Compensability of Medical Treatment in Oregon – Standard: Related in Material part to “Work Injury” or Directed to Accepted Conditions
In 2019 the Oregon Supreme Court determined that medical services under ORS 656.245 for an unclaimed, unaccepted condition can be the responsibility of a carrier if the medical services were due in material part to the work accident. Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019). This remains the standard but there are notable exceptions. In the recent Isa Dean case, Board Member Curry addresses one of the exceptions.
In Isa Dean the claimant contended her work as a Library program coordinator resulted in neck, shoulders, upper back, low back, hips, arms, and hand disability. Her claim was accepted for a lumbar strain and closed. Her claim was subject to a denial of several conditions: bilateral shoulder strains, segmental and somatic dysfunction of the cervical region, and sprain of right rotator cuff capsule. Nonetheless, claimant relied on the opinion of her treating provider, Dr. Perkins, to establish she is entitled to further chiropractic and massage treatments for cervicalgia/neck pain because the treatment arises from her compensable “work injury.”
The Board determined Dr. Perkins opinion was not persuasive because she relied on an unreliable history from claimant regarding prior medical treatment. Board Member Curey concurred, writing separately to distinguish the case from Garcia-Solis v. Farmers Ins. Co. She explained that the Supreme Court in Garcia-Solis determined that medical services under ORS 656.245 for an unclaimed, unaccepted condition can be the responsibility of a carrier if the medical services were due in material part to the work accident. Yet, because the disputed medical services in this case were derived from a condition that had already been denied, upheld by a previous ALJ’s decision, and affirmed by a final Board order, she found the case distinguishable.
The Isa Dean case is a good reminder there are limits to the broad compensability standard adopted by Garcia-Solis – treatment compensable if related to “work injury.” The Oregon Supreme Court did not create a loophole when the treatment is directed to conditions that have been claimed and denied by the employer.
If you have any further questions regarding this decision and its effects on your claim processing, or you have questions regarding any other Oregon workers’ compensation matters, please do not hesitate to contact me at 503-595-2136 or .
Posted by Stephen Verotsky.
