Processing of claims and payment of compensation
- payment by employer
- acceptance and denial of claim
- penalties and attorney fees
- cooperation by worker and attorney in claim investigation
- rules
Amended by HB 4138
Effective since January 1, 2023
Relating to workers’ compensation benefits; creating new provisions; and amending ORS 656.262 and 656.268.
Source:
Section 656.262 — Processing of claims and payment of compensation; payment by employer; acceptance and denial of claim; penalties and attorney fees; cooperation by worker and attorney in claim investigation; rules, https://www.oregonlegislature.gov/bills_laws/ors/ors656.html.
Notice; hearing requests
Interim compensation
Unreasonable employer behavior
Penalty and attorney fee availability/limitations
Acceptance, denial and revocation of acceptance
Other
Notes of Decisions
Notice; hearing requests
See also annotations under ORS 656.319.
Employer’s letter was not valid and effective denial of compensable claim in that it did not expressly disclaim responsibility and it failed to state with reasonable certainty what was being denied. Pettit v. Austin Logging Co., 9 Or App 347, 497 P2d 207 (1972)
Telephone conversation that did not inform claimant of reasons for denial of his claim or of his hearing rights was not adequate substitute for notice of denial requirement. Burkholder v. SAIF, 11 Or App 334, 502 P2d 1394 (1972)
Failure to strictly comply with notice requirement does not necessarily preclude jurisdiction over claim where no prejudice results from failure to give such notice. Murphy v. SAIF, 13 Or App 105, 508 P2d 227 (1973)
“Notification” of denial occurs on date denial notice is deposited in mail, not date shown on body of denial notice. Madewell v. Salvation Army, 49 Or App 713, 620 P2d 953 (1980)
Where notice was properly sent, fact that claimant did not actually receive notice did not toll time limitation for requesting hearing. Wright v. Bekins Moving and Storage Co., 97 Or App 45, 775 P2d 857 (1989), Sup Ct review denied
Request for hearing must be referable to particular denial. Guerra v. SAIF, 111 Or App 579, 826 P2d 1034 (1992)
After receiving actual or constructive notice of denial of workers’ compensation claim, claimant has 60 days to file request for hearing. SAIF v. Edison, 117 Or App 455, 844 P2d 261 (1992)
Where employer issues denial of coverage for condition, claimant may request hearing on denial notwithstanding that claimant did not comply with procedure for requesting acceptance of condition. Sound Elevator v. Zwingraf, 181 Or App 150, 45 P3d 958 (2002), Sup Ct review denied
Where claimant requests hearing of any type regarding denial of claim for failure to cooperate, duty to ensure that hearing is assigned to Expedited Claim Service rests with Workers’ Compensation Board. SAIF v. Dubose, 335 Or 579, 74 P3d 1072 (2003)
Interim compensation
Worker receiving payment over period of time for award of one class of compensation benefit is not prevented from receiving payment during same period of time for award of different class of compensation benefits. Wingfield v. Nat. Biscuit Co., 8 Or App 408, 494 P2d 905 (1972); Horn v. Tbr. Prods., Inc., 12 Or App 365, 507 P2d 36 (1973)
“Compensation” as used in this section has special meaning that includes only interim compensation paid for non-compensable injury. Jones v. Emanuel Hospital, 280 Or 147, 570 P2d 70 (1977); Williams v. Burns International Security, 36 Or App 769, 585 P2d 734 (1978)
Payment must be made from date of claimant’s injury rather than from date injury is reported to claimant’s employer. Gilroy v. General Distributors, 35 Or App 361, 582 P2d 428 (1978)
Claimant who was not “worker” within definition of Workers Compensation Law was not entitled to interim compensation pending denial of claim. Bell v. Hartman, 289 Or 447, 615 P2d 314 (1980)
