Court of Appeals Rules on New Medical Condition Claim

Posted on Mar 27, 2015

The Oregon Court of Appeals agreed with the Oregon Workers' Comp. Board's ruling involving a claim for a new/omitted medical condition.

"new/omitted" condition claim is a claim for a specific medical problem that resulted from an on-the-job injury. An injured worker in Oregon can make this claim at any time after the initial claim acceptance. The claim must be for an actual medical condition. If the claim is for a symptom, then the employer can deny the claim. Still, the employer must respond within 60 days of the date the claim is made.

In this case, the injured worker made a claim for shoulder arthralgia. The insurance company did not accept or deny the claim within the time required by law. The Workers Comp. Board awarded attorney fees, explaining that even though the claim would have been properly denied, the insurance company should have responded within the required time.

On appeal, the insurance carrier argued that it did not have to respond to the new medical condition claim, because it was a claim for a symptom, and not an actual medical condition. The Court explained that the insurance company has to respond either way, and because it did not, it owed an attorney fee.

Although this case appears to benefit the injured worker's attorney more than the injured worker, it does reinforce an insurance company's responsibility to issue denials. This is important, because a formal denial will town injured worker or his or her rights, including the right to have an attorney help on the case free of charge.

Oregon Workers' Compensation law provides that an attorney is not paid unless he or she is successful in obtaining benefits. If we overturn a denial, then the insurance company pays our fee.  An injured worker needs to know their rights when a claim is denied. That's what this case is about.

If you are not sure whether your workers' comp carrier is accepting responsibility for all of your injuries, call us at 503-325-8600. We can review your claims file, and determine whether not you should make additional claims.

Joe Di Bartolomeo
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