FILED: March 3, 1999
IN THE COURT OF APPEALS OF THE STATE OF OREGON
In the Matter of the Compensation of
Joe M. Mann, Claimant.
LABOR READY, INC.,
Petitioner,
v.
JOE M. MANN,
Respondent.
(WCB 96-01194; CA A100900)
Judicial Review from Workers' Compensation Board.
Argued and submitted September 25, 1998.
Wade R. Keenon argued the cause for petitioner. On the brief was Patrick D. Gilroy.
Floyd H. Shebley argued the cause and filed the brief for respondent.
Before De Muniz, Presiding Judge, and Haselton and Linder, Judges.
LINDER, J.
Reversed and remanded for an award of interim compensation beginning the 14th day after employer received claimant's attorney's letter of September 26, 1996.
LINDER, J.
Employer seeks review of a unanimous en banc order of the Workers' Compensation Board (Board) holding that employer had a duty to pay interim compensation to claimant pending acceptance or denial of claimant's claim for a "new medical condition." We agree with the Board that claimant was entitled to interim compensation pending acceptance or denial of his claim. We conclude, however, that the new medical condition claim was made on September 26, 1996, by a letter from claimant's attorney, rather than on August 8, 1996, in a telephone conversation between claimant's physician and employer's insurer. Accordingly, we reverse the Board in part and remand the case for an award of interim compensation beginning the 14th day after employer received the September 26, 1996 letter.
Claimant was injured at work in January 1995, when he fell from a roof.
Employer accepted a claim for rib fractures, finger dislocation, and a closed head injury.
Claimant was declared medically stationary in July 1995, and the claim was closed by a
determination order on September 8, 1995, with an award of temporary total disability
(TTD) benefits. The determination order was affirmed in an order on reconsideration,
and claimant did not seek a hearing.
After claim closure, claimant was hospitalized for a seizure. On
December 20, 1995, employer denied a claim for a seizure disorder.(1) Subsequently,
claimant was diagnosed with post-traumatic headaches and post-traumatic vestibular
dysfunction. On August 8, 1996, claimant's attending physician, Dr. So, had a telephone
conversation with employer's attorney and advised the attorney that claimant's post-traumatic headaches and post-traumatic vestibular dysfunction were related to the
accepted closed head injury and that claimant would be unable to return to work pending
therapy over the next 12 months. In a letter dated September 26, 1996,(2) claimant's
attorney requested that employer "correct" its acceptance notice to include post-traumatic headaches and post-traumatic vestibular dysfunction. The parties agreed to
process the September 26 letter as a "new medical condition claim." Claimant also filed a
claim for aggravation. Employer has neither accepted nor denied the compensability of
claimant's headache and vestibular disorders and has not paid interim compensation
pending its decision to accept or deny the newly diagnosed conditions. The question for
our review is whether employer had a duty to begin paying interim compensation. We
conclude that it did and that its obligation to do so was triggered by claimant's attorney's
letter of September 26, 1996.
The parties agree that claimant's claim is to be treated as a claim for a "new
medical condition" under ORS 656.262(7)(a), as distinct from a claim for aggravation or
an initial claim for compensation. In Johansen v. SAIF, ___ Or App ___, ___ P2d ___
(decided this date), we rejected the insurer's contention that a new medical condition claim
has no existence independent of the original claim and does not give rise to a processing
obligation independent of the original claim. With that background in mind, we consider
employer's contention that the Board erred in holding that an employer must pay interim
compensation pending its acceptance or denial of a claim for a new medical condition.
Employer asserts that, because ORS 656.262(7) does not specifically provide
for the payment of TTD or interim compensation on a claim for a new medical condition,
no such compensation is applicable. We reject that contention. As we held in Johansen,
the duty to pay benefits for TTD on a new medical condition claim, although not expressly
referred to in ORS 656.262(7), is encompassed within ORS 656.262(4)(a), which provides:
When a claim has neither been accepted nor denied, the benefits for temporary disability
that the employer must begin to pay no later than the 14th day after notice of the claim
are known as "interim compensation." Jones v. Emanuel Hospital, 280 Or 147, 570 P2d 70
(1977). The statutory language provides no basis to exclude the new medical condition
claim from the requirement that interim compensation must be paid on a claim pending
acceptance or denial.
The parties agree that claimant's attorney's letter of September 26, 1996, satisfied
the requirements of ORS 656.262(7)(a) for a claim for a new medical condition.
Employer's receipt of the letter triggered employer's obligation to pay interim
compensation pending acceptance or denial of the claim.
We reject claimant's contention and the Board's holding that employer's telephone
conversation with claimant's treating physician on August 8, 1996, constituted a claim for
a new medical condition. Even assuming that the conversation constituted a claim under
ORS 656.005(6), it did not satisfy the requirement for a claim for a new medical condition
under ORS 656.262(7)(a) by providing notice of the new medical condition and clearly
requesting acceptance of it. The September 26, 1996 letter, however, adequately did so.
Claimant's entitlement to interim compensation, therefore, began no later than the 14th
day after employer received claimant's attorney's letter of September 26, 1996.
Employer misreads the Board's order to hold that whether claimant is entitled to
interim compensation depends on whether ORS 656.262(7)(c) requires the reopening of an
original claim upon the making of a new medical condition claim. As enacted by the
legislature in 1997, ORS 656.262(7)(c) provides:
We disagree that the emphasized language of ORS 656.262(7)(c) has any bearing on
whether interim compensation must be paid pending acceptance or denial of a new
medical condition claim. We reiterate that employer's obligation to pay interim
compensation was triggered by the filing of a claim, after closure of the original claim, for
which time loss was authorized under ORS 656.262(4)(a).
Reversed and remanded for an award of interim compensation beginning the 14th
day after employer received claimant's attorney's letter of September 26, 1996.
"The first installment of temporary disability compensation shall be
paid no later than the 14th day after the subject employer has notice or
knowledge of the claim, if the attending physician authorizes the payment of
temporary disability compensation."
"When an insurer or self-insured employer determines that the claim
qualifies for claim closure, the insurer or self-insured employer shall issue at
claim closure an updated notice of acceptance that specifies which conditions
are compensable. * * * Any objections to the updated notice or appeal of
denied conditions shall not delay claim closure pursuant to ORS 656.268. If a
condition is found compensable after claim closure, the insurer or self-insured
employer shall reopen the claim for processing regarding that condition."
(Emphasis added.)
1. That claim is not a part of this proceeding.
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2. ORS 656.262(6)(d), enacted in 1995, requires the claimant to provide to the employer written communication regarding objections that "a condition has been incorrectly omitted from a notice of acceptance, or that the notice is otherwise deficient."
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