To receive interim compensation, claimant must establish absence from work or that earning power was diminished. Bono v. SAIF, 298 Or 405, 692 P2d 606 (1984)
Medical expenses are not interim compensation; there is no duty to pay medical expenses pending determination that claim is compensable. Anderson v. EBI Companies, 79 Or App 345, 719 P2d 1383 (1986), Sup Ct review denied; Wacker Siltronic Corp., v. Satcher, 103 Or App 513, 798 P2d 264 (1990); Meier & Frank Co. v. Smith-Sanders, 115 Or App 159, 836 P2d 1359 (1992), Sup Ct review denied, modified 118 Or App 261, 846 P2d 1194 (1993)
Award of interim compensation is not stayed pending appeal. Georgia-Pacific v. Hughes, 305 Or 286, 751 P2d 775 (1988)
Where claimant’s attending physician was unable to verify claimant’s inability to work, insurer or self-insured employer may suspend payment of temporary total disability, but claimant’s entitlement to temporary total disability does not terminate. Sandoval v. Crystal Pine, 118 Or App 640, 848 P2d 1224 (1993), Sup Ct review denied; Cameron v. Norco Contract Service, 128 Or App 422, 875 P2d 1196 (1994), Sup Ct review denied
Where claimant is injured on job, but leaves job for reasons unrelated to injury, interim compensation may be available for loss of earnings resulting from injury. RSG Forest Products v. Jensen, 127 Or App 247, 873 P2d 324 (1994)
1995 amendment limiting retroactive authorization of temporary disability benefits applies retroactively to claim existing at time of amendment. Jensen v. Conagra, Inc., 152 Or App 449, 954 P2d 822 (1998)
Employer must pay interim compensation pending processing of claim for new medical condition. Labor Ready, Inc. v. Mann, 158 Or App 666, 976 P2d 89 (1999), modified 160 Or App 576, 987 P2d 524 (1999), Sup Ct review denied; Johansen v. SAIF, 158 Or App 672, 976 P2d 84 (1999), on reconsideration 160 Or App 579, 987 P2d 524 (1999), Sup Ct review denied
Limitation on retroactive establishment of disability period applies both to procedural obligation to pay benefits while claim is open and to substantive entitlement to benefits at claim closure. Fred Meyer, Inc. v. Bundy, 159 Or App 44, 978 P2d 385 (1999); Menasha Corp. v. Crawford, 332 Or 404, 29 P3d 1129 (2001)
Claimant’s actual notice of claim denial cannot substitute for written denial so as to terminate interim compensation obligation. Bishop v. OBEC Consulting Engineers, 160 Or App 548, 982 P2d 25 (1999)
Where attending physician contemporaneously signifies approval for claimant to be off work, whether or not explicitly authorizing payment of temporary disability benefits, insurer or self-insured employer is obligated to pay benefits. Lederer v. Viking Freight, Inc., 193 Or App 226, 89 P3d 1199 (2004), modified 195 Or App 94, 96 P3d 882 (2004)
Withdrawal or replacement of attending physician does not cause open-ended authorization of temporary disability to cease. Dedera v. Raytheon Engineers & Constrs, 200 Or App 1, 112 P3d 1198 (2005), Sup Ct review denied
Unreasonable employer behavior
Refusal to pay temporary total disability benefits was not unreasonable where order to pay compensation due did not specify period for which benefits must be paid. Reed v. Del Chem. Corp., 16 Or App 366, 518 P2d 679 (1974), Sup Ct review denied
Where insurer has legitimate doubt from legal standpoint of its liability, refusal to pay medical expenses is not unreasonable. Norgard v. Rawlinsons, 30 Or App 999, 569 P2d 49 (1977); Price v. SAIF, 73 Or App 123, 698 P2d 54 (1985); Brown v. Argonaut Insurance Company, 93 Or App 588, 763 P2d 408 (1988); Atlas Cylinder v. Epstein, 114 Or App 117, 833 P2d 1374 (1992)
Delay in payment of interim compensation is unreasonable resistance to payment because requirement is that payment be made “promptly.” Williams v. SAIF, 31 Or App 1301, 572 P2d 658 (1977)
