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 processing an injury under a combined condition. A combined condition analysis necessitating a major contributing cause standard is an essential armor in an employer/insurer/administrator’s arsenal.
Recent Oregon case law has limited the scope of what constitutes an injury for combined condition. These limitations have complicated claim processing under combined condition and created a pitfall that, if not properly/correctly managed, might expose employer/insurer/administrator to penalties, cost and attorney fees.
So, what is classified as an injury under combined condition? And how does one avoid wrongly processing a claim under combined conditions? The Court addressed this question in several cases, narrowing the scope of an injury in every instance. In these three cases—Carrillo, Gibson, and Brown—the court addressed an acceptable injury for combined condition processing.
An injury under a combined condition must be a separate, distinct injury from the preexisting condition resulting from the work activity. Therefore, symptoms of a preexisting condition, the worsening of a preexisting condition, or work activity itself cannot combine with the preexisting condition. In Carrillo v. SAIF Corp., 291 Or. App. 589 (2018), the claimant experienced pain symptoms of his preexisting shoulder injury after a day of heavy lifting. SAIF denied the claim, asserting that the work injury had combined with preexisting conditions and was not the major contributing cause of the combined condition. The court concluded that SAIF could not process and deny the condition as a combined condition because there was no new injury in the first place to combine with the preexisting condition. The court ruled the condition is only an aggravation of a preexisting condition in which case a material contributing cause analysis was required.
Similarly, in Brown v. SAIF 361 Or. 241 (2017), where a lumbar strain was found to have combined with a preexisting degenerative back condition. The question before the court was what constituted “compensable injury” that may combine with preexisting condition? The Oregon Supreme Court ruled, for the purpose of combined condition, preexisting conditions combine with an accepted condition and not other conditions that may conceivably have resulted from the same work-related accident. Again, separating the injury itself from the work activity. The court also ruled in Gibson v. ESIS, 316 Or. App. 703 (2022) that symptoms of a preexisting condition, the worsening of a preexisting condition, or an incident itself, are not distinct conditions which may combine with a preexisting condition to give rise to a combined condition within the meaning of ORS 656.005(7)(a)(B). In Gibson, the Board, in upholding employer’s denial of osteoarthritis ruled that claimant’s preexisting condition combined with claimant’s accepted knee strain condition and was the major contributing cause of claimant’s need for treatment. Ultimately, the Oregon Court of Appeal in overruling the Board found that “symptoms of a preexisting condition triggered by a workplace incident cannot constitute a medical condition separate from the preexisting condition.”
These rulings make it a lot more daunting to process claims under a combined condition due to the distinctions in what injuries can combined with a preexisting condition. Sometimes there may be overlap in what constitutes a separate distinct injury or a mere symptom/aggravation of the preexisting conditions. These differences change a lot in claim processing as it may determine if the claim would be subjected to major contributing cause analysis or material contributing cause analysis which as we know goes a long way in determining the compensability of a claim. Therefore, an in-depth medical opinion on the specific causation of the work injury must be generated to determine if the condition is a separate medical condition distinct from symptoms of a preexisting condition. Furthermore, employer/insurer/administrator must provide reasoning for the conclusion that the condition is a separate medical condition to avoid exposure to penalties, cost, and attorney fee for unreasonable claim processing.
If you have any questions regarding the Injury under Combined Condition in Oregon, please do not hesitate to contact me at or 503-776-5423.
Posted by Dee Akinbosade.
