Oregon Workers Comp Case Report: Shoulder Injury Denial

Posted on Jan 31, 2015

The Oregon Workers' Compensation Board decided a case involving a claim for a rotator cuff tear condition.

In this case, SAIF had accepted a fracture of the left scapula (shoulder blade), as well as a separated shoulder and other injuries from a 2000 on-the-job injury.  The injured worker then went to an orthopedic surgeon, who performed surgery to repair a rotator cuff tear. After surgery, the injured worker filed a new/omitted medical condition claim for the rotator cuff tear. That claim was denied, and the injured worker requested a hearing.

In this case, neither the employer or the injured worker disputed that there was in fact a rotator cuff tear. However, the employer did not feel the rotator cuff tear was a direct result of the original compensable injury. In order to prove this kind of claim, the injured worker would have to show that the major cause of the rotator cuff tear was in fact the original compensable injury. The term "major cause" means that the on-the-job injury, more than any other cause or causes combined, is the dominant factor in causing the rotator cuff tear.

The surgeon he repaired the rotator cuff tear could only say that the on-the-job injury was a "material contributing cause" of the rotator cuff tear. In other words, the original injury was a significant factor in causing the rotator cuff tear, but not the dominant or overriding factor. Because the original injury was not sufficiently connected with the resulting rotator cuff tear, the Board upheld the denial.

This case shows the importance of medical opinions in establishing the right to benefits under a workers' compensation claim in Oregon. If you believe medical care as a result of an on-the-job injury, even if it has been closed for some time, you may  have a claim for benefits. Call us at 503-325-8600 to learn your options.