Claimant was entitled to award of penalties where employer’s unreasonable conduct was contributing cause of denial of compensation. Anfilofieff v. SAIF, 52 Or App 127, 627 P2d 1274 (1981)
Compensation duty of noncomplying employers assumed by SAIF includes any penalties for unreasonable behavior by noncomplying employer. Anfilofieff v. SAIF, 52 Or App 127, 627 P2d 1274 (1981)
Self-insured employer’s delay of six months in responding to Evaluation Division’s request for medical information necessary to close claim constituted “unreasonable delay” in payment of claim. Lester v. Weyerhaeuser, 70 Or App 307, 689 P2d 342 (1984), Sup Ct review denied
Where plaintiff was awarded permanent partial disability compensation and claim was reopened to offer evidence of permanent total disability, carrier should not have suspended payment on partial disability award. Allen v. Fireman’s Fund Ins. Co., 71 Or App 40, 691 P2d 137 (1984)
Insurer that timely and properly denies claim has duty to re-evaluate denial upon receipt of later medical report. Brown v. Argonaut Insurance Company, 93 Or App 588, 763 P2d 408 (1988)
Where claim was not result of compensable injury, insurer did not unreasonably resist payment of compensation or attorney fees. Ellis v. McCall Insulation, 308 Or 74, 775 P2d 316 (1989); Randall v. Liberty Northwest Ins. Corp., 107 Or App 599, 813 P2d 1120 (1991)
Order reciting incorrect award amount does not create substantive entitlement of claimant to erroneous extra compensation. Vega v. Express Services, 144 Or App 602, 927 P2d 1106 (1996), Sup Ct review denied
For purposes of determining whether insurer unreasonably refused to pay compensation, legitimate doubt concerning liability requires more than argument passing frivolousness test of ORS 656.390. SAIF v. Azorr, 182 Or App 90, 47 P3d 542 (2002), Sup Ct review denied
Penalty and attorney fee availability/limitations
Award of attorney fees is not limited to cases where employer or insurer requests hearing or review or files appeal. Wingfield v. Nat. Biscuit Co., 8 Or App 408, 494 P2d 905 (1972)
Penalty for unreasonable refusal need not be paid pending appellate review of claim. Reed v. Del Chemical, 26 Or App 733, 554 P2d 586 (1976), Sup Ct review denied
Where finding of unreasonable denial is overturned on appeal, penalties or attorney fees based solely on unreasonable denial are canceled. Duggan v. SAIF, 31 Or App 1059, 572 P2d 329 (1977)
Claimant was entitled to recover reasonable attorneys fees upon employer’s refusal to either deny claim or make total disability payments, notwithstanding that injury complained of was subsequently determined noncompensable. Jones v. Emanuel Hospital, 280 Or 147, 570 P2d 70 (1977); Likens v. SAIF, 56 Or App 498, 642 P2d 342 (1982)
There is no statutory authority for award of interest on unpaid temporary disability benefits, and only penalties available are those specified in this section. Button v. SAIF, 45 Or App 295, 608 P2d 206 (1980), Sup Ct review denied
Where claimant failed to raise issue of unreasonable denial of claim, referee improperly awarded penalty. Mavis v. SAIF, 45 Or App 1059, 609 P2d 1318 (1980)
Board could not award penalty for insurer’s unreasonable delay in requesting appointment of designated paying agent. EBI Companies v. Thomas, 66 Or App 105, 672 P2d 1241 (1983)
Since there was no duty to pay interim compensation for medical services pending acceptance or denial of claim, there were no “amounts then due” and no penalty could be assessed. Poole v. SAIF, 69 Or App 503, 686 P2d 1063 (1984); Anderson v. EBI Companies, 79 Or App 345, 719 P2d 1383 (1986), Sup Ct review denied; Wacker Siltronic Corp., v. Satcher, 103 Or App 513, 798 P2d 264 (1990); Meier & Frank Co. v. Smith-Sanders, 115 Or App 159, 836 P2d 1359 (1992), Sup Ct review denied, modified 118 Or App 261, 846 P2d 1194 (1993)
