Kaeo v. SAIF Corp.

57 P.3d 959, 185 Or. App. 1, 2002 Ore. App. LEXIS 1761
CourtCourt of Appeals of Oregon
DecidedNovember 13, 2002
Docket00-03730; A114015
StatusPublished

This text of 57 P.3d 959 (Kaeo 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
Kaeo v. SAIF Corp., 57 P.3d 959, 185 Or. App. 1, 2002 Ore. App. LEXIS 1761 (Or. Ct. App. 2002).

Opinion

DEITS, C. J.

Claimant seeks review of a Workers’ Compensation Board order upholding SAIF’s denial of his current condition on the ground that claimant’s accepted injury is no longer the major contributing cause of his disability or need for treatment. We review to determine whether the order is supported by substantial evidence and whether the board made errors of law. ORS 183.482(7), (8). We affirm.

Claimant worked for the University of Oregon as an electrician. In December 1997, he suffered a low back injury at work. Claimant underwent a compelled medical examination. The examiner diagnosed degenerative disc disease. In March 1998, SAIF issued a denial of claimant’s low back injury claim. Claimant underwent surgery for SI nerve root compression the next month. SAIF’s denial of the claim was litigated before an administrative law judge (ALJ) and the board. The board concluded that claimant’s December 1997 injury claim was compensable and that it combined with his preexisting condition. It also concluded that the compensable 1997 injury was the major contributing cause of the need for treatment of the combined condition. Accordingly, the board set aside SAIF’s denial.

On March 1, 1999, SAIF issued an acceptance of claimant’s “lumbar strain/sprain.” On March 31,1999, claimant saw his treating surgeon, Dr. Van Pett, who recommended additional surgery at different spinal levels for a right “foraminal decompression at L4-5 and L5-S1.” In January 2000, SAIF issued a modified notice of acceptance stating that claimant’s lumbar strain/sprain had combined with claimant’s “pre-existing SI left compression secondary to lateral recess stenosis at the L5-S1 level.” The notice of acceptance stated that SAIF was “responsible for the combined condition as long as and to the extent that the work injury remains the major contributing cause of the combined condition.”

In March 2000, Dr. White conducted a compelled medical examination and diagnosed diffuse lumbar spondylosis with mild spinal stenosis; mild left SI static sensory-only neuropathy; and chronic low back pain. White concluded [4]*4that claimant’s December 1997 work injury had healed without permanent impairment and that no combined condition existed. On April 14, 2000, claimant underwent an MRI that indicated “no abnormality detected on the left at the L5-S1 at the site of operation.” On April 26, 2000, SAIF denied claimant’s current condition on the ground that claimant’s compensable injury was no longer the major contributing cause of the current condition. In June 2000, a notice of closure was issued awarding claimant temporary disability and nine percent unscheduled permanent disability for the surgery.

Claimant requested a hearing challenging the procedural validity of the denial. He asserted that it should have been only a “partial” denial relative only to the additional surgery recommended by Van Pett at different levels that SAIF had not accepted as a part of the combined condition. The ALJ and, ultimately, the board upheld SAIF’s denial, concluding that it was procedurally valid and that there was no persuasive evidence that the compensable injury remained the major contributing cause of the disability or need for treatment of the current condition.

Before this court, claimant again argues that SAIF’s denial cannot be upheld as a denial of a previously accepted combined condition. Claimant does not dispute that, under the applicable statutes, an insurer may issue a denial of a previously accepted combined condition. Under ORS 656.262(7)(b), once an employer has accepted a combined condition, the employer, in fact, must issue a written denial when the accepted compensable injury is no longer the major contributing cause of the need for treatment of the combined condition before the claim may be closed. SAIF v. Belden, 155 Or App 568, 575, 964 P2d 300 (1998), rev den, 328 Or 330 (1999). ORS 656.262(6)(c) specifically authorizes such a denial:

“An insurer’s or self-insured employer’s acceptance of a combined or consequential condition under ORS 656.005(7), whether voluntary or as a result of a judgment or order, shall not preclude the insurer or self-insured employer from later denying the combined or consequential condition if the otherwise compensable injury ceases to be the major contributing cause of the combined or consequential condition.”

[5]*5Claimant, however, identifies a number of problems with the board’s decision to uphold SAIF’s denial in this case. Claimant first contends that the board erred in not specifying the nature of the combined condition or the nature of the denial. As the board found, however, SAIF’s modified acceptance stated that the December 1997 injury combined with “preexisting SI left compression secondary to lateral recess stenosis at the L5-S1 level.” The board adopted the ALJ’s finding that “SAIF is denying the accepted ‘combined condition.’ Thus, the denial left nothing accepted; in other words, it denied the entire accepted claim.” (Emphasis added.) In its order on reconsideration, the board again explained:

“In the prior litigation regarding compensability, we affirmed the prior AU’s order that found claimant’s low back injury claim compensable as a combined condition. The combined low back condition, not ‘lumbar laminectomy’ surgery, was found compensable. The statutory scheme allows carriers to issue denials when the compensable injury is no longer the major contributing cause of the combined condition. ORS 656.262(6)(c); 656.262(7)(b). That is what occurred here.”

(Citations to record omitted.) We conclude that the board adequately specified the nature of the accepted condition and of the denial.

Claimant also argues that, under those facts, the board simply cannot reach the conclusion that it did. First, it is claimant’s position that the board’s conclusion that the injury was no longer the major contributing cause of the combined condition is not supported by substantial evidence. Claimant asserts that, under ORS 656.262(6)(c), the combined condition could only be the compensable injury in combination with the SI left compression secondary to lateral recess stenosis at the L5-S1 level and that the only evidence relating to that combined condition is that claimant was given corrective treatment (surgery) and that claimant was awarded nine percent permanent disability for the impairment that remained after the surgery. From those facts, claimant reasons that the post-surgical condition was a “direct medical sequella” of the injury and, consequently, “the evidence preponderates overwelmingly” that the injury [6]*6remained the major contributing cause of the combined condition.

However, as the ALJ explained in detailed findings adopted by the board, there was evidence to support the conclusion that claimant’s injury was no longer the major contributing cause of the need for treatment of the combined condition.

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Related

Dietz v. Ramuda
882 P.2d 618 (Court of Appeals of Oregon, 1994)
SAIF Corp. v. Belden
964 P.2d 300 (Court of Appeals of Oregon, 1998)
Dietz v. Ramuda
898 P.2d 768 (Oregon Supreme Court, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
57 P.3d 959, 185 Or. App. 1, 2002 Ore. App. LEXIS 1761, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaeo-v-saif-corp-orctapp-2002.