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In re Compensation of Akins

Court of Appeals of Oregon

June 7, 2017

In the Matter of the Compensation of Karlynn Jo Akins, Claimant.
v.
SAIF CORPORATION and City of Springfeld, Respondents. Karlynn Jo AKINS, Petitioner,

          Argued and Submitted October 27, 2016

         Workers' Compensation Board 1205958.

          Christopher D. Moore argued the cause and fled the briefs for petitioner.

          David L. Runner argued the cause and fled the brief for respondents.

          Before Ortega, Presiding Judge, and Egan, Judge, and Lagesen, Judge.

         Case Summary: Claimant seeks review of a final order of the Workers' Compensation Board. In that order, the board upheld insurer SAIF Corporation's denial of claimant's "new and omitted condition" claims, and upheld SAIF's denial of claimant's "combined condition" claim. Claimant argues that SAIF was required to accept her claimed omitted conditions under ORS 656.267, even if those conditions, as a factual matter, were included within the previously accepted condition, and that the board erred in concluding otherwise. Claimant also challenges the board's affirmance of SAIF's denial of claimant's "combined condition" claim on the ground that the previously accepted combined condition no longer remained compensable. Held: The legislature intended for ORS 656.267 to permit a workers' compensation claimant to obtain acceptance of conditions that were not included within the scope of an insurer's acceptance of the claimant's claim, and nothing in the text, context, or legislative history of ORS 656.267 supports claimant's argument that the legislature intended to require an insurer to reaccept and reprocess a condition that already has been accepted. Substantial evidence supports the board's decision to uphold SAIF's denial of claimant's "combined condition" claim.

         Affirmed.

          LAGESEN, J.

         Claimant petitions for review of a final order of the Workers' Compensation Board. In that order, the board upheld insurer SAIF Corporation's (1) denial of claimant's "new and omitted condition" claims, ORS 656.267; and (2) denial of claimant's "combined condition" claim, ORS 656.262(6)(c). We review under ORS 183.482(8) and ORS 656.298(7), and affirm for the reasons that follow.

         On February 8, 2012, claimant injured her left knee at work, and claimed workers' compensation benefits in connection with the injury. SAIF accepted the claim, designating the accepted condition as a "left knee sprain and contusion."[1] Later, SAIF modified its acceptance to accept a combined condition beginning on the date of claimant's workplace injury. SAIF identified the combined condition as the knee sprain and contusion that claimant suffered at work combined with claimant's preexisting medial compartmental left knee arthritis. SAIF subsequently denied the continued compensability of claimant's combined condition, finding that, as of September 14, 2012, claimant's accepted workplace injury was no longer the major contributing cause of claimant's combined left knee condition.

         After SAIF's initial acceptance of her claim, claimant initiated two "new or omitted condition" claims under ORS 656.267. Claimant requested that SAIF accept the condition of "unicompartmental arthritis" and also a condition that was "a combination between what has been diagnosed as preexisting arthritis in [claimant's] left knee with the injury event of February 8, 2012." SAIF denied both of claimant's "new or omitted condition" claims.

         Claimant requested a hearing on the denials before an administrative law judge (ALJ), and the ALJ affirmed. Claimant then sought review before the board, which affirmed the ALJ's order. The board unanimously concluded that SAIF properly denied claimant's "new and omitted" condition claims, finding that "the record does not persuasively establish that" the conditions for which claimant sought acceptance were "separate and distinct" from the combined condition that SAIF already had accepted. A majority of the board, over one board member's dissent, also found that claimant's workplace injury ceased to be the major contributing cause of claimant's current combined condition as of September 14, 2012, and, therefore, that SAIF properly denied the continued compensability of claimant's combined condition after that date. The dissenting board member would have reached a different result, explaining that she found the medical opinions on which the majority relied unpersuasive, in part because the doctors who rendered those opinions appeared to evaluate claimant's condition in a manner that was contrary to our decision in Brown v. SAIF. 262 Or.App. 640, 325 P.3d 834 (2014), reversed. 361 Or. 241, 391 P.3d 773 (2017) (Brown I).

         Claimant seeks judicial review. In her first assignment of error, claimant challenges the board's determination that SAIF properly denied her "new or omitted condition" claims. In her second assignment of error, she challenges the board's finding that her workplace knee injury ceased to be the major contributing cause of her combined condition as of September 14, 2012. We address claimant's arguments in turn.

         ORS 656.267[2] governs claimant's "new and omitted condition" claims. By its terms, the statute provides a mechanism for a workers' compensation claimant to seek acceptance of conditions that are not included within the scope of an insurer's acceptance of the claimant's claim, which must "[s]pecify what conditions are compensable." ORS 656.262(6)(b)(A). Here, the board found that the conditions for which claimant sought acceptance in her "new and omitted condition" claims were included within the scope of the combined condition that SAIF already had accepted. Thus, the board concluded, SAIF properly denied claimant's claims under ...


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