Prejudice and intentional delay are not necessary predicates to imposition of penalty and attorney fees. Lester v. Weyerhaeuser, 70 Or App 307, 689 P2d 342 (1984), Sup Ct review denied
For purpose of imposing penalty, language excepting payment of medical benefits or burial expenses from definition of “compensation” pending acceptance or denial of claim refers only to period for timely acceptance or denial of claim. Whitman v. Industrial Indemnity Co., 73 Or App 73, 697 P2d 999 (1985)
Claimant was entitled to penalty and attorney fees because of delay in payment of interim compensation on aggravation claim notwithstanding later determination that original claim was prematurely closed. O’Dell v. SAIF, 79 Or App 294, 719 P2d 52 (1986)
Where penalty is assessed for delay in issuing denial, amount “then due” is calculated as of denial date. Wacker Siltronic Corp. v. Satcher, 91 Or App 654, 756 P2d 679 (1988); Weyerhaeuser v. Knapp, 100 Or App 615, 788 P2d 462 (1990)
Board may assess penalty for unreasonable delay based on interim compensation due but not on medical services. Eastmoreland Hospital v. Reeves, 94 Or App 698, 767 P2d 97 (1989)
Where compensation has been timely paid, failure to seek claim closure does not permit penalty. SAIF v. Wilson, 95 Or App 748, 770 P2d 972 (1989)
Award of attorney fee in addition to payment of penalty award is not permitted. Martinez v. Dallas Nursing Home, 114 Or App 453, 836 P2d 147 (1992), Sup Ct review denied; Corona v. Pacific Resource Recycling, 125 Or App 47, 865 P2d 407 (1993)
Where claim is unreasonably denied, penalty applies to amount due at time denial is withdrawn. Conagra, Inc. v. Jeffries, 118 Or App 373, 847 P2d 878 (1993)
Where more than one insurer unreasonably denies claim, separate 25 percent penalty may be assessed against each insurer. SAIF v. Whitney, 130 Or App 429, 882 P2d 614 (1994)
Once dispute is properly before Hearings Division, subsequent narrowing of issues to involve only penalty issue does not divest division of jurisdiction over dispute. Icenhower v. SAIF, 180 Or App 297, 43 P3d 431 (2002)
Liability for additional amount and attorney fee may be imposed on insurer or self-insured employer multiple times during processing of single claim if claimant satisfies predicates for imposing liability and fee in each instance. Cayton v. Safelite Glass Corporation, 232 Or App 454, 222 P3d 1134 (2009)
Claimant’s success in obtaining penalty and attorney fees under this provision for employer’s delay in payment of compensation does not mandate award of attorney fees under ORS 656.382. Cayton v. Safelite Glass Corporation, 257 Or App 188, 306 P3d 726 (2013)
Where insurer unreasonably delays denial of claimant’s claim, including claim for compensation for what is determined to be only symptom of other condition, insurer is liable to claimant for attorney fees even if no penalty is assessed against insurer because attorney fees are not contingent upon compensation. SAIF v. Traner, 270 Or App 67, 346 P3d 1248 (2015)
Where claimant did not receive award of compensation and insurer unreasonably delayed response to claim, claimant may still recover attorney fees independently authorized by this section. SAIF v. Traner, 273 Or App 310, 365 P3d 1078 (2015)
Workers’ Compensation Board erred in awarding penalties and attorney fees against insurer on grounds that employer’s misconduct could be attributed to insurer, when board had determined only that statutory prerequisite for termination of temporary total disability benefits had not been established and record was devoid of evidence of employer misconduct. SAIF v. Coria, 315 Or App 546, 500 P3d 42 (2021), Sup Ct review allowed
Acceptance, denial and revocation of acceptance
