Saif Corp. v. Allen

881 P.2d 773, 320 Or. 192, 1994 Ore. LEXIS 95
CourtOregon Supreme Court
DecidedSeptember 29, 1994
DocketWCB 91-09837; CA A76538; SC S40951
StatusPublished
Cited by41 cases

This text of 881 P.2d 773 (Saif Corp. v. Allen) 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
Saif Corp. v. Allen, 881 P.2d 773, 320 Or. 192, 1994 Ore. LEXIS 95 (Or. 1994).

Opinions

[195]*195DURHAM, J.

This workers’ compensation case presents two issues: (1) When the three-judge panel of the Court of Appeals issued a majority opinion, a concurring opinion, and a dissenting opinion, did that court comply with ORS 2.570(4), which requires the “concurrence of two judges * * * to pronounce judgment”? (2) Does ORS 656.386(1), set out below, allow an award of attorney fees when an employer or insurer denies a claim for medical services, but does not deny expressly the compensability of, or its responsibility for, the claimant’s injury or condition? We hold: (1) The Court of Appeals complied with ORS 2.570(4); and (2) ORS 656.386(1) allows an award of attorney fees when an employer or insurer denies a claim for medical services, but does not deny expressly the compensability of, or its responsibility for, the claimant’s injury or condition.

Claimant injured her back in 1988 while employed at a restaurant. Her employer’s insurer, Safeco, accepted her workers’ compensation claim for the injury.

In 1989, claimant went to work for a different restaurant, which was insured by SAIF Corporation (SAIF). Thereafter, claimant experienced back pain and neck pain. She filed an aggravation claim with Safeco and a new injury claim with SAIF.

The insurers agreed that claimant’s 1989 injury was compensable but disagreed as to responsibility. In 1990, a workers’ compensation referee held that Safeco remained responsible for claimant’s lower back condition, but that SAIF was responsible for her upper back and neck condition. That order was not appealed.

Meanwhile, claimant had moved to Rhode Island.1 She submitted various medical bills to SAIF from providers in Rhode Island. SAIF paid some bills but not others.2

Claimant’s lawyer wrote a letter to SAIF on March 14,1991, asking SAIF to pay four unpaid bills that SAIF had [196]*196received on October 31,1990.3 After making adjustments for charges that SAIF contended were excessive under Oregon’s workers’ compensation medical fee schedule and for charges related to claimant’s back condition for which Safeco was responsible, SAIF paid one of the bills on May 1, 1991, and two more on May 3, 1991.4

On July 25,1991, claimant filed a form Request for Hearing and checked the following boxes on the form:

“REQUEST IS MADE FOR A HEARING CONCERNING ONE OR MORE OF THE REASONS CHECKED BELOW:

£ £ íjí ifc s{í

“H _JX_ MEDICAL SERVICES ORS 656.245

££‡ s-t #

“Q JL OTHER - EXPLAIN AND CITE ORS[.] Failure to pay medical bills; penalties and attorney fees pursuant to ORS 656.262(10), 656.268, 656.382.”

Claimant did not check the boxes relating to “DENIAL,” “COMPENSABILITY,” or “AGGRAVATION.”

SAIF filed a form Response to Request for Hearing. In it, SAIF erroneously stated that “[t]he medical bills have been paid on a timely basis. ’ ’ SAIF also checked the box on the form stating that “[tjhere is no known basis for an award of penalties/attorney fees.” SAIF did not check the box asserting that a denial should be affirmed or any other box relating to entitlement to compensation.

[197]*197In fact, one bill remained unpaid at the time SAIF filed its response. With respect to that bill, SAIF contended that thermography was not reimbursable without prior authorization.5 Nonetheless, after making adjustments for allegedly excessive charges, SAIF paid the fourth and last medical bill on September 23, 1991.6

The referee convened a hearing to determine whether claimant was entitled to an attorney fee under ORS 656.386(1), because her attorney was instrumental in obtaining compensation for claimant before the hearing.7 The referee awarded claimant an attorney fee under the third sentence of ORS 656.386(1), “for her efforts in obtaining payment of medical bills.” The referee found: “It is doubtful that the bills would have been paid if it had not been for claimant’s attorney’s efforts.”

SAIF appealed the attorney fee award to the Workers’ Compensation Board (Board). The Board affirmed.

SAIF then sought judicial review. The Court of Appeals reversed the award of attorney fees under ORS 656.386(1). SAIF v. Allen, 124 Or App 183, 861 P2d 1018 (1993). The court held that “[a] claimant is entitled to attorney fees under ORS 656.386(1) only in an appeal ‘from an order or decision denying the claim for compensation.’ ” 124 Or App at 185 (quoting Shoulders v. SAIF, 300 Or 606, 611, 716 P2d 751 (1986)). The court explained that, “ ‘where the only compensation issue on appeal is the amount of compensation or the extent of disability[,] * * * ORS 656.386(1) is not the applicable attorney fee statute.’ ” Id. at 186 (quoting Short v. SAIF, 305 Or 541, 545, 754 P2d 575 (1988)).

Judge De Muniz concurred, because, in his view, “the Supreme Court has indicated that an insurer’s failure to [198]*198timely respond to a claim for compensation may not be construed as a de facto denial.” Id. at 187. He also said:

“[T]he Supreme Court has indicated that ‘[a]n insurer’s failure to respond to a claim [as required by ORS 656.262(6)] is neither acceptance [n]or denial.’ Johnson v. Spectra Physics, 303 Or 49, 58, 733 P2d 1367 (1987). The issue in that case was whether an insurer’s inaction could be construed as acceptance of a claim. The conclusion that inaction does not constitute denial is therefore dictum. I question whether the Supreme Court really intended claimants to languish while insurers failed to obey the law that requires them to accept or deny claims in a timely fashion. ” Id. at 189 (emphasis in original).

He also said:

“In my view, an insurer’s failure to timely accept or deny a claim ought to be considered a denial, and that should entitle the claimant to attorney fees under ORS 656.386(1) * * Id.

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Bluebook (online)
881 P.2d 773, 320 Or. 192, 1994 Ore. LEXIS 95, Counsel Stack Legal Research, https://law.counselstack.com/opinion/saif-corp-v-allen-or-1994.