FILED: February 11, 1998
In the Matter of the Compensation
of Morris B. Grover, Claimant.
SAIF CORPORATION and G & S MASONRY,
Petitioners,
v.
MORRIS B. GROVER,
Respondent.
Judicial Review from Workers' Compensation Board.
Argued and submitted July 9, 1997.
Michael O. Whitty argued the cause and filed the brief for petitioners.
Dale C. Johnson argued the cause for respondent. With him on the brief was Malagon, Moore, Johnson & Jensen.
Before Warren, Presiding Judge, and Edmonds and Armstrong, Judges.
ARMSTRONG, J.
Reversed.
ARMSTRONG, J.
SAIF seeks review of an own-motion order of the Workers' Compensation
Board. See ORS 656.278(1)(a). In that order, the Board concluded that claimant was
entitled to temporary total disability (TTD) benefits from SAIF for the time in which he
was hospitalized for back surgery, even though at that time he was receiving permanent
total disability (PTD) benefits from another carrier. We conclude that a worker who is
permanently totally disabled and receiving payments for that disability cannot at the same
time be temporarily totally disabled. Accordingly, we reverse the Board's order.
Before he became disabled, claimant was self-employed as a mason.(1) In
1988, he began receiving PTD benefits when the Board determined that a combination of
knee and back injuries so incapacitated him that he could not regularly perform work at a
gainful and suitable occupation. ORS 656.206(1)(a). Claimant's knee injuries first had
been accepted as compensable by EBI Companies in 1979, and claimant received an
award of 10 percent permanent partial disability for those injuries. In 1980, claimant
injured his back and, in 1982, submitted a claim to SAIF, the current insurer. SAIF
accepted the claim and claimant was awarded an additional 25 percent permanent partial
disability. Claimant appealed that award, contending that he was entitled to permanent
total disability. Between 1982 and 1984, while his appeal on the back injury claim was
pending, claimant had knee surgery. The claim with EBI for claimant's knee injuries
was reopened, and the permanent partial disability award for his knees was raised to 40
percent for the right knee and 45 percent for the left. Claimant appealed that ruling as
well, again contending that he was entitled to permanent total disability. The appeals
were consolidated and, after a review by this court, claimant was awarded PTD. In that
opinion, we stated:
EBI Companies v. Grover, 90 Or App 524, 526, 752 P2d 1274, rev den 306 Or 155
(1988) (citation omitted; emphasis supplied).
In 1996, claimant was hospitalized for back surgery at three spinal vertebrae
levels; he submitted a claim to SAIF for that surgery. SAIF issued a partial denial in
which it agreed to pay the medical expenses only for the treatment at one level.(2)
Claimant also submitted a claim for TTD, to be paid by SAIF, for the time spent in
surgery and recovery. SAIF submitted a "Carrier's Own Motion Recommendation" to
the Board, in which it recommended that TTD be denied because claimant was already
receiving PTD. The Board concluded that claimant was "in the work force" at the time
of his hospitalization and, therefore, was entitled to TTD. The Board did not address the
seeming inconsistency of declaring an individual both permanently and temporarily
disabled at the same moment in time, but it did recognize that to do so would allow a
claimant to receive a double recovery. For that reason, the Board recommended that
SAIF petition the Workers' Compensation Division for a pro rata distribution of
payments. When SAIF petitioned the Division for relief, however, the Division ruled
that, although there was a rule allowing for such a distribution between two TTD awards,
there was no comparable rule authorizing a distribution between a PTD award and a TTD
award. SAIF then sought review of the Board's own-motion order.
In Gwynn v. SAIF, 304 Or 345, 745 P2d 775 (1987), the Supreme Court
attempted to provide a clear description of the meaning of temporary, permanent, partial
and total disability:
"If a worker is permanently disabled but not to the extent of being
totally disabled, as the statute defines total disability, that worker must be
permanently partially disabled. The fact that the worker is not totally
disabled excludes the worker from the class of those permanently totally
disabled, and either the fact that the disability is permanent or that it is not
total excludes the worker from the class of those temporarily totally
disabled.
"To be a bit redundant but to emphasize a point, one who is only
temporarily disabled cannot fall into either class of permanent disability." Gwynn, 304 Or at 351. What was left unsaid by the court in Gwynn, but which must
follow, is that one who has been determined to suffer from permanent total disability
cannot, by force of logic, be temporarily totally disabled as well.
Claimant argues that he is entitled to benefits under both categories, because
two different insurers are involved. He contends that, although EBI is responsible for the
permanent disability benefits, SAIF has an independent responsibility to pay temporary
disability benefits for the time that he spent in the hospital for treatment of the back
injury previously accepted by SAIF. That argument is not well taken. Once the Board
determined that claimant was permanently and totally disabled, claimant was entitled to
full wage-replacement benefits under ORS 656.206(2). Temporary total disability
benefits are also wage-replacement benefits. Nothing in the relevant statutes suggests
that a person who is receiving permanent and total wage replacement is entitled to
receive additional wage-replacement benefits.
We find further support for our conclusion that PTD and TTD are mutually
exclusive benefit categories in the fact that the legislature has recognized situations in
which overlap of disability benefits may occur and has provided offset mechanisms to
ensure against double recovery. See, e.g., ORS 656.209 (allows for reduction of PTD
benefits by amount of federal social security disability benefits); see also OAR 436-060-0020(8) (allows for pro rata distribution of compensation due for two or more
concurrent TTD claims). There is no offset provision for a PTD/TTD overlap, either
statutory or regulatory, presumably because such an overlap is not logically possible.
Reversed.
"Claimant's injuries occurred over a number of years, and each
materially contributed to his overall disability. The most recent injury that
bears a causal relation to claimant's total disability is the aggravation of the
knee conditions. EBI was responsible for the first knee injury, and it was
the aggravation of that injury that last contributed to the disability. * * *
EBI is the responsible carrier."
"[T]he adjectives 'permanent' and 'temporary' describe duration, not the
extent, of disability. 'Partial' and 'total' describe extent. It follows that if
a worker meets the test of being totally disabled but that it cannot be said
that the disability is permanent, that worker is temporarily totally disabled.
1. The facts and timing of claimant's injuries leading to his PTD status are found in EBI Companies v. Grover, 90 Or App 524, 526, 752 P2d 1274, rev den 306 Or 155 (1988).
Return to previous location.
2. Claimant did not appeal the partial denial, and we do not address it.
Return to previous location.
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