Failure to issue denial in written form tolls time for filing request for hearing. Bebout v. SAIF, 22 Or App 1, 537 P2d 563 (1975), aff’d 273 Or 487, 541 P2d 1293 (1975)
Misrepresentation by claimant is material if decision of insurer could reasonably have been affected by knowledge of true facts. Ebbtide Enterprises v. Tucker, 303 Or 459, 738 P2d 194 (1987)
Acceptance of claim for condition includes acceptance of compensability of underlying causes of condition. Georgia-Pacific v. Piwowar, 305 Or 494, 753 P2d 948 (1988); Freightliner Corp. v. Christensen, 163 Or App 191, 986 P2d 1263 (1999)
Claim status report filed with Workers’ Compensation Division was not notice to claimant of claim determination. EBI Ins. Co. v. CNA Insurance, 95 Or App 448, 769 P2d 789 (1989)
Acceptance of claim for one condition did not require acceptance of claim for second condition in same location, but did estop employer from denying that work-related injury had occurred. Boise Cascade Corp. v. Katzenbach, 104 Or App 732, 802 P2d 709 (1990), Sup Ct review denied
Where employer gave oral authorization for surgery to claimant and claimant’s doctors, employer was estopped from denying responsibility for claimant’s medical expenses associated with surgery. Meier & Frank Co. v. Smith-Sanders, 115 Or App 159, 836 P2d 1359 (1992), Sup Ct review denied, modified 118 Or App 261, 846 P2d 1194 (1993)
Employer may reclassify claim from disabling to nondisabling only if done within sufficient time for claimant to challenge reclassification within one year from date of injury. DeGrauw v. Columbia Knit, Inc., 118 Or App 277, 846 P2d 1214 (1993), Sup Ct review denied
Later obtained evidence allowing insurer to revoke claim acceptance means evidence other than evidence insurer had at time of initial acceptance. CNA Ins. Co. v. Magnuson, 119 Or App 282, 850 P2d 396 (1993); Curry Educational Service Dist. v. Bengtson, 175 Or App 252, 27 P3d 526 (2001)
Change in legal significance of existing evidence does not make it “later obtained evidence.” CNA Ins. Co. v. Magnuson, 119 Or App 282, 850 P2d 396 (1993)
Settlement agreement between parties is not claim acceptance and is not subject to later revocation for noncompensability. Fimbres v. Gibbons Supply Co., 122 Or App 467, 857 P2d 904 (1993)
Litigation of aggravation claim precludes later denial of compensability of original injury. SAIF v. Hansen, 126 Or App 662, 870 P2d 247 (1994)
Insurer acquiescence to designation of paying agent does not constitute acceptance of claim. Taylor v. Masonry Builders, Inc., 127 Or App 230, 872 P2d 442 (1994), Sup Ct review denied
Denial based on lack of coverage is subject to limitation of two years from date of claim acceptance. SAIF v. Shaffer, 129 Or App 289, 878 P2d 1114 (1994)
Acceptance of claim is not required to process claim while compensability is litigated. SAIF v. Mize, 129 Or App 636, 879 P2d 907 (1994)
Two-year rescission period begins at date of claim acceptance, not at end of 90-day period for accepting or denying claim. SAIF v. Andrews, 130 Or App 620, 883 P2d 248 (1994)
Acceptance of particular condition, rather than acceptance of symptom, does not necessarily include acceptance of cause for condition. Granner v. Fairview Center, 147 Or App 406, 935 P2d 1252 (1997); Cloud v. Klamath County School District, 191 Or App 610, 83 P3d 918 (2004)
Employer is not estopped from amending denial of claim at hearing. SAIF v. Ledin, 149 Or App 94, 941 P2d 1093 (1997)
Retroactive 1997 amendment allowing employer or insurer to deny compensability of previously accepted claim does not violate privileges and immunities provision of Oregon Constitution (section 20, Article I). Kmart Corp. v. Lloyd, 155 Or App 270, 963 P2d 734 (1998)
1995 amendment, which requires insurer to send written denial before claim closure if asserting that accepted condition is no longer compensable, applies retroactively. SAIF v. Belden, 155 Or App 568, 964 P2d 300 (1998), Sup Ct review denied
