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 of the nature of the compensable conditions.
After an Oregon claim has been accepted, the worker can request for the scope of acceptance to be expanded to include new or omitted conditions related to their initial injury or occupational disease. ORS 656.267(1). A condition is “new” if it arose after acceptance of an initial claim, was related to an initial claim, and involved a condition other than the condition initially accepted. Mark A. Baker, 50 Van Natta 233 (1998). A condition is “omitted” if it arose at the time the claim was accepted but not included (omitted) in the Notice of Acceptance. Johansen v. SAIF, 158 Or App 672, 679 (1999).
A new or omitted medical condition claim may be denied if the condition has already been accepted. Akins v. SAIF, 286 Or App 70, 73-74, rev den (2017). Whether a claimed new or omitted condition is distinct from the accepted condition is a question of fact, the resolution of which depends on the medical evidence in the record. See DeBoard v. Fred Meyer, 285 Or App 732, 737 (2017).
A claim’s acceptance does not need to specify every applicable medical diagnosis or condition as long as it reasonably apprises claimant and their medical providers of the nature of the compensable conditions accepted under the claim. Greg H. Westphal, 69 Van Natta 1693, 1694 (2017); ORS 656.267(1).
In Stringer, claimant requested “status post right total ankle arthroplasty and status post right calcaneal osteotomy” to be accepted under the claim. SAIF accepted numerous conditions under this claim, including traumatic arthritis of the right ankle, traumatic arthritis of the right foot, right tibiotalar arthritis, right subtalar arthritis, right calcaneocuboid joint arthritis, right talonavicular joint arthritis, and right calcaneus fracture.
The medical providers disagreed on whether the nature of the requested “status post right total ankle arthroplasty and status post right calcaneal osteotomy” qualified them as procedures or conditions. The Board found the requested “status post right total ankle arthroplasty and status post right calcaneal osteotomy” were conditions. Both requested conditions were encompassed in the previously accepted arthritis and fracture conditions.
Regardless of this distinction, the medical providers agreed the absence of the requested conditions would not hinder the understanding of the nature and treatments of the accepted conditions. Further, the requested conditions were redundant in light of the arthritic conditions already accepted under this claim. Because the requested conditions were encompassed in the accepted conditions, they could not qualify as “new” or “omitted.”
The carrier did not deny the causal relationship between the requested conditions and the work injury. Rather, the denial was appropriate because the conditions were redundant and addressed within the context of an already accepted conditions. Stringer providers an avenue to deny solely on the basis of a requested condition being encompassed or subsumed in a previously accepted condition under the same claim. This distinction offers clarifications of the avenue to deny requests for new/omitted conditions that are unnecessary and duplicative without disputing their compensability.
If you have questions about this matter or encompassed conditions in Oregon, please contact me at or 503-776-5434.
Posted by Hayley Porter.
