Employer’s Attempt to Escape Responsibility Backfires

Posted on Oct 01, 2014

In this unusual case, the Oregon Workers’ Compensation Board found that an insurance company actually accepted several medical conditions when it attempted to deny a claim.

In this case, a worker was injured, and the employer accepted a left hip strain. Three months after the initial injury, the injured worker experienced ongoing lower back pain, and sought treatment for low back injuries. The insurance company wrote a letter to the injured worker stating that the current medical problems appeared to be related to the prior injury, and that all benefits with the paid on that claim. In the same letter, the insurance company stated it was denying this “new” claim, and notified the injured worker that he could request a hearing. The injured worker then sought to have the lower back conditions accepted, and that claim was denied.

The injured worker argued that the insurance company could not deny the low back conditions because it stated in the previous denial letter that it considered all current problems to be related to the original injury. Because the language in the insurance company’s letter was unclear, the Board examined the medical evidence, and found that the insurance company was responsible for all of the low back medical conditions.

This case teaches us that the Board will examine the facts and circumstances surrounding an insurance company’s actions in determining whether not it was actually accepting or denying a claim. In reading this case over, it appears the insurance company was trying to accept and deny the very same medical conditions and one letter, and the Board would not allow it.

If you have questions about whether or not your workers’ compensation carrier is taking full responsibility for your injuries, call us at 503-325-8600. We handle these cases every day.