Category: Caselaw Update
WA BIIA 2024 Significant Decisions
Every year the Washington Board of Industrial Insurance Appeals designates several notable decisions each year as significant. A significant decision is one which the Board considers to have an analysis or decision of substantial importance to the Board. For 2024, the Board designated the following decision as significant: In re…
In Washington, Can a Worker Successfully Pursue an Occupational Disease Condition under an Open Industrial Injury Claim?
When a claim has been accepted, and compensation has been paid, the self-insurer is required to send the Department the SIF-2, the claim allowance request form, the SIF-5, and an explanation and documentation used to determine the date of manifestation for occupational disease claims. At that point, the Department will…
Oregon WCB clarifies carrier’s obligation to accept or deny encompassed conditions
A WCB Order on Review, Collin Stringer, 76 Van Natta 462 (2024), distinguished conditions encompassed within previously accepted conditions are not new or omitted conditions. The Board affirmed and supplemented ALJ Naugle’s order to confirm encompassed conditions may be denied where the accepted conditions adequately informed claimant and medical providers…
What type of medical services are compensable after a worker is medically stationary in Oregon?
A common question which arises in Oregon workers’ compensation claims process is what type of medical services will continue to be compensable once a worker has reached a medically stationary status. The Workers’ Compensation Division recently providing some clarification when an insurer will be held liable to compensate a proposed…
Washington Court of Appeals: New Insight on Notice and the Authority of DLI Policies
In the State of Washington, employers are required to give notice of a mandatory IME at least 14 to 60 days prior to the examination, and must provide the worker with the date, time, and location of the exam. But is the worker free to miss the exam without penalty…
Oregon Court of Appeals Upholds Nava Rule
In Nava v. SAIF, 333 Or App 196 (2024), claimant sought judicial review of the Board’s denial of penalty and attorney fees under ORS 656.262(11)(a) for unreasonable delay in payment of compensation. By way of background, claimant was compensably injured in November 2017 and the claim was accepted for left…
Oregon: Processing Proposed Surgical Authorization Requests Is Not Solely Based on Accepted Conditions
In 2019, the Oregon Supreme Court held that medical services materially related to the work injury are compensable under ORS 656.245 and are not limited to only the accepted conditions. Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019). This decision continues to have a significant impact on claim processing…
OREGON: When post-denial IME reports are submitted as evidence at hearing to bolster denial, Court of Appeals declares denial is based on the post-denial IME report.
On April 17, 2024, the Oregon Court of Appeals issued a ruling in Teitelman v. SAIF that a Worker Requested Medical Examination (WRME) can be based on a post-denial IME that was submitted into evidence by the insurer to bolster a denial. WRMEs are governed by ORS 656.325(1)(e) and OAR…
Normally Reasonable: Transferring Attending Providers in Washington Workers’ Compensation Claim
Claimant’s attending physician plays an important role in assisting claimant’s return to their job of injury. Their attentiveness and skill as a provider often dictate how efficiently a claim is processed. Many claims have one attending provider for the duration, however, there are some instances where claimant seeks treatment from…
In Oregon, Delay In Seeking Clarification From Attending Physician Regarding an IME, PCE, and Regular Work Release Can Result in Unreasonable Refusal to Close.
The Oregon Workers’ Compensation Board is holding carriers to a high standard when it comes to securing the evidence needed to rate impairment and work disability. The expectation is the carrier will arrange the closing examination, physical capacity evaluation and then ensure the attending physician provides a clear and unconditional…
OREGON: “Exclusive Remedy” win for employers/administrators/insurers at Oregon Court of Appeals
On April 10, 2024, the Oregon Court of Appeals issued a ruling reiterating the importance of the exclusive remedy clause under ORS 656.018. The case, Pierce v. Best Western Int., was litigated by Rebecca Watkins of SBH Legal. ORS 656.018 is the “exclusive remedy” clause for workers’ compensation claims in…
Oregon Board finds “going and coming” rule does not apply to worker crossing street to retrieve work clothes from her vehicle
A recent Oregon Workers’ Compensation Board case, In re Cambria Souza, 76 Van Natta 130 (2024), found a workers’ injury compensable where they were hurt crossing a public street to retrieve work clothing from their car. Cambria involved an Oregon restaurant server who parker her car in a public lot…
Navigating the Pitfalls of Oregon Workers’ Compensation. The Ins and Outs of Injury under a Combined Condition.
