SAIF Corp. v. Sweeney

839 P.2d 254, 115 Or. App. 506, 1992 Ore. App. LEXIS 1838
CourtCourt of Appeals of Oregon
DecidedOctober 14, 1992
Docket90-09754; CA A68897
StatusPublished
Cited by4 cases

This text of 839 P.2d 254 (SAIF Corp. v. Sweeney) 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. Sweeney, 839 P.2d 254, 115 Or. App. 506, 1992 Ore. App. LEXIS 1838 (Or. Ct. App. 1992).

Opinion

*508 DEITS, J.

Employer seeks review of the Workers’ Compensation Board’s order that held that it did not have the authority to re-evaluate and reduce payments on a permanent partial disability (PPD) award that had been suspended during claimant’s participation in vocational rehabilitation and which assessed a penalty and attorney fees against it for unreasonable claim processing.

Claimant suffered a back injury on the job in 1988. Employer accepted the claim, and a determination order was issued on July 28,1989, awarding temporary disability from the time of the injury until June 12, 1989, and 36 percent unscheduled PPD. Claimant applied for a lump sum payment, which was approved. Neither claimant nor employer requested a hearing on the determination order. On July 30, 1989, claimant entered an authorized vocational rehabilitation program. Under the applicable statutes and rules, payment of claimant’s PPD award was suspended during his participation in vocational training. On March 23, 1990, claimant was examined at employer’s request. He completed the vocational rehabilitation program on April 13,1990, and began work for a new employer on April 16,1990. On April 30, 1990, employer issued a notice of closure, by which it reevaluated and reduced claimant’s PPD award from 36 percent to 17 percent. Subsequently, employer paid claimant a lump sum award of 17 percent.

Claimant requested a hearing. The referee held that employer did not have the authority to reduce claimant’s award in its notice of closure and ordered it to pay the 36 percent award in the 1989 determination order. The referee reasoned that the 1989 determination order had become final 180 days after it was issued and that employer should have begun paying on it as soon as claimant finished the training program. The referee concluded, however, that claimant’s disability was 25 percent and authorized an offset of the difference between the 36 percent and 25 percent against any future award of permanent disability. The referee also assessed a penalty against employer and ordered it to pay attorney fees.

*509 On review, the Board held that, because the 1989 determination order had become final by operation of law, employer did not have the authority to re-evaluate and reduce claimant’s award. The Board reversed the referee’s reduction of claimant’s PPD award, as well as the attorney fees related to the increase of the employer closure award from 17 percent PPD to 25 percent, awarded attorney fees for Board review and otherwise affirmed.

Employer assigns error to the Board’s holding that it did not have the authority to re-evaluate and reduce claimant’s original PPD award after he had finished the vocational rehabilitation program. Employer argues that, after a worker completes a vocational rehabilitation program, an earlier determination order may be determined anew and the previous award, even if it has become final, may be adjusted.

The pertinent statute is ORS 656.268C5): 1

“If, after the determination made or notice of closure issued pursuant to subsection (3) or (4) of this section, the worker becomes enrolled and actively engaged in training * * * any permanent disability payments due under the determination shall be suspended, and the worker shall receive temporary disability compensation while the worker is enrolled and actively engaged in the training. When the worker ceases to be enrolled and actively engaged in the training, the Department of Insurance and Finance shall redetermine the claim pursuant to subsection (4) of this section unless the worker’s condition is not medically stationary. If the worker has returned to work, the insurer or self-insured employer may reevaluate and close the claim without the issuance of a determination order by the Department of Insurance and Finance.” (Emphasis supplied.)

Under that statute, payments on a permanent disability award are suspended while the worker is involved in training. However, the statute does not provide that the determination order itself is affected when the worker enters a training program. The administrative rules that implement the statute also provide only for suspension of permanent disability payments while the worker is involved in a training program. OAR 436-60-040 provides:

*510 “(2) When training commences in accordance with OAR 436-120 after the issuance of a determination order, * * * the insurer shall suspend any award payments due under the order * * * and pay temporary disability benefits.
“(3) The insurer shall stop temporary disability compensation payments and resume any suspended award payments upon the worker’s completion or the ending of the training, unless the worker is not then medically stationary. If no award payment remains due, temporary disability compensation payments shall continue pending a subsequent determination order by Evaluation. However, if the worker has returned to work, the insurer may reevaluate and close the claim without the issuance of a determination order by Evaluation.” (Emphasis supplied.)

Employer argues that, because the statute permits it to re-evaluate a previous permanent disability award after the completion of vocational rehabilitation and close the claim without the issuance of a new determination order if the worker has returned to work, it can refuse to resume payments on the earlier award until it has redetermined the amount due. We disagree. As the Board said:

“[W]e do not agree with SAIF that, because it had the right to reevaluate and close the claim at the end of claimant’s formal training program, the July 28,1989 Determination Order, in effect, became null and void and it is only required to pay claimant the permanent disability awarded under its April 30, 1990 Notice of Closure. The option of reevaluating and closing the claim by notice of closure is an alternative to resubmitting the claim for determination under ORS 656.268(4), which provides for the determination of any further compensation owed, including permanent disability. See ORS 656.268(5). It is not an alternative to resuming the payment of the suspended award. Thus, given the fact that the original determination had become final by operation of law, the Referee correctly found that SAIF was required to resume the suspended payments owed thereunder.” (Emphasis supplied.)

We conclude that, when an employer chooses the alternative of re-evaluation under ORS 656.268(5), rather than submitting the claim for redetermination, it must follow normal procedures for carrier closure. ORS 656.268

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Related

Holdren v. SAIF Corp.
63 P.3d 1238 (Court of Appeals of Oregon, 2003)
Fox v. Ross Bros.
28 P.3d 631 (Court of Appeals of Oregon, 2001)
SAIF Corp. v. Coburn
977 P.2d 412 (Court of Appeals of Oregon, 1999)
SAIF Corp. v. Sweeney
854 P.2d 487 (Court of Appeals of Oregon, 1993)

Cite This Page — Counsel Stack

Bluebook (online)
839 P.2d 254, 115 Or. App. 506, 1992 Ore. App. LEXIS 1838, Counsel Stack Legal Research, https://law.counselstack.com/opinion/saif-corp-v-sweeney-orctapp-1992.