Employer “notice or knowledge of claim” for possible compensable injury arises at time employer becomes aware of allegedly compensable injury. Allied Systems Co. v. Nelson, 158 Or App 639, 975 P2d 923 (1999)
Employer may not deny combined condition after acceptance unless condition was combined condition at time of acceptance. Croman Corp. v. Serrano, 163 Or App 136, 986 P2d 1253 (1999)
All causes underlying accepted condition are compensable in their own right and cannot be viewed as preexisting conditions for purposes of finding combined condition. Freightliner Corp. v. Christensen, 163 Or App 191, 986 P2d 1263 (1999)
Where employer accepts combined condition involving new injury and preexisting compensable injury, employer may deny combined condition if new injury ceases to be major contributing cause, but will remain subject to shifted responsibility for preexisting injury under ORS 656.308. Barrett Business Services v. Morrow, 164 Or App 628, 993 P2d 179 (1999)
Notice of claim acceptance that adequately identifies accepted combined condition is not rendered insufficient by failure to expressly identify accepted claim as claim for combined condition. Columbia Forest Products v. Woolner, 177 Or App 639, 34 P3d 1203 (2001)
Later obtained evidence of compensability or responsibility for claim does not include evidence employer had, or with reasonable diligence should have had, at time of acceptance nor does it include restatement, reevaluation, analysis or confirmation of such evidence. Barrett Business Services, Inc. v. Stewart, 178 Or App 145, 35 P3d 1055 (2001)
Where employer denial is limited to specific medical condition, denial does not place at issue other existing medical conditions unknown to employer. Longview Inspection v. Snyder, 182 Or App 530, 50 P3d 1201 (2002)
“Other written clarification” made in response to claimant communication regarding omitted condition must clarify notice of acceptance. Rasmussen v. SAIF, 182 Or App 642, 50 P3d 248 (2002)
Employer or insurer may issue acceptance and denial of combined condition in single letter, provided effective date of denial is later than effective date of acceptance. Stockdale v. SAIF, 192 Or App 289, 84 P3d 1120 (2004)
Suspension sanction provided under ORS 656.325 for claimant failure to cooperate with insurer medical examination prevents using failure as basis for denying claim. Lewis v. CIGNA Insurance Co., 339 Or 342, 121 P3d 1128 (2005)
Effective date for modified acceptance of combined condition need not coincide with date of original injury. Oregon Drywall Systems, Inc. v. Bacon, 208 Or App 205, 144 P3d 987 (2006)
Updated notice of acceptance issued at time of claim closure is subject to restrictions on revocation of acceptance. City of Grants Pass v. Hamelin, 212 Or App 414, 157 P3d 1206 (2007)
Where claimant had no prior accepted claim and denial was directed at claimant’s only pending claim for new injury, misstating date of claim did not nullify denial. Mills v. The Boeing Co., 212 Or App 678, 159 P3d 375 (2007)
When Director of the Department of Consumer and Business Services modifies date of injury, director does not affect insurer’s or self-insured employer’s acceptance of claim. Martin v. SAIF, 247 Or App 377, 270 P3d 296 (2011)
Section requires insurers and self-insured employers to reopen claim for processing upon any finding that omitted claim is compensable, regardless of pendency of appeal or review of that compensability finding. Providence Health System v. Walker, 252 Or App 489, 289 P3d 256 (2012), Sup Ct review denied
New or omitted condition claim for compensable condition made after claim closure may not be denied due to assumption that previously denied condition has been previously processed because encompassed in original acceptance. Simi v. LTI, Inc. - Lynden, Inc., 368 Or 330, 491 P3d 33 (2021)
