FILED: November 4, 1998
In the Matter of the Compensation
of Ronald E. Rogers, Claimant.
REYNOLDS METALS and CIGNA
INSURANCE COMPANY,
Petitioners - Cross-Respondents,
v.
RONALD E. ROGERS,
Respondent,
and
LIBERTY MUTUAL INSURANCE CO.,
Respondent - Cross-Petitioner.
Judicial Review from the Workers' Compensation Board.
Argued and submitted June 3, 1998.
Montgomery W. Cobb argued the cause and filed the briefs for petitioners - cross-respondents Reynolds Metals and Cigna Insurance Company.
Meagan A. Flynn argued the cause for respondent Ronald E. Rogers. With her on the briefs was Pozzi Wilson Atchison, LLP.
Alexander Libmann argued the cause for respondent - cross-petitioner Liberty Mutual Insurance Co.
Before Riggs, Presiding Judge pro tempore, and Landau and Wollheim, Judges.
WOLLHEIM, J.
Reversed and remanded for reconsideration on the petition; affirmed on the cross-petition.
WOLLHEIM, J.
Cigna Insurance Co. (Cigna), on behalf of its insured Reynolds Metals,
seeks review of a Workers' Compensation Board (Board) order assigning it responsibility
for claimant's right shoulder condition. Liberty Mutual (Liberty), which insured
Reynolds Metals prior to Cigna, cross-petitions seeking review of the Board's order
assessing a penalty and attorney fees. We review for substantial evidence and errors of
law. ORS 183.482(8), 656.298(7). We affirm in part and reverse in part on the petition
and affirm on the cross-petition.
Claimant began working for Reynolds Metals in 1967 and stopped working
there in November 1991. In 1979, while Liberty insured employer, claimant sought
medical treatment from Dr. Manley for right shoulder pain. In a letter to Liberty, Manley
diagnosed claimant's condition as degenerative osteoarthritis of the right shoulder joint.(1)
Manley wrote that the condition was due to claimant's work. Liberty responded by
returning the billings for the right shoulder treatment, stating that no claim had been
made for the right shoulder. Manley replied, stating that claimant had sustained a new
injury, and that his opinion remained that claimant's shoulder condition was work related.
Liberty did not process Manley's request for payment as a workers' compensation claim.
Claimant continued working for Reynolds Metals, and he periodically
complained of right shoulder ailments. In May 1990, claimant had a sudden onset of
right shoulder pain and sought medical treatment. Cigna, employer's new insurer,
accepted the claim as a disabling injury but did not specify what condition it accepted. In
1993, claimant again had a sudden onset of right shoulder pain and sought medical
treatment. Manley requested authorization from Cigna for right shoulder surgery. In
September 1993, Cigna denied that claimant's May 1990 injury was either the material or
major cause of the proposed surgery. During a deposition of Manley, Cigna and claimant
first learned of the 1979 correspondence between Manley and Liberty. Based on this
information, Cigna issued a second denial of compensability and also disclaimed
responsibility for the right shoulder condition. Claimant then filed a hearing request
against Liberty, alleging a de facto denial of the 1979 claim. In response, Liberty
formally denied compensability and disclaimed responsibility for claimant's right
shoulder condition. The Administrative Law Judge (ALJ) set aside both compensability
denials, assessed attorney fees against both insurers for setting aside the denials, found
Cigna responsible, and assessed a penalty against Liberty for its unreasonable processing
of the 1979 claim. The Board affirmed.
Both Cigna and Liberty argue that the Board erred in not dismissing the
right shoulder claim because it was not timely filed with Liberty and because there was
no timely request for a hearing. In addition, Cigna argues that the Board erred in
assigning it responsibility for claimant's right shoulder condition. Liberty argues that the
Board erred in assessing a penalty and attorney fees against it.
We first address the insurers' contention that the claim was not timely filed.
In 1979, an occupational disease claim had to be filed within 180 days from the date a
worker became disabled or was informed by a physician that he was suffering from an
occupational disease. ORS 656.807(1) (1979).(2) Both insurers
argue that no claim was
filed with Liberty until 1994 and that claimant's 1994 request for a hearing was also
untimely. In support of that argument, insurers rely on ORS 12.010 and 12.140. ORS
12.010 provides:
"Actions shall only be commenced within the periods prescribed in
this chapter, after the cause of action shall have accrued, except where a
different limitation is prescribed by statute."
ORS 12.140 provides:
"An action for any cause not otherwise provided for shall be
commenced within 10 years."
Relying on those statutes, insurers argue that claimant failed to timely request a hearing
on Liberty's de facto denial. We disagree.
