Nicholson v. Salem Area Transit & Saif Corp.

884 P.2d 864, 320 Or. 391, 1994 Ore. LEXIS 118
CourtOregon Supreme Court
DecidedDecember 2, 1994
DocketWCB 91-03460; CA A76237; SC S41208
StatusPublished
Cited by2 cases

This text of 884 P.2d 864 (Nicholson v. Salem Area Transit & Saif Corp.) 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
Nicholson v. Salem Area Transit & Saif Corp., 884 P.2d 864, 320 Or. 391, 1994 Ore. LEXIS 118 (Or. 1994).

Opinion

DURHAM, J.

The issue in this case is whether the Workers’ Compensation Board (Board) erred in dismissing claimant’s request for a hearing regarding insurer’s refusal to approve palliative medical care under ORS eSG^éSllXb).1 The Court of Appeals affirmed the Board’s conclusion that the palliative care dispute was not a “question concerning a claim,” under ORS 656.283(1),2 because the approval procedure for palliative care in ORS 656.245(1)(b) was the exclusive procedure for obtaining that care. Therefore, according to the court, under the last sentence of ORS 656.704(3),3 the Board had no jurisdiction over the dispute. Nicholson v. Salem Area Transit, 126 Or App 172, 173, 866 P2d 525 (1994) (citing Hathaway v. Health Future Enterprises, 125 Or App 549, 865 P2d 503 (1993), aff’d, 320 Or 383, 884 P2d 549 (1994)). We allowed review to address the jurisdictional issue. As in Hathaway, we affirm the decision of the Court of Appeals, but for a different reason.

In 1985, claimant suffered a work-related back and neck strain. Insurer accepted the claim, and it was closed by a [394]*394determination order in November 1986. In July 1990, Dr. Stringham, claimant’s attending physician, recommended to insurer that claimant receive treatment from a chiropractic physician.4 According to the Board,

“[t]he treatment recommended by Dr. Stringham was for palliative care, i.e., manual manipulation and electrical stimulation. The treatment modality was recommended by Dr. Stringham to maintain claimant’s level of functioning, control pain, keep claimant from being severely symptomatic and allow claimant to work full time. The requested treatment is not required to monitor administration of prescription medicine!,] to maintain claimant in a medically stationary status or to monitor the status of a prosthetic device * *

In September 1990, insurer disapproved String-ham’s recommendation. In January 1991, Stringham requested that the director of the Department of Insurance and Finance5 approve the treatment. In March 1991, the director issued an order denying the request. Claimant requested a hearing before the Board under ORS 656.283(1). The Board held that it had no jurisdiction over the dispute, and the Court of Appeals affirmed.6

In Hathaway v. Health Future Enterprises, supra, 320 Or at 390, this court held that a request for a hearing regarding noncompensable palliative care is not a “question concerning a claim” under ORS 656.283(1), because it does not concern “compensation”:

“We conclude that claimant’s request for a hearing regarding insurer’s disapproval of noncompensable palliative care is not a ‘matter!] in which a worker’s right to receive compensation, or the amount thereof, [is] directly in issue,’ within the [395]*395meaning of ORS 656.704(3), because noncompensable palliative care is not ‘compensation’ within the meaning of ORS 656.005(8).

The facts in this case are similar to those in Hathaway. Claimant agrees that her request, like that in Hathaway, does not concern palliative care that is covered by an exception to the rule of noncompensability stated in the first sentence of ORS 656.245(1)(b). In each case, the attending physician requested that the insurer approve palliative care, and the insurer declined.

One procedural matter distinguishes this case from Hathaway. In Hathaway, after the insurer disapproved the physician’s request, the claimant requested a board hearing under ORS 656.283(1). In this case, after insurer declined approval, the physician requested approval by the director, and the director refused to approve the care.

Claimant argues that her physician satisfied the requirements of the approval procedure described in the second and third sentences of ORS 656.245(1)(b). She also argues that the legislature’s use of the permissive term “may” in the third sentence of ORS 656.245(1)(b) indicates a legislative intent to permit claimant to use other procedural avenues, such as ORS 656.283(1), to obtain approval of noncompensable palliative care, at least where, as here, the physician first exhausts the statutory approval procedure. We do not agree.

In Hathaway, we rejected the argument that the term “may” in this context signifies a legislative intention to permit the Board to address claims for palliative care under ORS 656.283(1):

“The legislature’s use of the permissive term ‘may’ in describing the physician’s procedural right to request director approval is a recognition that the right of the physician to [396]*396make the request does not create any duty on the physician to do so. So understood, the sentence does not alter the fact that the subject of the physician’s request — if it is made — is noncompensable palliative care. Claimant’s reading of the third sentence would make palliative care a compensable medical service, in contradiction of the first sentence in ORS 656.245(1)(b). Her reading also would render the approval procedure described in the second and third sentences of that subsection duplicative or useless. She does not explain those contradictions.

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Related

Errand v. Cascade Steel Rolling Mills, Inc.
888 P.2d 544 (Oregon Supreme Court, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
884 P.2d 864, 320 Or. 391, 1994 Ore. LEXIS 118, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nicholson-v-salem-area-transit-saif-corp-or-1994.