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Saif Corp. v. Ross12/10/2003
Argued and submitted July 30, 2003.
Affirmed.
The Director of the Department of Consumer and Business Services (director) issued an order requiring petitioner SAIF Corporation (SAIF) to pay for claimant's chiropractic treatment, concluding that claimant had provided SAIF with an adequate treatment plan even though different components of the plan came to SAIF in separate documents. SAIF seeks judicial review, arguing that the relevant rule requires a plan submitted in a single document signed by claimant's treating physician. We review the interpretation of an agency rule for legal error, ORS 183.482(8)(a), but we defer to an agency's interpretation of its own rule if that interpretation is plausible and is not inconsistent with the rule's wording, its context, or any other source of law. Don't Waste Oregon Com. v. Energy Facility Siting, 320 Or 132, 142, 881 P2d 119 (1994). We conclude that the director's interpretation meets that standard; we therefore affirm.
A covered worker who suffers from a compensable condition that renders the worker permanently and totally disabled is entitled to reimbursable medical services required to treat that compensable condition even after the worker is medically stationary. ORS 656.245(1)(c)(A). Those services may be provided by a medical service provider who is not the claimant's attending physician if the following requirements, set out in former OAR 436-010-0230(3)(a) (1999), renumbered as OAR 436-010-0280(4)(a) (2001), are met:
" ervices * * * by a medical service provider other than the attending physician shall not be reimbursed unless carried out under a written treatment plan prescribed * * * and approved by the attending physician * * *. The treatment plan shall include objectives, modalities, frequency of treatment and duration. The treatment plan may be recorded in any legible format including, but not limited to, signed chart notes. A copy of the signed treatment plan shall be provided to the insurer by the attending physician * * *. A chiropractor is a "medical service provider" for purposes of this rule. Former OAR 436-010-0230(3)(b), renumbered as OAR 436-010-0230(4)(b) (2001). The dispute in this case is whether SAIF received a treatment plan in some "legible format," "signed by the attending physician," and including "objectives, modalities, frequency of treatment and duration."
The following undisputed facts are taken from the director's final order, which accepted, with supplementation, facts found by an administrative law judge (ALJ) after SAIF sought review of an administrative decision. Claimant suffered a work-related back injury in 1983 and was declared permanently and totally disabled in 1987. He moved to Arizona where, in 1992, he began chiropractic treatment on a twice-monthly basis with Dr. Watts. SAIF paid for these treatments until November 1999. Then, for reasons not apparent from the record, SAIF sent a letter to Watts requesting a description of claimant's treatment plan. At the same time, SAIF sent claimant's attending physician, Dr. Lindow, a letter containing a summary of Oregon workers' compensation regulations that Lindow had to follow and stating that chiropractic treatment would be reimbursed only if Lindow provided a written treatment plan. The letter did not outline the specific requirements of former OAR 436-010-0230(3)(a). That information reached Lindow in a February 15 letter from SAIF informing him that, "If Chiropractic treatment is to be continued as part of your treatment plan, please indicate specifically for which condition(s) the treatment is to be provided and provide a treatment plan which includes; specific modalities, frequency, duration, the anticipated goal(s)
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