Spurger v. SAIF Corp.

337 P.3d 883, 266 Or. App. 183
CourtCourt of Appeals of Oregon
DecidedOctober 8, 2014
Docket1006324; A150351
StatusPublished
Cited by3 cases

This text of 337 P.3d 883 (Spurger v. SAIF Corp.) 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
Spurger v. SAIF Corp., 337 P.3d 883, 266 Or. App. 183 (Or. Ct. App. 2014).

Opinion

EGAN, J.

Claimant seeks judicial review of an order of the Workers’ Compensation Board (the board) that denied her compensation for what she maintained was a “chronic condition impairment” of her left hip under OAR 436-035-0019. That order concluded that claimant had failed to demonstrate that she was “significantly limited in the repetitive use” of her hip such as would entitle her to compensation under that rule. Claimant contends that the board erred in failing to either identify or apply a proper interpretation of the term “significantly limited.” Because we conclude that the board’s order is not supported by substantial reason, we reverse and remand.

The facts are undisputed. After claimant was injured at work, SAIF, her employer’s workers’ compensation insurer, accepted her claim for — among other things — a left-hip strain. One of the issues raised during the process of closing her claim was whether claimant was entitled to additional compensation for a “chronic condition impairment” in her left hip. That determination is controlled by OAR 436-035-0019, which provides: “(1) A worker is entitled to a 5% chronic condition impairment value for each applicable body part, when a preponderance of medical opinion establishes that, due to a chronic and permanent medical condition, the worker is significantly limited in the repetitive use of [a list of body parts that includes the hip].”1

As part of the claim-closure process, Dr. Franklin Wong examined claimant. SAIF sent Wong a check-the-box letter, asking him various questions about claimant’s medical condition. One of those questions asked: “Which best describes the worker’s limitation in repetitive use of the left hip for the accepted condition(s)?” Underneath that question were three boxes, labeled “[n]o limitation,” “[s]ome limitation,” and “[significant limitation.” Wong checked the “[s]ome limitation” box.

Claimant’s attorney sent Wong a “concurrence letter,” asking Wong to memorialize his understanding of a [185]*185previous conversation of theirs concerning claimant’s left-hip condition. Claimant’s attorney asked Wong whether he agreed with the following characterization of their discussion:

“I asked you specifically what limitation you would anticipate. You indicated that [claimant] would have difficulty with repetitive squatting, walking long distances and static standing for long periods of time. You indicated that, as a physician, the term ‘significant’ means that there is a major loss of function as a result of limitation. Because SAIF Corporation only gave you three choices — no limitation, some limitation or significant limitation — you selected some limitation. We discussed the fact that neither the [Workers’ Compensation] Division nor the Board has provided any guidance with what the word ‘significant’ actually means, but that the dictionary definition of the word ‘significant’ merely means important, weighty, or notable. You indicated that it would be beneficial if someone would provide more guidance with how the word ‘significant’ was supposed to be interpreted.”

(Emphasis added.) Wong indicated that the statement accurately reflected both their conversation and his “opinion to a reasonable medical probability.”

Claimant’s attorney also sent a letter to claimant’s attending physician, Dr. Hai Tran. That letter first asked Tran whether he agreed with the “findings, opinion, and diagnosis (es)” that Wong had expressed in the concurrence letter; Tran responded that he did. It then asked, “Assuming the definition of ‘significant’ applies (important, weighty, or notable), would you consider [the] limitations discussed on page 2 [i.e., difficulty with squatting, walking, and standing] to be significant?” Tran initially responded “yes” to that question, but then crossed out that response and wrote: “there’s no clear criteria for ‘significant’ therefore unable to comment either way.”

SAIF issued a notice of closure that did not include, in its calculation of compensability, the five-percent chronic-condition impairment value permitted by OAR 436-035-0019. Claimant sought reconsideration of that decision before the Administrative Review Unit (ARU), which functions as a part of the Department of Consumer and Business Services (the department), the agency that administers the [186]*186Workers’ Compensation Division. The ARU issued an order that did not assign the impairment value on the ground that claimant had failed to prove that she was “significantly limited” in the repetitive use of her hip. The ARU order reasoned as follows:

“It is noted that Dr. Wong initially indicated that claimant had ‘some’ rather than ‘significant’ limitation in the repetitive use of the [left] hip due to the accepted hip conditions. Dr. Tran concurred with that assessment. Upon clarification to claimant’s attorney, Dr. Wong agreed that claimant had some limitation in repetitive use and described some anticipated limitations. Dr. Wong also noted the dictionary definition of ‘significant’ and agreed that guidance as to the meaning of the meaning [sic] of ‘significant’ would be helpful. Dr. Wong did not clearly state claimant was significantly limited in repetitive use. In response to the request for clarification, Dr. Tran, claimant’s attending physician, indicated he was unable to comment either way as to whether there were significant limitations.
“We conclude that claimant has not met the threshold (minimum) impairment established in the rule and has not proved entitlement to a value under OAR 436-035-0019. See ORS 656.266 and OAR 436-035-0007(13).”

In response to that order, claimant requested review of the chronic-condition-impairment determination before an administrative law judge (ALJ). The parties submitted the matter on the record. The ALJ upheld the order on reconsideration, reasoning, in part, as follows:

“Here, Dr. Wong opined that claimant had ‘some’ limitation in the repetitive use of her left hip. Dr. Wong explained that claimant would have difficulty repetitively squatting, walking long distances and static standing for long periods of time. ‘Magic Words are not required to establish a “chronic condition” limitation.’ See Buss v. SAIF, 182 Or App 590, 594-95 [, 50 P3d 253] (2002) (‘magic words’ not required for ‘chronic condition’ rating when the record contained medical opinions from which it could be found the claimant was entitled to a ‘chronic condition’ award) * * *. However, without further explanation from Drs. Wong and Tran, it cannot be inferred that claimant’s limitations amount to a ‘significant limitation.’ See Benz v. SAIF, 170 Or App 22, 25 [, 11 P3d 698] (2000) (although the Board may draw reasonable inferences from the medical evidence, [187]*187it is not free to reach its own medical conclusions in the absence of such evidence); see also SAIF v. Calder, 157 Or App 224, 227-28 [, 969 P2d 1050] (1998) (the Board is not an agency with specialized medical expertise entitled to take official notice of technical facts within its specialized knowledge); see also, Lenore A. Barrett, 55 Van Natta 3261, 3262 (2003) (physician’s opinion that the claimant had ‘difficulty with doing repetitive activity’ was insufficient to establish a chronic condition).
“Moreover, even when Dr.

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Related

Wiggins v. SAIF
453 P.3d 603 (Court of Appeals of Oregon, 2019)
Broeke v. SAIF
453 P.3d 597 (Court of Appeals of Oregon, 2019)
Spurger v. SAIF Corp.
423 P.3d 121 (Court of Appeals of Oregon, 2018)

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Bluebook (online)
337 P.3d 883, 266 Or. App. 183, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spurger-v-saif-corp-orctapp-2014.