FILED: April 28, 1999
In the Matter of the Compensation of
Joni M. Varah, Claimant.
SAIF CORPORATION and FAIRVIEW
TRAINING CENTER,
Petitioners,
v.
JONI M. VARAH,
Respondent.
Judicial Review from Workers' Compensation Board.
Argued and submitted January 21, 1999.
Steve Cotton, Special Assistant Attorney General, argued the cause for petitioners. With him on the brief were Hardy Myers, Attorney General, and Michael D. Reynolds, Solicitor General.
Dale C. Johnson filed the brief for respondent.
Before De Muniz, Presiding Judge, and Haselton and Linder, Judges.
HASELTON, J.
Reversed and remanded.
HASELTON, J.
Petitioners, an employer and its insurer, seek reversal of an order of the Workers' Compensation Board that awarded claimant assessed attorney fees pursuant to ORS 656.386(1)(a) and (c). They contend that the Board erred in concluding that the original notice of acceptance of claimant's claim was, in fact, a denial and that the insurer's subsequent modification of that notice constituted a "rescission of the denial." ORS 656.386(1)(a). We reverse and remand.
In April 1997, claimant, who was employed as a habilitive training technician, suffered a compensable injury while lifting a client. Claimant subsequently filed a Report of Occupational Injury or Disease and received medical treatment for what was ultimately diagnosed as "[t]horacolumbar muscular back strain relating to lifting activities * * * resolved stationary without impairment." On July 14, 1997, the insurer, SAIF Corporation, issued a Notice of Acceptance, accepting a "thoracolumbar muscular back strain, resolved." (Emphasis added.) On August 5, 1997, claimant filed a request for hearing, describing the issue as "Improper prospective denial (see Notice of Claim Acceptance dated 7/14/97 alleging that accepted claim is resolved)." On August 27, 1997, before any hearing, SAIF issued a Modified Notice of Acceptance, accepting a "thoracolumbar muscular back strain"--i.e., the modified notice deleted the term "resolved."(1)
Claimant then sought an assessed attorney fee pursuant to ORS 656.386(1),
which provides, in part:
"(b) For purposes of this section, a 'denied claim' is:
"(A) A claim for compensation which an insurer or self-insured
employer refuses to pay on the express ground that the injury or condition
for which compensation is claimed is not compensable or otherwise does
not give rise to an entitlement to any compensation;
"* * * * *
"(c) A denied claim shall not be presumed or implied from an
insurer's or self-insured employer's failure to pay compensation for a
previously accepted injury or condition in timely fashion. Attorney fees
provided for in this subsection shall be paid by the insurer or self-insured
employer."(2) Claimant contended that, because of SAIF's use of the term "resolved" in the original
notice of acceptance, that notice was, in fact, a denial and not an acceptance and that
SAIF's deletion of "resolved" in the modified notice effected a "rescission of the denial
prior to a decision by the Administrative Law Judge." ORS 656.386(1)(a).
The administrative law judge rejected that argument, reasoning that, even if
SAIF's use of "resolved" "impl[ied] that future responsibility might be denied," such an
"implication" was insufficient to trigger ORS 656.386(1)(a). An en banc majority of the
Workers' Compensation Board disagreed and concluded that claimant was entitled to an
assessed fee. The essence of the Board's holding, which invoked Galbraith v. L.A.
Pottsratz Construction, 152 Or App 790, 955 P2d 319 (1998), was that, although "SAIF
did not literally state that claimant was entitled to no relief * * * its acceptance of a
'resolved' condition * * * constitutes a denial of further benefits under the claim." The
Board majority observed:
Two members of the Board dissented:
On review, SAIF relies primarily on the Board dissent's reasoning,
contending that the inclusion of "resolved" in the original notice of acceptance did not
give rise to a "denied claim" within the meaning of ORS 656.386(1). We agree.
In Stephenson v. Meyer, 150 Or App 300, 945 P2d 1114 (1997), we held
that, before a claimant can recover an assessed fee under ORS 656.386(1), three
conditions must be met:
Under the statute, there is no "denied claim" unless the employer "refuses to pay on the
express ground that the injury or condition * * * is not compensable." ORS 656.386(1).
Here, there was no express refusal to pay compensation. At most, the use
of "resolved" in the original notice of acceptance implied that SAIF might refuse to pay
future benefits for claimant's condition. The Board majority acknowledged as much:
"[A]cceptance of a 'resolved' condition carries the implication that claimant is no longer
entitled to relief for her compensable condition."(3) (Emphasis added.) Such an
"implication" is not "express" and, thus, does not trigger the statutory entitlement to an
assessed fee.
Galbraith, on which the Board majority relied, is materially factually
distinguishable. There, in responding to the claimant's hearing request, SAIF stated,
"The claimant is entitled to no relief." In concluding that the claimant was entitled to
attorney fees, we emphasized that language and concluded, "We are at a loss to
understand how SAIF's statement can be understood as anything but an express denial of
the claim" for purposes of ORS 656.386(1). 152 Or App at 793-94 (emphasis in
original). Thus, Galbraith turned on an explicit denial. In this case, "resolved"
connotated, at most, an implicit denial of future benefits.
The Board erred in awarding claimant attorney fees under ORS
656.386(1).(4)
Reversed and remanded.
"* * *In such cases involving denied claims where an attorney is
instrumental in obtaining a rescission of the denial prior to a decision by
the Administrative Law Judge, a reasonable attorney fee shall be allowed.
"Because it is well settled that the term 'resolved' carries with it the
connotation of a denial of future claims for benefits, its inclusion in an
'acceptance' essentially represents a notice to the injured worker
discouraging him/her from seeking further benefits for their 'resolved'
condition. To find that the removal of the word 'resolved' from a carrier's
acceptance does not warrant an attorney fee under ORS 656.386(1) for
finally prevailing over a 'denied claim' would also mean that there are no
consequences for the carrier's acceptance of a 'resolved' condition. * * *
[A]cceptance of a 'resolved' condition carries the implication that claimant
is no longer entitled to relief for her compensable condition."
"In light of the legislature's requirement [in the 1995 amendments to
ORS 656.386(1)] that a 'denied claim' involve a refusal to pay
compensation on the 'express ground' that an injury or condition is not
compensable or otherwise does not give rise to an entitlement to any
compensation, it seems clear that the concept of an implied denial of future
benefits * * * did not survive the 1995 legislative amendments."
"(1) [T]here is a request for compensation; (2) the request for
compensation is denied; and (3) the claimant prevails finally against the
refusal to pay compensation as requested." 150 Or App at 304.
1. The parties stipulated that all compensation was paid--that is, the use of "resolved" in the original Notice of Acceptance did not result in any staying or nonpayment of compensation.
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2. The quoted language was, for the most part, originally enacted as part of the 1995 amendments to ORS 656.386. Or Laws 1995, ch 332, § 43. In 1997, the legislature modified the structure and numbering of subsections within ORS 656.386(1) but did not alter the substance of the quoted provision. Or Laws 1997, ch 605, § 3.
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3. Indeed, the Board majority relied substantially on Board precedent that held that the term "resolved" implied that the carrier was no longer responsible for the future benefits for claimant's condition. Gary L. Best, 46 Van Natta 1694 (1994). That authority antedated the 1995 amendments to ORS 656.386(1), including the statutory definition of "denied claim," which is central to our analysis.
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4. Our disposition obviates any need to address petitioners' other assignment of error, which asserts that the Board, in awarding fees, failed to comply with the dictates of Schoch v. Leupold & Stevens, 325 Or 112, 934 P2d 410 (1997).
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