Was that Oregon Claim Closure Unreasonable?
The Court of Appeals issued an important decision which addressed in part an employer’s reliance upon an attending physician’s repeated determinations of medically stationary status when issuing a notice of closure.
An insurer must close an Oregon Workers’ Compensation claim when a worker is medically stationary. OAR 436-030-0020(1). Proper notice of claim closure is accomplished with a Notice of Closure sent to the worker and their attorney, if represented.
A worker has the right to request reconsideration of a Notice of Closure. The Appellate Review Unit (ARU) will review the Notice of Closure to determine whether closure was appropriate. The ARU’s review includes but is not limited to medically stationary status and date, temporary disability benefits, and permanent impairment rating. Following their review, the ARU will issue an Order on Reconsideration with their decision, either affirming, modifying, or rescinding the Notice of Closure. When an Order on Reconsideration rescinds the Notice of Closure due to premature closure, sometimes a worker may request a hearing for unreasonable claim closure. Pursuant to ORS 656.268(5)(f), a penalty will be assessed if a finding is made that the notice of closure was not reasonable.
In SAIF v. Krusenstjerna, 346 Or App 429 (2026), claimant believed claim closure was unreasonable as the ARU concluded the claim was closed prematurely and rescinded the Notice of Closure. This decision was based on the attending physician’s opinions and chart notes. Specifically, the ARU found it was unclear claimant was medically stationary at the time of closure based on the attending physician’s observations that claimant’s impairment may improve over time. Claimant requested a hearing for unreasonable claim closure. The ALJ agreed SAIF’s closure was unreasonable since the record was unclear as to whether claimant was medically stationary at the time of closure. The board agreed with claimant and affirmed the order. However, SAIF contended closure was not unreasonable as supported by substantial evidence and substantial reason.
The Court of Appeals explained when assessing reasonableness, “the board must consider the information that was available to the insurer at the time that it issued the notice of closure and whether it reasonably believed that conditions appropriate for closure existed at that time.” Brooks v. Tube Specialties – TCSO International, 300 Or App 361, 366, 455 P3d 938 (2019), rev den, 366 Or 257 (2020). Although claimant’s attending physician believed claimant may improve over time, the attending physician also repeatedly declared claimant was medically stationary. The Court of Appeals concluded a reasonable factfinder could deduce SAIF did have a legitimate doubt about its liability because SAIF believed the attending physician’s statements of claimant possibly experiencing an improvement did not negate the attending physician’s repeated statements of finding claimant medically stationary. Additionally, the Court of Appeals found if the information available to SAIF about claimant’s medically stationary status at the time of closure was capable of more than one reasonable interpretation, and SAIF picked one of those reasonable interpretations, SAIF’s interpretation should not be deemed unreasonable.
Although the ARU may rescind a claim closure, it does not necessarily mean claim closure was unreasonable. SAIF v. Krusenstjerna, helps determine when claim closure is reasonable. Closing a claim and determining whether it was reasonable, is very fact specific.
If you have questions regarding how to ensure claim closure is reasonable, feel free to contact me at or 503-776-5421.
Posted by Daisha Barnes.
