In this case, the Board ruled on whether a request for hearing filed by an unrepresented injured worker was adequate.
The denial involved a "combined condition." When an insurance company or employer accepts a combined condition claim under Oregon Workers' Compensation law, it is agreeing that a work injury event combined with a pre-existing medical condition to cause a need for medical care. a "pre-existing" condition can be "arthritis," or some other medical problem that the injured worker had to do with before his or her injury. The employer or insurance company is only responsible for this combined condition for as long as the work injury event is the major cause of the need for treatment, or disability. When we use the term "major cause," we are referring to the majority of the cause, or more than 50% of the costs.
When the insurance company decides that the injury event is no longer the major cause of a combined condition, it will issue a "current combined condition denial." Attorneys often refer to these kinds of denials as a "ceases" denial. This is because the insurance company is claiming that the injury event has ceased to be the major cause of the need for care.
In this case, the injured worker did not specify the date of the denial, but instead explained that he was requesting a hearing for any outstanding denial. The Board found that this adequately advised the insurance company of the nature of the request for hearing, and allowed the case to go forward.
Sometimes, requesting a hearing can be tricky, and if you have questions, call us at 503-325-8600. We can advise you on all your options.