Providence Health System v. Walker

289 P.3d 256, 252 Or. App. 489, 2012 WL 4378581, 2012 Ore. App. LEXIS 1166
CourtCourt of Appeals of Oregon
DecidedSeptember 26, 2012
Docket0900276; A145132
StatusPublished
Cited by14 cases

This text of 289 P.3d 256 (Providence Health System v. Walker) 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
Providence Health System v. Walker, 289 P.3d 256, 252 Or. App. 489, 2012 WL 4378581, 2012 Ore. App. LEXIS 1166 (Or. Ct. App. 2012).

Opinion

DUNCAN, J.

In this workers’ compensation proceeding, we are asked to resolve three issues: (1) whether employer was obligated under ORS 656.262(7)(c)1 to reopen and process claimant’s omitted condition claims after an administrative law judge (ALJ) had found the conditions compensable but while employer’s appeal of the ALJ order was pending; (2) if employer was so obligated, whether employer fulfilled those obligations; and (3) if employer was so obligated but did not fulfill its obligations, whether claimant is entitled to attorney fees and a penalty because employer lacked legitimate doubt about its obligations.2

We set out the pertinent procedural facts in some detail. In April 2004, claimant, who worked as a certified nursing assistant in an elder-care facility, filed a workers’ compensation claim with employer, reporting symptoms of “acute anxiety [with] chest pain [and] headaches” after having reported narcotic misuse by a coworker and then having received a disciplinary sanction. In May 2004, employer denied the claim, which it characterized as being for a “condition involving Stress/Anxiety.”

Claimant contested the denial of her claim. After a hearing, ALJ Mills, in an order dated August 8, 2005, set aside employer’s denial of claimant’s “stress claim” and remanded the claim for processing. Employer appealed the order to the Workers’ Compensation Board (board), and the board affirmed ALJ Mills’s order. Employer then sought review in this court, and, in January 2007, we affirmed the board’s order without opinion. Providence Health System v. Walker, 210 Or App 466, 151 P3d 960 (2007).

[491]*491In July 2007, employer accepted a claim for “disabling anxiety with depression.” In August 2007, claimant requested that employer issue a “modified notice of acceptance to include major depression and panic disorder without agoraphobia” and that employer issue a notice of closure for those conditions. In October 2007, employer declined to modify its acceptance of the claim to include major depression and panic disorder without agoraphobia, which it characterized as omitted conditions. In January 2008, employer issued a notice of closure and an “updated notice of acceptance at closure,” which included the originally accepted condition “disabling anxiety with depression” only. The notice of claim closure stated that claimant’s condition had become medically stationary on August 19, 2004, and awarded temporary total disability from April 8 through August 19, 2004, and no permanent partial disability.

Claimant contested the denial of her omitted medical condition claims for major depression and panic disorder and contended that employer unreasonably refused to close her claim in August 2007. In an order dated September 9, 2008, ALJ Mills concluded that the denial of claimant’s omitted condition claims for major depression and panic disorder should be set aside but upheld the denial of claim closure based on employer’s argument that it had insufficient evidence for closure at the time of the request. Employer appealed that order to the board. While employer’s appeal to the board was pending, on October 9, 2008, claimant again requested that employer issue a notice of closure on claimant’s major depression and panic disorder claims. Employer declined to close those claims because, in employer’s view, the claims were not open. Employer’s position appears to have been that only final orders operate to reopen claims and that ALJ Mills’s September 2008 order, which had been appealed to the board, was not final and so did not require reopening or closure of the claims. In an order dated March 23, 2009, the board affirmed ALJ Mill’s September 2008 order. Employer did not seek judicial review and, accordingly, the set-aside of employer’s denial of claimant’s omitted condition claims became final.

Claimant subsequently sought attorney fees and penalties based on employer’s failure to process her [492]*492omitted condition claims. The matter was submitted to ALJ McCullough, who, in an order issued on June 11, 2009, noted that “[t]he threshold question is whether [employer] was required by law to reopen claimant’s claim after the issuance of the September 9, 2008 Opinion and Order, even though the Opinion and Order was on appeal.” More particularly, ALJ McCullough examined ORS 656.262(7)(c), which provides, in part:

“If a condition is found compensable after claim closure, the insurer or self-insured employer shall reopen the claim for processing regarding that condition.”

ALJ McCullough observed that the determinative issue was when an employer’s obligation to reopen a claim arises and, to address that issue, the key phrase was “found compensable.” Claimant contended that an employer’s obligation to reopen arises upon any litigation order that includes a determination of compensability, regardless of whether the order is appealed. Employer, on the other hand, contended that a condition is not “found compensable” until a compensability determination has become final, either because all appeals and judicial review have been exhausted or because no further appeal has been timely pursued. ALJ McCullough reviewed orders of the board and opinions of the appellate courts addressing similar, but not identical, questions.

Ultimately, ALJ McCullough concluded as follows:

“I am inclined to conclude that claimant’s interpretation of ORS 656.262(7)(c) is the correct one, and that [employer] should have reopened claimant’s claim and then re-closed it following the issuance of the September 9, 2008 Opinion and Order, even though it had appealed the Opinion and Order to the Board.”

ALJ McCullough did not, however, hold employer liable for penalties and attorney fees related to the failure to reopen and reclose the omitted condition claims. Given the “lack of explicit language in ORS 656.262(7)(c)” and lack of clarity in the case law, ALJ McCullough found that employer had a “legitimate doubt” about its obligations while its appeal of ALJ Mills’s September 2008 order was pending. And, because of that legitimate doubt, ALJ McCullough concluded that employer’s failure to reopen and reclose the omitted condition claims was not unreasonable and, hence, [493]*493did not give rise to penalties or attorney fees under ORS 656.262(11), ORS 656.268(5)(d), or ORS 656.382(1).

Claimant appealed ALJ McCullough’s order to the board. In an order dated March 2, 2010, the board held that ALJ McCullough had correctly concluded that employer was required to reopen and process claimant’s omitted condition claims after its denial was set aside by ALJ Mills in September 2008.

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Bluebook (online)
289 P.3d 256, 252 Or. App. 489, 2012 WL 4378581, 2012 Ore. App. LEXIS 1166, Counsel Stack Legal Research, https://law.counselstack.com/opinion/providence-health-system-v-walker-orctapp-2012.