Dr. Manley's submission of medical records and his billing constituted a
workers' compensation claim. A claim is any written request for compensation tendered
by the injured worker or by someone else on the worker's behalf. ORS 656.005(6). See
also Safeway Stores, Inc. v. Smith, 117 Or App 224, 227, 843 P2d 1000 (1992) (a
physician's report requesting medical treatment for a specified condition constitutes a
claim). Thus, a claim for compensation was timely filed with Liberty and with Reynolds
Metals when each received Manley's records and reports. The fact that neither Liberty
nor Reynolds Metals processed the 1979 claim does not mean that the claim was not
timely filed.
Insurers' argument is further deflated by the fact that ORS 12.140 does not
apply to workers' compensation claims. Instead, the Workers' Compensation Act is the
"complete statement of the parties' rights and obligations, and they are sui generis."
Haret v. SAIF, 72 Or App 668, 674, 697 P2d 201, rev den 299 Or 313 (1985). ORS
12.140 states that an action must be commenced within 10 years. ORS 12.020(1)
provides that an action is commenced when a complaint is filed and summons served on
a defendant. See also ORCP 3 (action is commenced by the filing of a
complaint with
the clerk of the court). In contrast, a workers' compensation claim is not an action. No
complaint is ever filed with the clerk of the court when a workers' compensation claim is
made. Rather, a notice of a claim is filed with the employer. ORS 656.265(1). There is
no service of a summons on the "defendant" because there is no defendant in a workers'
compensation case. Accordingly, claimant's 1994 request for hearing, alleging a de facto
denial, was timely because Liberty had not issued a written denial. Bebout v. SAIF, 22
Or App 1, 5-6 n 1, 537 P2d 563, aff'd 273 Or 487 (1975) (insurer has an obligation to
formally deny a claim when they have actual knowledge of it). While there is a time
limitation to file a request for hearing on a written denial, ORS 656.319(1), there is no
similar time limitation to file a request for hearing on a de facto denial. ORS
656.283(1)(3)
provides that a party can file a request for hearing at any time on any matter concerning a
claim.
Next, Cigna argues that the Board erred in assigning it responsibility for
claimant's right shoulder condition because ORS 656.308(1) relieves an employer of
responsibility when the employee is injured again. That statute provides, in part:
"When a worker sustains a compensable injury, the responsible
employer shall remain responsible for future compensable medical services
and disability relating to the compensable condition unless the worker
sustains a new compensable injury involving the same condition."
Cigna argues that because the Board found that claimant sustained a compensable injury
in 1979, while Liberty insured employer, Liberty remains responsible for claimant's
condition. We disagree. ORS 656.308(1) does not apply in this situation. The statute
applies only where there is a previously accepted compensable injury. In SAIF v. Yokum,
132 Or App 18, 23, 887 P2d 380 (1994), we held:
"On its face, [ORS 656.308(1)] addresses the issue of when a responsible
employer can shift responsibility to a subsequent employer. It begins from
the premise that there is an employer that is responsible to pay for a
particular compensable condition. There is no responsible employer until
there is an accepted claim and a determination of responsibility, if there is
more than one potentially responsible employer. Thus, for the statute to be
triggered, there must be an accepted claim for the condition, for which
some employer is responsible. In an initial claim context, no employer is
responsible until responsibility is fixed."
See also Norstadt v. Murphy Plywood, 148 Or App 484, 493, 941 P2d 1030, on recons
150 Or App 245, 945 P2d 654 (1997), rev den 327 Or 432 (1998) (ORS 656.308(1) is
limited to claims involving previously processed claims).
Cigna also argues that the Board improperly assigned it responsibility
under the last injurious exposure rule (LIER). There are, at least, two aspects of LIER:
(1) proof of a compensable claim, and (2) assignment of liability between insurers.
Bracke v. Baza'r, 293 Or 239, 245, 646 P2d 1330 (1982). LIER allows the injured
worker to establish compensability based on all employment-related exposure without
proving causation against any particular employer or insurer. Once it is established that a
condition is work related, the rule assigns initial responsibility to the last period of
employment whose conditions might have caused the disability. Boise Cascade Corp. v.
Starbuck, 296 Or 238, 244, 675 P2d 1044 (1984). The "onset of disability" is the
triggering date for determining which employment is the last potentially causal
employment. Bracke, 293 Or at 248. If the injured worker receives medical
treatment
before experiencing time loss due to the condition, then the date of first medical
treatment is determinative for assigning initial responsibility for the claim. Timm v.
