview with its investigator. The Workers’ Compensation Board (the board) upheld that denial under ORS 656.262(15), determining that claimant failed to prove that her failure to cooperate was “for reasons beyond [her] control.” ORS 656.262(15). On review of the board’s order under ORS 656.298, we affirm, concluding that the board’s decision rests on a correct interpretation of ORS 656.262 and is supported by substantial evidence.

I. BACKGROUND

Claimant injured her lower back at work in September 2011 and filed a claim for workers’ compensation for the injury. Shortly after claimant filed the claim, SAIF sent claimant a letter explaining the claims process and informing claimant of her obligation under ORS 656.262(14) to cooperate with that process. Around the same time, SAIF contacted claimant by phone to alert her that she would need to make a statement about her claim to a SAIF investigator. Claimant did not take any affirmative steps to contact SAIF’s investigator.

A few weeks later, on October 17, SAIF sent a letter to claimant stating that she had an appointment for an interview on October 21. Claimant did not attend the interview or otherwise contact SAIF. On November 2, SAIF sent a letter to the Workers’ Compensation Division (WCD) of the Department of Consumer and Business Services and requested that claimant’s benefits be suspended based on her failure to participate in an interview. That letter was copied to claimant. Two days later, on November 4, WCD sent claimant a letter by certified mail stating that her benefits would be suspended within five working days unless she cooperated with SAIF or demonstrated to WCD that her failure to cooperate with SAIF was reasonable. A member of claimant’s household signed for the letter upon delivery, but claimant did not follow up with either WCD or SAIF.

[467]*467Four days later, on November 8, SAIF sent claimant a letter stating that she had 30 days from the date of WCD’s November 4 letter to cooperate with its interview request, or claimant’s claim would be denied. On November 16, claimant’s benefits were suspended in accordance with WCD’s letter, effective November 14.

On November 21, claimant left a phone message with a SAIF claims adjuster. The adjuster returned claimant’s call and told claimant that her claim had been suspended and would remain suspended and, ultimately, be denied, if claimant did not contact one of SAIF’s investigators. The adjuster gave claimant the number for the investigator on her claim. Claimant did not follow up with the investigator or otherwise, and, on December 5, SAIF denied claimant’s claim for failure to cooperate with the claims process.

More than a month later, claimant requested, and was granted, an expedited hearing under ORS 656.262(15) and ORS 656.291 on SAIF’s denial. Claimant’s theory as to why the denial should be set aside was that claimant “did completely and fully cooperate with the investigation and that if she didn’t, it was for reasons beyond her control.” In support of that theory, claimant testified that her brother died unexpectedly on October 9, and that two days later, her mother discovered her brother’s body at his apartment while claimant waited outside the apartment. Claimant further testified that she was depressed as a result of her brother’s death and that she had not opened the letter notifying her of the October 21 interview until after the date had passed. Claimant acknowledged that she had received the other communications from SAIF regarding the need for an interview, but had not followed up. Claimant also reported that she had been in a motor vehicle accident on November 3 in which she sprained her spine. Claimant did not miss any work because of the accident; claimant reported that she had missed one day of work in connection with her brother’s death. Claimant also testified that, after she had her motor vehicle accident, she had contacted her insurance company, and the company had been paying her medical bills incurred as a result of the accident. Claimant’s mother also testified that claimant’s brother’s death had been “really hard” for [468]*468claimant “because it was the first death in her immediate family.”

Following the hearing, the administrative law judge (ALJ) issued an order setting aside SAIF’s noncooperation denial. The ALJ found that claimant had not proved that she cooperated with SAIF’s request for an interview or that SAIF’s request for an interview was unreasonable. However, the ALJ found that claimant’s brother’s death and claimant’s motor vehicle accident, which the ALJ found were both beyond claimant’s control, were the reasons for claimant’s failure to comply with SAIF’s interview request.

SAIF requested review before the board. On de novo review,1 the board determined that claimant’s brother’s death and claimant’s motor vehicle accident were circumstances beyond her control that could, in theory, excuse her noncooperation if they were, in fact, the reasons for her noncooperation. The board found, however, that it was “not persuaded” that those circumstances were the reasons for claimant’s noncooperation. Instead, the board found that claimant’s “lack of diligence” was the reason that she failed to comply with SAIF’s interview request. Based on that finding, the board reversed the ALJ’s order and reinstated SAIF’s denial of claimant’s claim. One board member dissented, stating that she would have found that claimant was overwhelmed by her brother’s death and her motor vehicle accident, and that those events were the reasons that claimant did not cooperate with SAIF’s interview request. Claimant timely petitioned this court for judicial review.

II. STANDARDS OF REVIEW

ORS 183.482(7) and (8) supply the standards of review applicable for our review of board orders. ORS 656.298(7). On review, claimant assigns error to the board’s determination that she did not demonstrate that her failure to cooperate was “for reasons beyond [her] control” within the meaning of ORS 656.262(15). To the extent that assignment of error implicates [469]*469the board’s interpretation of ORS 656.262

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Cite This Page — Counsel Stack

Bluebook (online)
336 P.3d 530, 265 Or. App. 465, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hopper-v-saif-corp-orctapp-2014.