Other
Insurer acceptance of claim does not prevent noncomplying employer from denying claim and demanding hearing on compensability. Clark v. Linn, 98 Or App 393, 779 P2d 203 (1989)
Failure of party to raise issue at hearing did not constitute waiver where no relinquishment of right was intended. Drews v. EBI Companies, 310 Or 134, 795 P2d 531 (1990); V. W. Johnson & Sons v. Johnson, 103 Or App 355, 797 P2d 396 (1990), Sup Ct review denied
SAIF and Department of Insurance and Finance had standing to seek review of disputed claim settlement between claimant and noncomplying employer. Trojan Concrete v. Tallant, 107 Or App 429, 812 P2d 433 (1991), Sup Ct review denied
Where out-of-state employer accepts claim for subsequent injury, inadequacy of compensation for subsequent injury does not bar release of Oregon employer from responsibility for combined condition. Wootton v. Stadeli Pump & Construction, 108 Or App 548, 816 P2d 689 (1991)
Where claimant was employee, stockholder and manager of corporate employer, claimant satisfied injury notice requirement by notifying employer, and claim was not barred notwithstanding failure of employer to notify insurer of claim. Barney’s Karts, Inc. v. Vance, 110 Or App 62, 821 P2d 422 (1991)
Claimant is not entitled to overpayment of temporary disability benefits for period between medically stationary date and claim closure. Santos v. Caryall Transport, 152 Or App 322, 954 P2d 187 (1998)
“New medical condition” is one that: 1) arises after acceptance of initial claim; 2) is related to initial claim; and 3) involves condition other than condition initially accepted. Johansen v. SAIF, 158 Or App 672, 976 P2d 84 (1999), on reconsideration 160 Or App 579, 987 P2d 524 (1999), Sup Ct review denied
Unless direct medical sequela to accepted compensable condition has been specifically denied, both condition and its sequelae must be medically stationary at time of claim closure. Manley v. SAIF, 181 Or App 431, 45 P3d 1027 (2002)
New medical condition is subject to 1995 and 1997 amendments if, on July 25, 1997, claim was perfected and not yet processed or was pending in litigation. Hiner v. Crawford Health & Rehabilitation, 183 Or App 640, 54 P3d 633 (2002)
Duty of injured worker to cooperate in investigation of claim for compensation is not breached by failure to explain alleged lack of cooperation. SAIF v. Dubose, 193 Or App 62, 88 P3d 933 (2004)
Administrative system for issuing backup denial does not divest circuit court of jurisdiction over unjust enrichment action arising out of payment on mistakenly accepted claim. Specialty Risk Services v. Royal Indemnity Co., 213 Or App 620, 164 P3d 300 (2007)
If claimant requests hearing on employer’s denial of combined condition injury claim, employer bears burden of proving that, as of date of denial, claimant’s condition had ceased to be major contributing cause of claimant’s combined condition unless claim involves occupational disease. Washington County v. Jansen, 248 Or App 335, 273 P3d 278 (2012)
Where claimant receives medical services for denied claim from physician outside of employer’s managed care organization, physician may serve as “attending physician” for purposes of authorizing time loss. Orowheat-Bimbo Bakeries USA-BBU, Inc. v. Vargas, 287 Or App 331, 401 P3d 1256 (2017)
When benefits have been suspended due to failure of claimant to reasonably cooperate with employer’s investigation, denial of claim for noncooperation is procedurally invalid if claimant reasonably cooperates within 30 days of notice of suspension. Hilton Hotels Corp. v. Yauger, 295 Or App 330, 433 P3d 411 (2018)
Law Review Citations
27 WLR 81 (1991); 32 WLR 217 (1996)
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