In this recent decision, the Oregon Workers' Compensation Board found that an insurance carrier was required to obtain sufficient information so that it could re-close an accepted aggravation claim. This new closure was required, even if the reopening of the claim was for medical conditions that occurred before the first closure on the original claim.
This case is a good example of the complexities involved with on-the-job injury claims in Oregon.
When a worker is injured on the job, he or she can file a claim. If that claim is accepted, the injured worker receives medical service benefits and may also qualify for temporary total disability benefits. However, the scope of those benefits is limited to the accepted medical condition. This is why the Notice of Acceptance of such an important document for the injured worker.
When the injured worker becomes "medically stationary," then the insurance company, depending on the kind of claim involved, will file a Notice of Closure. Before it can file the closure, the insurance company must gather the necessary information it needs to determine benefits at closure, including a permanent partial disability. in the Notice of Closure, the insurance company will rate any permanent partial disability resulting from the accepted conditions. Sometimes, the injured worker may have suffered additional medical problems that were not originally accepted. As result, any permanent impairment from those conditions may not be rated for permanent partial disability.
If, within five years after the date the claim is closed, the injured worker experiences and "actual worsening" of his or her accepted medical condition, the injured worker, through a physician, can file an aggravation claim. this is a request to reopen the claim so that the injured worker can obtain medical care for the worsened condition. If that claim is accepted, then the injured worker is entitled to many of the same benefits that came along with the original claim. When the injured worker becomes medically stationary on an aggravation claim, the insurance company still must obtain necessary information to re-close the claim a second time. If there is additional permanent partial disability, then the injured worker is entitled to additional permanent partial disability benefits.
The strange part about this case is that the insurance company had accepted the aggravation claim, but in doing so, indicated that the effective date of the aggravation claim was several years prior to the initial claim closure. This is because there were additional medical conditions that had not been accepted during the initial claim.
The Workers' Compensation Board found that even though the effective date of the aggravation claim predated the first Notice of Closure, the first Notice of Closure did not capture any impairment due to the newly accepted conditions. As result, the insurance company was required to go back and take a look at any permanent impairment resulting from the newly accepted medical conditions.
This is a complicated case but it is important because it held an insurance company responsible for a benefit that it would have otherwise denied an injured worker. If you have a complicated workers' compensation claim, call us with your questions at 503-325-8600. We go through claims files all the time, and can sort things out so that you know where you stand.
