This Oregon Workers' Compensation Board case involved a denied claim for thoracic outlet syndrome. At the hearing, the Administrative Law Judge found that the Claimant did not prove that his thoracic outlet syndrome resulted from the on-the-job injury. The injured worker relied upon an opinion from his orthopedic physician, but that physician stated only that the thoracic outlet syndrome "could have" resulted from the on-the-job injury.
Under the Oregon Workers' Compensation statutes, rules and case law, in order to prove that a specific medical condition resulted from an on-the-job injury, the physician's opinion must state that the specific medical problem was likely a result of the on-the-job injury. There is a difference between something being possible, and something being probable.
Claimant, on appeal, argued that the treating physician's opinion was more persuasive then the insurance physician's opinion. However, the Board pointed out that the initial question is whether or not the Claimant provided in opinion that meets the minimal proof requirements. If it does not, it really doesn't matter whether that opinion is more persuasive than the insurance physician's opinion. In other words, the Claimant has to meet a minimum "burden of proof" before he can argue that his opinion is more convincing.
Sometimes, the specific words that a physician uses in setting out an opinion can make or break a case. If you are in the middle of an Oregon Workers' Compensation claim, and wonder if the medical opinions are sufficient to support your request for benefits, call us at 503-325-8600. We have offices in Astoria and Beaverton, and if we take your case, we earn a fee only if we are successful in overcoming a claim denial.