Lewis v. CIGNA Insurance

121 P.3d 1128, 339 Or. 342, 2005 Ore. LEXIS 562
CourtOregon Supreme Court
DecidedSeptember 29, 2005
DocketCC 97-05360, 97-05050, 97-00071; CA A106117; SC S51710
StatusPublished
Cited by17 cases

This text of 121 P.3d 1128 (Lewis v. CIGNA Insurance) is published on Counsel Stack Legal Research, covering Oregon Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lewis v. CIGNA Insurance, 121 P.3d 1128, 339 Or. 342, 2005 Ore. LEXIS 562 (Or. 2005).

Opinion

*344 DE MUNIZ, J.

In this workers’ compensation case we examine the kinds of sanctions that are available when a claimant refuses to participate in an insurer medical examination (IME). After claimant was summoned but failed to appear for two IMEs, the Department of Consumer and Business Services (department) approved the denial of his claims under ORS 656.262(13) and (14) (former ORS 656.262(14) and (15) (1999)). An administrative law judge (ALJ) concluded that the department could not impose a sanction of denial, but could only suspend the claims under ORS 656.325(l)(a), because that statute applied specifically to lack of cooperation in an IME. The Workers’ Compensation Board (board), in a divided decision, reversed the AL J’s order and approved the denial of the claim. The Court of Appeals affirmed the board’s decision. Lewis v. CIGNA Ins. Co., 192 Or App 658, 87 P3d 698 (2004). On review, we conclude that only the sanction of suspension under ORS 656.325(1)(a), not the sanction of claim denial under ORS 656.262(13) and (14), applies to a claimant’s noncooperation in an IME. We therefore reverse the decision of the Court of Appeals.

The Court of Appeals set out the following facts:

“Claimant filed claims [in 1997] for compensation following back injuries. Insurer arranged for claimant to take an IME. He failed to appear. Insurer rescheduled the IME and again [claimant] failed to appear. Further, on instructions from his attorney, [claimant] walked out of a deposition before opposing counsel had finished questioning him. As a result of these acts, insurer denied his claims under former ORS 656.262(14) and (15) (1999). * * * ORS 656.262(14) requires injured workers ‘to cooperate * * * in the investigation of claims for compensation,’ and ORS 656.262(15) allows an insurer to deny a claim if the claimant continues noncooperation for 30 days after notice.
“Claimant requested a hearing to contest the denial. In doing so, he did not explicitly indicate that he was requesting an expedited hearing. When his nonexpedited appeal reached the board, he made two arguments: First, that his conduct at the deposition did not amount to noncooperation; and second, that failure to attend an IME was not noncooperation under ORS 656.262(14) and (15) — rather, it *345 was noncooperation under ORS 656.325(l)(a), and under that statute the maximum penalty was suspension of benefits as opposed to outright denial. Insurer, for its part, argued that claimant had forfeited his right to a hearing on noncooperation because ORS 656.262(15) allowed either an expedited hearing, which [claimant] did not request, or no hearing at all.
“The board rejected insurer’s argument that claimant had forfeited his right to a hearing. On the merits of his claim, however, it concluded that his failure to appear at IMEs amounted to noncooperation under ORS 656.262(14). Because that incident of noncooperation sufficed to justify the insurer’s denial, the board did not reach claimant’s argument that his conduct at the deposition did not amount to noncooperation.”

Lewis, 192 Or App at 660-61 (emphasis in original; footnote omitted).

Claimant sought judicial review. Insurer cross-petitioned, arguing that the board lacked authority to consider claimant’s challenge to the noncooperation denials. The Court of Appeals agreed with insurer. Lewis v. CIGNA Ins. Co., 174 Or App 531, 26 P3d 165 (2001). On review of that decision, this court concluded that the Court of Appeals erred, vacated that decision, and remanded the case in light of SAIF v. Dubose, 335 Or 579, 74 P3d 1072 (2003). Lewis v. CIGNA Ins. Co., 336 Or 125, 79 P3d 882 (2003).

On remand, claimant argued that the insurer could suspend, but could not deny, his claim based on claimant’s noncooperation at the IME because ORS 656.325(l)(a) specifically authorized only the sanction of suspension for a refusal to submit to an IME. He conceded that a more general statute, ORS 656.262, authorized a sanction of denial, but argued that that statute applied to noncooperation with less intrusive discovery techniques such as a deposition. Applying the maxim of statutory construction that, between inconsistent statutes, the more specific statute controls the more general statute, the Court of Appeals determined that suspension of the payment of compensation of the claimant’s claim under ORS 656.325 was not inconsistent with the sanction of dismissal under ORS 656.262:

*346 “Claimant’s argument fails because the two statutes are not inconsistent. As the board noted, the general statute, ORS 656.262(14) and (15), applies to initial claims that involve compensability or the reopening of an aggravation claim, whereas the specific statute applies to any failure to attend an IME, for example, one requested in order to determine the propriety of proposed treatment. It is true that in the circumstances where the two statutes overlap— failure to cooperate in an IME for an initial claim — the two statutes provide different remedies. However, they are not inconsistent remedies. ORS 656.325(1)(a) requires suspension of benefits for noncooperation at an IME. ORS 656.262(14) and (15) permit an insurer to deny

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Cite This Page — Counsel Stack

Bluebook (online)
121 P.3d 1128, 339 Or. 342, 2005 Ore. LEXIS 562, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lewis-v-cigna-insurance-or-2005.