SAIF Corp. v. Kollias

227 P.3d 188, 233 Or. App. 499, 2010 Ore. App. LEXIS 63
CourtCourt of Appeals of Oregon
DecidedFebruary 3, 2010
Docket0605027; A138457
StatusPublished
Cited by3 cases

This text of 227 P.3d 188 (SAIF Corp. v. Kollias) 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
SAIF Corp. v. Kollias, 227 P.3d 188, 233 Or. App. 499, 2010 Ore. App. LEXIS 63 (Or. Ct. App. 2010).

Opinion

*501 ORTEGA, J.

The issue in this workers’ compensation case is the operation of the burden of proof when an employer or insurer seeks to establish that a claimant’s “otherwise compensable injury” combines with a preexisting condition to cause a combined condition pursuant to ORS 656.005(7)(a)(B) and ORS 656.266(2). SAIF seeks review of an order of the Workers’ Compensation Board holding that, because SAIF had failed to make a prima facie case that claimant had a preexisting condition, the burden of proof did not shift to SAIF under ORS 656.266 and, accordingly, SAIF was not entitled under the board’s administrative rules to present rebuttal evidence. We conclude that the board erred in its interpretation of the statute and therefore reverse the board’s order and remand so that SAIF can put on rebuttal evidence.

Because they provide context for the parties’ dispute and are central to our analysis, we quote at the outset the relevant statutes and rules. ORS 656.005(7)(a) provides that “[a] ‘compensable injury’ is an accidental injury * * * arising out of and in the course of employment requiring medical services or resulting in disabilityt.]” A claimant establishes compensability of a work injury by providing that work was a material contributing cause of the injury. Coleman v. SAIF, 203 Or App 442, 446, 125 P3d 845 (2005). However, ORS 656.005(7)(a)(B) provides:

“If an otherwise compensable injury combines at any time with a preexisting condition to cause or prolong disability or a need for treatment, the combined condition is compensable only if, so long as and to the extent that the otherwise compensable injury is the major contributing cause of the disability of the combined condition or the major contributing cause of the need for treatment of the combined condition.”

(Emphasis added.) Thus, if an otherwise compensable injury “combines” with a preexisting condition to cause disability or a need for treatment, a more rigorous, “major contributing cause” standard of proof is applicable. Id.

A “preexisting condition” is defined in ORS 656.005(24)(a):

*502 “ ‘Preexisting condition’ means, for all industrial injury claims, any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to disability or need for treatment, provided that:
“(A) Except for claims in which a preexisting condition is arthritis or an arthritic condition, the worker has been diagnosed with such condition, or has obtained medical services for the symptoms of the condition regardless of diagnosis; and
“(B)(i) In claims for an initial injury or omitted condition, the diagnosis or treatment precedes the initial injury[.]”

ORS 656.266 sets forth the burden of proof in workers’ compensation claims and provides, as relevant:

“(1) The burden of proving that an injury or occupational disease is compensable and of proving the nature and extent of any disability resulting therefrom is upon the worker. * * *
“(2) Notwithstanding subsection (1) of this section, for the purpose of combined injury claims under ORS 656.005(7)(a)(B) only:
“(a) Once the worker establishes an otherwise com-pensable injury, the employer shall bear the burden of proof to establish the otherwise compensable injury is not, or is no longer, the major contributing cause of the disability of the combined condition or the major contributing cause of the need for treatment of the combined condition.”

As we said in Coleman, ORS 656.266(1) generally places the burden of proving compensability of a claim on the claimant. 203 Or App at 447. If, however, the employer asserts that the claimed injury is a “combined condition injury claim” because it combines with a preexisting noncompensable injury, after the worker has established an “otherwise compensable injury,” 1 the burden of proof shifts to the employer to prove *503 that the “otherwise compensable injury” is not the major contributing cause of the disability or need for treatment of the combined condition. Id.

The board has developed rules of procedure for the presentation of evidence. OAR 438-007-0023 provides that “[t]he party bearing the burden of proof on an issue in a hearing has the right of first and last presentation of evidence and argument on the issue.” OAR 438-006-0091(3) allows the administrative law judge (ALJ) to continue a hearing, on a showing of due diligence, “if necessary to afford reasonable opportunity for the party bearing the burden of proof to obtain and present final rebuttable evidence.” Thus, the party with the burden of proof is entitled to an opportunity to present the last evidence — rebuttal evidence — and to a postponement if necessary to obtain that evidence. The dispute in this case turns on whether SAIF was the party with the burden of proof and the right to present rebuttal evidence.

With that background in mind, we turn to the facts of this case. After injuring his back at work while lifting tires, claimant filed a workers’ compensation claim. Doctors ultimately diagnosed a herniated disk at L4-5, and claimant’s treating doctor performed a laminectomy and discectomy. Medical imaging also revealed that claimant has a preexisting condition in his lumbar region known as “Scheuermann’s Disease,” which is a nonarthritic developmental abnormality of the spine resulting in thinning of the vertebral body end plates that predisposes a person to disk protrusion by weakening of the annulus fibrosis.

SAIF denied the claim on the ground that the disk herniation was not compensably related to claimant’s work, and claimant requested a hearing. SAIF essentially asserted at the hearing that, although work was a material cause of the need for treatment of claimant’s disk herniation, claimant’s Scheuermann’s Disease was a preexisting condition that combined with his work injury to cause the disk herniation. In SAIF’s view, the major contributing cause of claimant’s disk herniation was his Scheuermann’s Disease, not the work injury.

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Cite This Page — Counsel Stack

Bluebook (online)
227 P.3d 188, 233 Or. App. 499, 2010 Ore. App. LEXIS 63, Counsel Stack Legal Research, https://law.counselstack.com/opinion/saif-corp-v-kollias-orctapp-2010.