U. S. Bakery v. Duval

739 P.2d 37, 86 Or. App. 120
CourtCourt of Appeals of Oregon
DecidedJune 24, 1987
DocketWCB 84-12417; CA A40810
StatusPublished

This text of 739 P.2d 37 (U. S. Bakery v. Duval) 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
U. S. Bakery v. Duval, 739 P.2d 37, 86 Or. App. 120 (Or. Ct. App. 1987).

Opinion

VAN HOOMISSEN, J.

Employer seeks review of a Workers’ Compensation Board order awarding compensation for claimant’s aggravation claim. The issues are compensability and whether employer’s denial of claimant’s aggravation claim is precluded by Bauman v. SAIF, 295 Or 788, 670 P2d 1027 (1983). On de novo review, ORS 656.298, we reverse.

In November, 1981, claimant stepped off a loading dock at work and injured his back. Dr. Kelber diagnosed “lumbar strain possible recurrent disc disease.” Claimant filed an 801 form, which included boxes numbered 15, 16 and 17, labeled respectively: “nature of injury or disease,” “part of body affected” and “describe accident.” He wrote on the form “twisted back,” “back right” and “carrying cubes off dock in warehouse — stepped off dock and hurt back.” Employer accepted the claim by checking the appropriate options included in box 35 of the form. Employer checked “accepted,” “disabling” and “injury.”1

Dr. Melgard examined claimant. He had treated him before, performing a laminectomy in November, 1969, to remove a herniated disc. At that time, he also had diagnosed probable Paget’s Disease.2 Kelber, Melgard and his treating physician, Dr. Tiley, continued to treat him. He was released for work twice in 1982, but his back problem persisted. In July, 1982, he left work permanently. A November, 1982, determination order awarded him 22 percent permanent partial unscheduled disability for his back. A June, 1983, stipulated order increased his award of unscheduled disability.

In August, 1984, claimant suffered back pain while lifting groceries from his car. He filed an aggravation claim, contending that his compensable condition had worsened. Employer denied the aggravation claim on the ground that the condition had not worsened. The October 24 denial letter provided, in relevant part: “We accepted your claim for your lumbrosacral strain, and related pagets [sic] disease and have [123]*123continued to provide benefits to you for this condition.” In June, 1985, employer “clarified” its denial, telling claimant that its denial letter, which stated that it had accepted Paget’s Disease was a “misstatement of your employers [sic] position.”

The referee concluded, in relevant part:

“The partial denial dated October 24,1984, specifically denies the aggravation claim, but accepts the claim for lumbrosacral strain and the related Paget’s disease. Once a claim has been accepted the insurer may not subsequently deny the compensability of the underlying claim, Bauman v. SAIF, 295 Or 788 (1983). Paget’s disease has become a part of this claim prior to the Determination Order and stipulated settlement. Consequently, it cannot now be denied.”

The referee vacated the denial and remanded the claim for payment of compensation from July 6, 1984. Thereafter, the referee allowed employer’s motion to reopen for reconsideration. On reconsideration, the referee affirmed his previous order, except that he held that compensation would be due from August 13,1984. He also stated that, if Bauman did not bar denial, the claim would not be compensable. The Board adopted the referee’s modified order and affirmed.

Employer contends that the Board erred in ruling that it was barred from denying the compensability of claimant’s Paget’s Disease. Employer argues that its acceptance of the original claim was an acceptance of back strain only. It also argues that the only condition which it specifically and officially accepted by checking the boxes on the 801 form was the back strain described by the claimant on the form. See Johnson v. Spectra Physics, 303 Or 49, 733 P2d 1367 (1987). It argues that, because Paget’s Disease was never accepted, Bauman v. SAIF, supra, does not apply. Claimant argues that employer knew from the medical records that Paget’s Disease was part of his original claim.

If, after the last award or arrangement of compensation, conditions resulting from the original injury worsen, an injured worker is entitled to additional compensation. ORS 656.273. On de novo review, we find that the preponderance of the evidence in the record indicates that claimant’s worsened condition is due to the natural progression of Paget’s Disease, [124]*124independent of the injury; there has been no worsening resulting from the original injury itself.3 Hence, the compensability of claimant’s aggravation claim depends entirely on whether Paget’s Disease was a compensable aspect of his original claim.

The disease was not caused by the injury. The evidence indicates that the effect of the disease in the original injury was to increase the extent of disability caused by the original injury. The back strain, which would otherwise have been a minor injury, caused a compression fracture of the disease-weakened vertebra at L3. Thus, the disease affected the extent of claimant’s disability but did not itself become a compensable aspect of the claim. See Barrett v. D & H Drywall, 300 Or 325, 709 P2d 1083 (1985), on reconsideration, 300 Or 553, 555, 715 P2d 90 (1986).

Because Paget’s Disease itself was not compensable, it is not a compensable aspect of the original claim, unless employer accepted it. In Bauman the Supreme Court held:

“[0]nce an insurer has accepted a claim under ORS 656.262(6), which requires acceptance or denial of a Workers’ Compensation claim within 60 days after the employer has notice or knowledge of the claim, the insurer may not subsequently deny the compensability of the underlying claim.” 295 Or at 790.

After the Board’s order here, the Supreme Court clarified the question of when a claim has been accepted for the purposes Bauman. In Johnson v. Spectra Physics, supra, the court explained:

“Bauman applies only to a claim ‘specifically’ or ‘officially’ accepted by the insurer. 295 Or at 793-94. * * * An insurer must accept a particular claim in writing, and subsequently deny that particular claim after the 60 days prescribed by ORS 656.262(6) have elapsed, before Bauman applies.” 303 Or at 55.

In Johnson, the claimant had filed an 801 form stating that she had injured her back and right arm. Before the [125]*125insurer accepted her claim, it received a medical report indicating that she was suffering a bilateral carpal tunnel syndrome, which her doctor believed was work related. Eight days later, the insurer accepted Johnson’s claim by checking the “accepted” box on the same form that she had submitted. Eighty days after the insurer received the report of carpal tunnel syndrome, it notified claimant that it was denying the compensability of the syndrome, although it still accepted the back injury. The Supreme Court characterized the carpal tunnel syndrome and the back injury as separate “aspects” of one claim.4

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Related

Johnson v. Spectra Physics
733 P.2d 1367 (Oregon Supreme Court, 1987)
Barrett v. D & H DRYWALL
709 P.2d 1083 (Oregon Supreme Court, 1985)
Bowman v. Oregon Transfer Co.
576 P.2d 27 (Court of Appeals of Oregon, 1978)
Bauman v. State Accident Insurance Fund Corp.
670 P.2d 1027 (Oregon Supreme Court, 1983)
Barrett v. D & H Drywall
715 P.2d 90 (Oregon Supreme Court, 1986)

Cite This Page — Counsel Stack

Bluebook (online)
739 P.2d 37, 86 Or. App. 120, Counsel Stack Legal Research, https://law.counselstack.com/opinion/u-s-bakery-v-duval-orctapp-1987.