The Oregon Supreme Court recently struck down an administrative rule that allowed insurance retained doctors and medical arbiters to reduce permanent partial disability awards in certain claims. In a decision that provides a broad overview of the Workers’ Compensation system, the Supreme Court focused on the term “due to” to determine what an insurance company can consider when calculating a permanent partial disability benefit.
In this case, the injured worker appealed a Notice of Closure that awarded him no permanent partial disability benefits. This first appeal is called a Request for Reconsideration. As result of the appeal, the injured worker attended a medical arbiter examination. A medical arbiter examination is a medical exam ordered by the State of Oregon. The medical arbiter examiner, a doctor retained by the State of Oregon, concluded that the injured worker did have some permanent impairment, but attributed a certain percentage of the permanent impairment to “advanced aging” and “mild degenerative changes” in the lumbar spine. As result, the permanent partial disability award was reduced. The Appellate Review Unit, which is the agency that handles Requests for Reconsideration, adopted the findings of the medical arbiter, and reduce the permanent partial disability rating.
The injured worker requested a hearing, and when the Administrative Law Judge agreed with the Order on Reconsideration. The injured worker then appealed the case to the Oregon Workers’ Compensation Board, who agreed with the hearings Judge. The injured worker then went to the Oregon Court of Appeals. That court also disagreed with the injured worker, and the injured worker asked the Oregon Supreme Court to take a look at the issue. The Oregon Supreme Court agreed to hear to case.
The Oregon Supreme Court reviewed many statutory provisions of the Workers’ Compensation Act, especially those dealing with different types of accepted claims, including consequential claims, aggravation of pre-existing conditions, and combined condition claims. Noting that the statute only allowed for apportionment of permanent partial disability with certain kinds of combined condition claims, the Supreme Court found that the statute did not allow for rule that apportioned part of a permanent disability to some pre-existing condition.
The bottom line is that insurance companies can no longer reduce permanent partial disability awards by having a doctor attribute a percentage of permanent partial disability to some pre-existing condition that the injured worker may never have treated for in the past. This is simply because the statute does not allow this type of award reduction. In all honesty, these apportionments sometimes appeared to be guesswork and speculation more than anything else.
The other take away from this decision is the reminder that Oregon Workers’ Compensation is sometimes overly technical, and if you are dealing with a complex injury claim, you may have questions. If you do, call us at 503-325-8600. We help injured workers all the time.