What does the word “injury” mean in Oregon workers’ compensation law?
The definitions section of ORS 656 defines a “compensable injury” as an accident injury arising out of and in the course of employment requiring medical services or resulting in disability or death. This seems simple enough, and a reasonable person might conclude the word “injury” will mean the incident throughout the workers’ compensation chapter. Unfortunately, processing an “injury” is not so simple.
The word can mean various things at various times, including the inciting incident and the accepted condition in a compensable claim. The Board recently issued a decision clarifying what it means for an “injury” to combine with a pre-existing condition and create a combined condition.
If a worker establishes a condition was materially caused by a work “injury” (here meaning an incident), the condition is compensable. But under ORS 656.005(7), an employer can shift the burden back to the worker to establish the work injury was the major cause if the “otherwise compensable injury” combined with a pre-existing condition.
In Amanda C. Roberts, 74 Van Natta 607 (2022), the Board clarified earlier case law indicating the “otherwise compensable injury” refers to the accepted condition under a claim, not the inciting event. The Board held the examining physician’s diagnosis of a combining of the “incident” with “pre-existing rheumatoid arthritis, fibromyalgia, depression, and anxiety” was insufficient to establish a pre-existing condition. Because the accepted conditions included hip and shoulder contusions, the physician would have needed to diagnose a combining of the shoulder contusions with the pre-existing conditions, rather than a combining of the incident with the conditions.
So, if an “otherwise compensable injury” really means the accepted conditions, is it safe to assume this definition holds in other parts of the workers’ compensation chapter? The Oregon Supreme Court previously provided a definitive “no” to this question. In Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019), the Court held the term injury had two different meaning within one sentence of ORS 656.245. The Court determined the first use of “injury” in the statute required employers to provide medical services directed at a compensable incident, even for conditions not yet accepted, while the second use of “injury” determining duration of treatment referred to the accepted conditions.
With this confusing mix of definitions, there are a few principals to keep in mind which can help to avoid penalties. First, just knowing the word “injury” is used inconsistently throughout the statute can help to slow down and consider the meaning in any particular phrase. Second, the Amanda C. Roberts decision is a helpful reminder that the Board has consistently defined “injury” as the accepted condition in combined condition cases, permanent impairment uses, and generally where the term is used to define the types of disability benefits which can be awarded or apportioned. Thirdly, the Garcia-Solis case is a good reminder that disability benefits and medical benefits are treated differently, and the term “injury” can be used in different ways depending on which type of benefit is being considered.
Claims processing can be difficult even when terms are clearly defined and consistently used. When a word as important in the statutes as “injury” is inconsistently used, the risk of processing penalties is raised. If you have any questions about what benefits might be due a worker or what the use of the term means in any particular context, please feel free to reach out to me at or 971-867-2718.
Posted by Matthew Baker.