Maley, 125 Or App 396, 401, 865 P2d 1315 (1993), rev den 319 Or 81 (1994). The last
insurer can transfer liability to a previous insurer by establishing that it was impossible
for its employer to have caused the condition or that a prior period of employment was
the sole cause of the condition. Roseberg Forest Products v. Lang, 325 Or 305, 313, 937
P2d 517 (1997). Alternatively, the initially responsible insurer can transfer liability to a
subsequent insurer by establishing that the subsequent employment actually contributed
to a worsening of the condition. Oregon Boiler Works v. Lott, 115 Or App 70, 74, 836
P2d 756 (1992). However, in order to shift responsibility to a subsequent insurer, the
injured worker must suffer a worsening of the condition; a mere increase in symptoms is
not sufficient. Boise Cascade, 296 Or at 243; Timm v. Maley, 134 Or App 245, 249, 894
P2d 1245 (1995); Oregon Boiler Works, 115 Or App at 74.(4)
Claimant first sought medical treatment in 1979, while Liberty insured
Reynolds Metals. Therefore, initial responsibility is assigned to Liberty. In order to shift
responsibility to Cigna, there must be evidence that claimant's condition worsened while
Cigna insured Reynolds Metals. The problem is that neither the ALJ nor the Board
determined whether the medical evidence established that claimant's shoulder condition
worsened. Rather, the ALJ and the Board applied the test discussed in Beneficiaries of
Strametz v. Spectrum Motorwerks, 135 Or App 67, 74, 897 P2d 335, mod 138 Or App 9,
906 P2d 825 (1995). The Supreme Court subsequently reversed our decision in
Strametz. 325 Or 439, 939 P2d 617 (1997). Accordingly, it is necessary to remand this
case to the Board for reconsideration under the correct standard and such proceedings as
the Board deems necessary.(5)
We turn next to Liberty's cross-petition for review. Liberty argues that the
Board erred in assessing a penalty under ORS 656.262(11) for unreasonable claim
processing. Liberty argues that ORS 656.319(6) bars a claim for unreasonable claim
processing that is more than two years after the fact. ORS 656.319(6) provides:
"A hearing for failure to process or an allegation that the claim was
processed incorrectly shall not be granted unless the request for hearing is
filed within two years after the alleged action or inaction occurred."
That language was enacted by the 1995 legislature. Or Laws 1995, ch 332, § 39.
Generally, the 1995 amendments to the Workers' Compensation Act were retroactive.
Volk v. America West Airlines, 135 Or App 565, 572-73, 899 P2d 746 (1995), rev den
322 Or 645 (1996). However, there are exceptions to the retroactive effect of the 1995
amendments. Oregon Laws 1995, chapter 332, section 66(6) provides:
"The amendments to statutes by this Act and new sections added to
ORS chapter 656 by this Act do not extend or shorten the procedural time
limitations with regard to any action on a claim taken prior to the effective
date of this Act."
The requests for hearing filed on Liberty's denials were filed before the
effective date of ORS 656.319(6). At the time of filing, there was no time limitation on
requesting a hearing concerning a penalty before the enactment of ORS 656.319(6).
Accordingly, it follows that ORS 656.319(6) shortened a procedural time limit and, thus,
cannot apply retroactively. See Boone v. Wright, 314 Or 135, 141, 836 P2d 727 (1992)
(a statute that shortens a limitation period applies prospectively if the legislature does not
clearly express a contrary intent). The Board correctly held that ORS 656.319(6) does
not apply to this case. We agree with the Board that Liberty and Reynolds Metals acted
unreasonably in processing the 1979 claim.
Liberty's final assignment concerns the assessment of attorney fees under
ORS 656.386(1). Liberty concedes that if the 1979 claim was timely then the award of
attorney fees was proper. Because we conclude that the Liberty claim was timely, we
affirm the award of attorney fees for prevailing on Liberty's compensability denial.
Reversed and remanded for reconsideration on the petition; affirmed on the
cross-petition.
1. Manley provided a copy of the letter to employer's on-site physician. Thus,
employer also had knowledge of the 1979 medical treatment.
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2. At that time, ORS 656.807(1) (1979) provided, in part:
"All occupational disease claims shall be void unless a claim is filed * * *
within 180 days from the date the claimant becomes disabled or is informed by a
physician that he is suffering from an occupational disease."
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3. ORS 656.283(1) provides, in part:
"Subject to ORS 656.319, any party * * * may at any time request a hearing
on any matter concerning a claim, except matters for which a procedure for
resolving the dispute is provided in another statute, including ORS 656.245,
656.248, 656.260, 656.327 and subsection (2) of this section."
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4. We recognize the apparent inconsistency concerning LIER. The rule does not always assign liability to the last employer or insurer. The operation of the rule is "somewhat arbitrary." Bracke, 293 Or at 249. The rule is still useful, and its application consistent. Any employer can prove that its work environment could not possibly have been the cause of the condition or that the condition was caused solely by a prior period of employment. Thus, the last employer can shift responsibility backwards. Likewise, an employer who is initially assigned responsibility based on the "onset of disability" can shift responsibly forward by establishing that a subsequent period of employment caused a worsening of the injured worker's condition.
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5. There is medical evidence from Manley in the record that claimant's condition worsened while Cigna insured employer. However, there is also medical evidence in the record indicating that claimant's condition had not worsened. The Board must resolve this dispute in the first instance.
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