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 an accepted claim for a lumbar strain. A medical arbiter examined claimant and concluded the lumbar strain had resolved, and as such they could not attribute any impairment to the lumbar strain. The medical arbiter assigned 100% of the loss found on exam to pre-existing degenerative conditions documented in claimant’s lumbar spine imaging studies.
At hearing, the ALJ affirmed the Reconsideration Order. Claimant requested Board Review, arguing she was entitled to PPD because SAIF did not issue a combined condition denial and because the medical arbiter attributed no impairment to the “accepted lumbar condition” rather than attributing no impairment to the “compensable injury.” The Board adopted and affirmed the ALJ’s Order, finding no error in the reconsideration process.
On appeal, claimant asserted entitlement to a PPD award, arguing the term “compensable injury” under ORS 656.214 “refers to more than just the accepted condition.” Gramada v. SAIF, 326 Or App 276, 280 (2023). Claimant contended a compensable injury refers to the “full measure of impairment in the injured body part regardless of whether the impairment is the result of the accepted conditions.” Id.
The Court analyzed the use of the terms and “accepted condition” and “compensable injury” within several Oregon Supreme Court decisions, including Garcia-Solis v. Farmers Ins. Co., Brown v. SAIF, Robinette v. SAIF, and Johnson v. SAIF. It also considered the processing requirements under ORS 656.268 and ORS 656.262.
The Court held a finding of permanent impairment requires two things: (1) a loss of use or function of the body part or system, and (2) that the loss is due to the compensable injury. Each loss of use or function must be considered separately, and a loss is “due to the compensable injury” when the accepted condition is found to be a material cause of the loss.
The Court concluded the medical arbiter’s findings of loss in this case were not considered impairment under ORS 656.214 because the record confirmed no part of claimant’s impairment was related to the accepted lumbar strain. Thus, claimant was not entitled to a permanent partial disability award.
Gramada is significant for reinforcing the rule that no impairment award is due if there is no loss of use or function caused in material part by the accepted condition. Nonetheless, in claims where there is preexisting pathology, there is some risk an arbiter can conclude there was combining and impairment a la Johnson v. SAIF, when no other expert has diagnosed a combined condition. Employers and TPAs should closely monitor all potential contributors to impairment as they process claims toward closure to ensure there are no surprises on reconsideration.
If you have any questions about compensability issues, combined conditions, or claim closure, please do not hesitate to contact me at or by telephone at (503) 595-6108.
Posted by Evan Novotny.
