Jackson v. State Accident Insurance Fund

490 P.2d 507, 7 Or. App. 109, 1971 Ore. App. LEXIS 536
CourtCourt of Appeals of Oregon
DecidedNovember 5, 1971
StatusPublished
Cited by12 cases

This text of 490 P.2d 507 (Jackson v. State Accident Insurance Fund) 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
Jackson v. State Accident Insurance Fund, 490 P.2d 507, 7 Or. App. 109, 1971 Ore. App. LEXIS 536 (Or. Ct. App. 1971).

Opinion

SCHWAB, C. J.

This is an appeal by the State Accident Insurance Fund from a judgment order of the circuit court reversing an order of the Workmen’s Compensation Board and reinstating the order of the hearing officer which:

(1) Imposed a penalty upon the Fund and in favor of the claimant for unilaterally terminating temporary total disability payments previously being paid by the Fund;

(2) Directed the Fund to continue the payment of temporary total disability benefits; and

(3) Awarded attorney fees to the claimant. This litigation actually arises out of a controversy between two insurance carriers, the Fund and Employers Insurance of Wausau, hereafter called Wausau.

The Fund contends that the trial court erred in each instance.

There are two basic questions involved in this appeal.

(1) Does an insurance carrier, including the Fund, or a direct responsibility employer have the right to unilaterally terminate without hearing tem *112 porary total disability payments being made pursuant to an accepted claim?

(2) ’When a claimant is temporarily totally disabled following two injuries, for each of which different employers are responsible, and each of which, injuries was in itself sufficient to cause total disability, may the Board pro-rate the temporary disability payments between the two employers?

Our answer to question (1) is, “no,” and to question (2), is “yes.”

Claimant sustained an injury to his low back November 28, 1966, when he was employed by a direct responsibility employer insured by "Wausau. On November 21, 1968, the claim was closed because his condition appeared to be medically stationary. A permanent partial award was made and the claimant filed a request for a hearing December 2, 1968.

Claimant subsequently began to work for a different employer, the Corvallis Hotel. On January 15, 1969, he sustained an injury to his neck. His claim was accepted and he began receiving temporary total disability compensation from the Fund, which insured the hotel.

During the time that he was receiving these temporary total disability benefits as a result of the neck injury, claimant underwent low back surgery for aggravated conditions arising out of the 1966 injury. Wausau paid the cost of this surgery and other medical care. In addition, Wausau and claimant entered into an agreement that Wausau would pay claimant the difference between the temporary total disability payments claimant was receiving from the Fund at the time and what he would have received from Wau *113 san. The increased amount was based on the higher salary that claimant had earned on his former job and brought the weekly payments to approximately $45, of which $5 was paid by Wausau and $40 by the Pund. This agreement was approved by a hearing officer on April 24, 1969.

The agreement was executed without the knowledge of the Pund. The Pund learned about claimant’s operation and the temporary total disability payments during the first part of May. It assumed that claimant was receiving double payments and unilaterally suspended all payments as of April 30, 1969. On June 9, 1969, the Pund requested the Compliance Division of the Workmen’s Compensation Board to authorize the suspension of payment of temporary total disability compensation retroactively, effective to the date of the unrelated surgery, April 24, 1969. The suspension was authorized on June 10, 1969. Wausau then began to pay the additional amount to claimant, designating it as a loan. Claimant sought a hearing after the Pund stopped paying benefits.

The Fund asked the hearing officer to join Wausau as a necessary party so that there could be a complete and final determination between the two insurers and the claimant. He did, and Wausau appeared at the hearing which was held October 2, 1969.

The insurers admitted that either injury alone would entitle the claimant to temporary total disability benefits. Claimant considered the issue of the hearing to be whether the Pund had arbitrarily stopped payment. The Fund felt that Wausau was responsible for all the temporary total disability payments because one of the doctors consulted by the claimant had diagnosed the back injury as more de *114 bilitating than the neck injury. The Fund argued that Wausau’s obligation related back to the date of the first injury and urged the hearing officer to apply ORS 656.222. The portion of that statute which deals with temporary disability requires the claimant to be receiving temporary disability at the time of the subsequent injury. Since the back injury claim was closed at the time the neck injury occurred, the hearing officer was correct in concluding that the facts here did not come within that statute.

The hearing officer found the issue to be as stated by the claimant and interpreted a prior Workmen’s Compensation Board decision, Arnold, Claimant, W.C.B. Case #68-928, to mean that temporary total disability could be terminated in only three ways: the claimant’s return to his regular work; a release by claimant’s doctor that he could return to regular work; or upon hearing on a request by the employer for a determination pursuant to ORS 656.268 that claimant’s condition was medically stationary. He further ruled that the Compliance Division had no statutory power to authorize the Fund to suspend payments and that its authorization to so do was null and void. The hearing officer ordered the Fund to resume full temporary total disability benefits and assessed attorney’s fees and a penalty of 25 per cent of the money owed to claimant under the correct rate.

*115 The Fund appealed to the Workmen’s Compensation Board. The Board reversed that portion of the order of the hearing officer that imposed a penalty and attorney’s fees. The Board ordered Wausau and the Fund to each pay 50 per cent of the amount due under the correct January rate on the ground that each insurer was responsible for an injury that resulted in temporary total disability. Wausau was to continue the additional payments provided for in the agreement between claimant and Wausau.

The claimant and Wausau appealed from the Workmen’s Compensation Board to the circuit court which reversed the Board’s order on review and reinstated the order of the hearing officer.

The first issue is whether the Fund could unilaterally stop paying temporary total disability. The Workmen’s Compensation Law protects the workman against arbitrary suspension of payments by an employer. Once the employer accepts a claim, he must pay “periodically, promptly and directly.” OBS 656.262(2).

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Bluebook (online)
490 P.2d 507, 7 Or. App. 109, 1971 Ore. App. LEXIS 536, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jackson-v-state-accident-insurance-fund-orctapp-1971.