In this case, an injured worker prevailed at a workers' hearing where he appealed a claim denial. The ALJ (Administrative Law Judge) found that the injured worker proved he suffered an “injury.” The Judge also found the insurance company was unreasonable and its denial of the claim, and assessed penalties. The Employer appealed this decision.
In front of the Workers’ Compensation Board, the employer argued that the Judge at the hearings level should have evaluated the case as an “occupational disease claim.” An “injury” is something that arises suddenly due to an identifiable event or has an onset that occurs over a discrete period of time. An “occupational disease” claim is something that occurs gradually. The Employer argued for an “occupational disease” claim because the injured worker must show that the work activity is the “major” cause of the development of the occupational disease. This is a higher burden than proving an “injury” claim, which only requires the injured worker to show that the work activity is a significant factor in causing the need for medical care, or disability from work.
The Board looked at other past case decisions that examined the same issue as to whether a claim should be evaluated as an “occupational disease” or an “injury.” It found that symptoms that occur over a discrete period of time, even as long as six weeks, is discrete enough that it should be evaluated as an injury.
The Board also evaluated the penalties assessed against the insurance company at hearing. The Board found that the insurance company could not have legitimately doubted whether this claim should be accepted, and agreed with the Judge at the hearings level that penalties were appropriate.
The Claimant’s attorney sought penalties in addition for a frivolous appeal. However, the Board found that the statute did not give it authority to assess penalties for an unreasonable request for Board review. That might be something for the legislature to address.
If you have a denied claim, and want to know whether you should appeal your denial, contact us at 503-325-8600. With convenient offices in Beaverton and Astoria, we can meet with you to discuss your claim, and let you know where you stand.