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In re Compensation of Stockdale2/25/2004
Argued and submitted December 15, 2003.
Affirmed
Claimant seeks review of an order of the Workers' Compensation Board (board) upholding the denial of the compensability of her combined condition. This case requires us to determine whether, consistently with ORS 656.262(6)(c), an employer or insurer may issue a single letter to notify a claimant that it is both accepting and denying compensation for a combined condition. We conclude that such a letter is not prohibited by ORS 656.262(6)(c) provided that the effective date of the denial of the condition is later than the effective date of acceptance of the condition. Because SAIF's letter in this case satisfied that criterion, we affirm.
In June 2000, claimant suffered a low back injury while working for Marquis, her employer. She submitted a claim for workers' compensation benefits soon thereafter. SAIF, on employer's behalf, accepted the claim as a nondisabling lumbosacral strain in August 2000. In September 2000, an MRI revealed that claimant had "desiccated" intervertebral discs, as well as an "annular bulge" and subannular fissures. In June 2001, claimant underwent an insurer medical examination (IME) by Dr. Bergquist, who diagnosed claimant's condition as chronic low back pain secondary to degenerative disc disease. The next month, SAIF sent claimant a letter informing her that it had accepted her injury as a combined condition (specifically, lumbosacral strain combined with degenerative disc disease) effective August 29, 2000. In a later paragraph of the same letter, SAIF denied the compensability of the combined condition as of the date of the IME, June 13, 2001, on the ground that, as of that date, claimant's lumbosacral strain was no longer the major contributing cause of her need for treatment. Claimant appealed the denial, asserting, among other things, that SAIF's denial of compensability in the June 2001 letter was procedurally invalid under ORS 656.262(6)(c). An administrative law judge (ALJ) upheld the denial, and claimant appealed to the board, which affirmed the ALJ's decision.
On review, we are presented with the narrow question of whether ORS 656.262(6)(c) precludes an employer or insurer from denying the compensability of a combined condition in the same letter in which it accepts that condition. That presents a question of statutory interpretation, which we review for errors of law. ORS 183.482(8).
ORS 656.262(6)(c) provides:
"An insurer's or self-insured employer's acceptance of a combined or consequential condition under ORS 656.005(7), whether voluntary or as a result of a judgment or order, shall not preclude the insurer or self-insured employer from later denying the combined or consequential condition if the otherwise compensable injury ceases to be the major contributing cause of the combined or consequential condition."
(Emphasis added.) The emphasized word in that statute--"later"--is the source of claimant's argument. She asserts that, by including that word, the legislature intended that "acceptance and denial of combined condition cannot occur simultaneously," and that, by including notice of both acceptance and denial in a single letter, SAIF did just that. Therefore, she argues, the board erred in upholding the denial. In response, SAIF and employer argue that the statute was "intended merely to make clear that acceptance of a combined condition would have no preclusive effect on denial of that condition once the compensable injury was no longer the major contributing cause of the combined condition" and that the board properly upheld the denial.
To interpret ORS 656.262(6)(c), we turn to the template of PGE v. Bureau of La
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