We are all familiar with the idea of a “compensable injury” in Oregon workers’ compensation law. A compensable injury is any injury sustained while performing work-related duties that results in a disability or the requirement for medical attention. However, this broad concept of an injury may be somewhat limited when…
Washington Significant Vocational Board Decisions
Two significant decisions regarding the vocational process were recently determined by the Board of Industrial Insurance Appeals. In re Michael Killpatrick BIIA Dec., 21 13384 (2023) clarified what qualifies as good cause for an interruption of a vocational plan. Mr. Killpatrick was in the process of going through vocational retraining…
Ordered to accept a new/omitted condition in Oregon? Combined condition processing remains a responsive option
On January 9, 2024, the Workers’ Compensation Board ruled in Maria F. Opferman, 76 Van Natta 10 (2024), that the employer’s post-litigation acceptance of a concussion combined with a preexisting condition was valid. Through prior litigation, an administrative law judge (ALJ) ordered the employer to accept a concussion. In lieu…
New Washington case provides limitations to Maphet
For self-insured employers in Washington, one of the most significant decisions in recent years was the Washington Court of Appeals’ 2019 opinion in Clark County v. Maphet. 10 Wn.App.2d 420 (2019). This decision was significant because it no longer allowed employers to authorize treatment for conditions that held no causal…
Flare-Ups, Aggravation, and Combined Conditions: When is Arthritis Compensable in Oregon workers’ compensation?
If a worker with longstanding cervical arthritis injures her neck while lifting a box at work, can the arthritis itself be a compensable condition under her workers’ compensation claim? In Oregon workers’ compensation law, arthritis is specifically listed as a pre-existing condition. Pre-existing conditions can be compensable only under certain…
Can a denial in Oregon based on an independent record review trigger entitlement to WRME?
Recently, the Oregon Workers’ Compensation Board confirmed that entitlement to a worker requested medical examination (WRME) is only triggered when the employer’s denial is based on an in-person IME with which an attending physician has not concurred. Michelle L. Knowlden, 75 Van Natta 505 (2023). In Knowlden, the claimant was…
What evidence is necessary to support a ceases denial in Oregon?
ORS 656.262(6)(c) authorizes an administrator to deny an accepted combined condition if the compensable injury ceases to be the major contributing cause of the combined condition. In such situations, the administrator has the burden to show the compensable injury is no longer the major contributing cause of the workers’ disability…
Acute Stomach Pain and the Sheepherder–Oregon Court of Appeals issues decision on course and scope
The Oregon Court of Appeals issued a non-precedential memorandum opinion on an interesting case recently involving a worker who experienced an acute medical condition, a burst appendix, but in a remote geographical area. This decision addresses the fact, regardless of the category of risk, claimant must still establish a causal…
Oregon Court of Appeals Rejects Claimant Argument to Expand Meaning of “Compensable Injury” for Purposes of Assigning Permanent Impairment
On June 7, 2023, the Oregon Court of Appeals issued its Opinion on Gramada v. SAIF, refusing to expand the meaning of the term “compensable injury” for the purposes of assigning permanent impairment. Gramada stems from an appeal of an Order on Reconsideration which affirmed the Notice of Closure on…
There’s a fee for that! The Oregon Court of Appeals authorized the award of attorney fees incurred while litigating the reasonableness of an attorney fee award.
In the case of Peabody v. SAIF, 326 Or App 132 (2023), the Oregon Court of Appeals addressed appeals brought by Ms. Peabody regarding entitlement to attorney fees. The Court of Appeals ultimately reversed the Oregon Workers’ Compensation Board’s decision denying the award of an attorney fee to claimant’s attorney…
Complexities with CRPS as a new/omitted condition, and positioning to win the battle in Oregon Workers’ Compensation
The cause of complex regional pain syndrome (CRPS) is not well understood. It is a form of chronic pain, usually affecting an arm or leg, and typically develops after an injury, surgery, stroke, or heart attack. A diagnosis of CRPS should include disproportionate pain symptoms compared the severity of the…
Washington’s Board of Industrial Insurance Appeals Limits Workers’ Ability to Add Occupational Disease Conditions to Industrial Injury Claims in Tentatively Significant Decision
In some Washington workers’ compensation cases, a significant hurdle can be determining whether a condition in a worker’s claim resulted from an industrial injury or an occupational disease. While this distinction may not have a large impact on the administration and outcome of every claim, it can cause a significant…
Washington Court of Appeals Issues New Decision Which Defines Reasonable Accommodations of Religious Beliefs – and Raises New Questions For Employers
The Washington Court of Appeals, Division 3, issued a decision on September 20, 2022 defining for the first time what is a “reasonable accommodation” of an employee’s religious practices under state law. In the recently published decision of Suarez v. State, the Court of Appeals adopted the federal definition that…
