Mills v. Boeing Co.

159 P.3d 375, 212 Or. App. 678, 2007 Ore. App. LEXIS 699
CourtCourt of Appeals of Oregon
DecidedMay 16, 2007
Docket0400942; A130079
StatusPublished
Cited by3 cases

This text of 159 P.3d 375 (Mills v. Boeing Co.) 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
Mills v. Boeing Co., 159 P.3d 375, 212 Or. App. 678, 2007 Ore. App. LEXIS 699 (Or. Ct. App. 2007).

Opinion

ROSENBLUM, J.

Claimant seeks review of an order of the Workers’ Compensation Board (the board) that reversed the administrative law judge’s (ALJ’s) order awarding benefits, assessing a penalty against employer, and granting attorney fees. We affirm.

On May 5, 2003, while working for employer, claimant slipped off a ladder and fell approximately three feet. He sought medical treatment for his right hip from Dr. Breen at the end of May. Claimant filed a workers’ compensation claim and listed the date of injury as May 5, 2003. On the claim form, Breen diagnosed claimant with arthritis of the hip.

On August 11, 2003, employer’s insurance carrier sent a letter denying claimant’s claim:

“RE: Claim Number: 7870085182
Date of Loss: 5/9/03
Employer: The Boeing Company
“Dear Mr. Mills:
“The information we have received to date is insufficient to support a finding that you have sustained a compensable injury or occupational disease arising out of and in the course and scope of your employment with the above-named employer.
“This letter is a denial of the above claim. We will not be providing any workers’ compensation benefits under this claim.”

(Emphasis added.) In the caption of the denial, above the body of the letter, employer listed “5/9/03” as the “[d]ate of [1] oss,” even though claimant had identified the date of injury as May 5, 2003. Claimant did not seek a hearing within 60 days. See ORS 656.319 (requiring that, under most circumstances, a request for a hearing be filed no more than 60 days after the denial is mailed).

In October 2003, claimant saw Dr. Toal regarding the continuing pain in his hip. Toal referred claimant to [681]*681Dr. Ellis to perform an MRI to rule out a labral tear.1 In December 2003, after the MRI, Ellis diagnosed a right hip labral tear and mild hip arthritis and attributed claimant’s symptoms to a traumatic labral tear. On February 5, 2004, more than 60 days after receiving the notice that bis claim had been denied, claimant requested a hearing.

On February 18, 2004, claimant submitted a second job-injury report, this time identifying his injury as a right labral tear sustained on May 5, 2003. On February 26, 2004, the carrier responded that claimant had already filed such a claim, which had been denied. On March 1, claimant answered that the denial had been issued for a nonexistent “date of loss” (May 9, 2003) and for arthritis, and that the second job-injury report was filed for the correct date of injury (May 5, 2003) and a newly diagnosed condition (labral tear). On April 19, 2004, claimant requested a hearing, contending that the claim made by his second job-injury report had been de facto denied.

The ALJ presiding over that hearing agreed with claimant that the employer was bound by the typographical error of its denial of claimant’s first job-injury report. See Tattoo v. Barrett Business Service, 118 Or App 348, 351, 847 P2d 872 (1993) (“[E]mployers are bound by the express language of their denials.”). The ALJ reasoned that employer’s letter denied a claim that was never made because claimant was not injured on May 9, 2003, and thus the denial was of no legal effect. Accordingly, the ALJ found that claimant had timely filed a request for a hearing from a de facto denial. The ALJ also reasoned that, even if the denial of the claim for arthritis was not a legal nullity under Tattoo, claimant’s claim for a labral tear was not precluded under Jeremy J. Hawkins, 53 Van Natta 566 (2001). The ALJ ultimately concluded that the labral tear was a compensable injury, awarded benefits, assessed a penalty against employer, and granted attorney fees.

Employer appealed, and the board reversed the ALJ’s order, finding that employer’s denial responded to the only claim that claimant had filed and was therefore valid [682]*682despite the typographical error. The board also concluded that, because the letter denied that claimant had sustained any injury or occupational disease arising out of the course and scope of his employment, the claim for a labral tear fell within the denial’s scope, and claimant was precluded from raising it because he did not timely request a hearing. Claimant seeks judicial review.

Claimant does not contest the board’s factual findings that the “5/9/03” notation was a typographical error and that employer intended to deny the claim for an injury that occurred on May 5, 2003. Rather, he contends that the board failed to apply the correct legal standards when construing the denial. According to claimant, because he never filed a claim for an incident occurring on May 9, 2003, the board should have set aside the denial as a legal nullity. We review the claim that the board failed to correctly apply a legal standard for errors of law. ORS 183.482(8)(a).

In determining whether the board applied the correct legal standard when construing the denial, we begin with Tattoo. In that case, we considered whether a claims examiner’s testimony that she intended to deny future treatment could be considered when construing the meaning of the denial for “current chiropractic care.” We held that

“employers are bound by the express language of their denials and the testimony of the claims examiner here is irrelevant. * * * If we were to hold to the contrary, an employer could change what it had expressly said in a denial to the detriment of all parties who have relied on the language.”

118 Or App at 351-52; see also Sound Elevator v. Zwingraf, 181 Or App 150, 154-55, 45 P3d 958, rev den, 334 Or 693 (2002) (where an employer issued a denial in response to an improperly filed claim, it was bound by the denial and the claimant was entitled to request a hearing).

Although evidence that an employer intended something other than what it expressly said may not be considered in construing a denial, whether a denial is directed at a particular claim “does not depend solely on the words [the denial] uses.” SAIF v. Allen, 193 Or App 742, 749, 91 P3d 808 (2004). It depends also on “the context in which [the denial] is [683]*683made * * * including what the insurer did or did not know” and the date the denial was sent. Id.; see Altamirano v. Woodburn Nursery, Inc., 133 Or App 16, 19, 889 P2d 1305 (1995) (considering the date of the denial letter as context for the phrase “then current condition”); Longview Inspection v. Snyder, 182 Or App 530, 536, 50 P3d 1201 (2002) (“[A] general denial will put at issue all of the relevant medical conditions of which the employer was aware.”). If, in context, the language of a denial has only one possible meaning, it must be read consistently with that contextual meaning. See, e.g., Altamirano, 133 Or App at 19 (deeming a denial ineffective where it could be read only to refer to a nonexistent condition).

Thus, the legal question before us is whether the board was permitted to consider, as context, the fact that claimant had filed only one claim when employer issued its denial.

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Cite This Page — Counsel Stack

Bluebook (online)
159 P.3d 375, 212 Or. App. 678, 2007 Ore. App. LEXIS 699, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mills-v-boeing-co-orctapp-2007.