ORS 656.273
Aggravation for worsened conditions

  • procedure
  • limitations
  • additional compensation

(1)

After the last award or arrangement of compensation, an injured worker is entitled to additional compensation for worsened conditions resulting from the original injury. A worsened condition resulting from the original injury is established by medical evidence of an actual worsening of the compensable condition supported by objective findings. However, if the major contributing cause of the worsened condition is an injury not occurring within the course and scope of employment, the worsening is not compensable. A worsened condition is not established by either or both of the following:

(a)

The worker’s absence from work for any given amount of time as a result of the worker’s condition from the original injury; or

(b)

Inpatient treatment of the worker at a hospital for the worker’s condition from the original injury.

(2)

To obtain additional medical services or disability compensation, the injured worker must file a claim for aggravation with the insurer or self-insured employer. In the event the insurer or self-insured employer cannot be located, is unknown, or has ceased to exist, the claim shall be filed with the Director of the Department of Consumer and Business Services.

(3)

A claim for aggravation must be in writing in a form and format prescribed by the director and signed by the worker or the worker’s representative and the worker’s attending physician. When an insurer or self-insured employer receives a completed aggravation form, the insurer or self-insured employer shall process the claim.

(4)

The claim for aggravation must be filed within five years:

(a)

After the first notice of closure made under ORS 656.268 (Claim closure) for a disabling claim; or

(b)

After the date of injury, provided the claim has been classified as nondisabling for at least one year after the date of acceptance.

(5)

The director may order the claimant, the insurer or self-insured employer to pay for such medical opinion.

(6)

A claim submitted in accordance with this section shall be processed by the insurer or self-insured employer in accordance with the provisions of ORS 656.262 (Processing of claims and payment of compensation). The first installment of compensation due under ORS 656.262 (Processing of claims and payment of compensation) shall be paid no later than the 14th day after the subject employer or paying agent of the subject employer receives a written report that verifies the worker’s inability to work resulting from a compensable worsening under subsection (1) of this section and that establishes by medical evidence supported by objective findings that the claimant has suffered a worsened condition attributable to the compensable injury.

(7)

A request for hearing on any issue involving a claim for aggravation must be made to the Workers’ Compensation Board in accordance with ORS 656.283 (Hearing rights and procedure).

(8)

If the worker submits a claim for aggravation of an injury or disease for which permanent disability has been previously awarded, the worker must establish that the worsening is more than waxing and waning of symptoms of the condition contemplated by the previous permanent disability award. [1973 c.620 §5 (enacted in lieu of 656.271); 1975 c.497 §1; 1977 c.804 §7; 1979 c.839 §6; 1981 c.854 §20; 1987 c.884 §23; 1989 c.171 §76; 1990 c.2 §18; 1995 c.332 §31; 1999 c.313 §2; 2001 c.350 §1; 2005 c.50 §1]

Source: Section 656.273 — Aggravation for worsened conditions; procedure; limitations; additional compensation, https://www.­oregonlegislature.­gov/bills_laws/ors/ors656.­html.

See also annotations under ORS 656.271 in permanent edition.

Notes of Decisions

Under former similar statute (ORS 656.271)

Same procedure applies to aggravation claims for injury and aggravation claims for occupational disease. Schoch v. SAIF, 9 Or App 100, 496 P2d 53 (1972)

Physician’s opinion in support of aggravation claim must indicate that there are reasonable grounds for claim that disability has been aggravated subsequent to last award or arrangement of compensation, and in absence of opinion that meets this requirement, board lacks jurisdiction to award increased compensation on account of aggravation. McKinney v. G. L. Pine, Inc., 16 Or App 619, 519 P2d 1265 (1974)

In general

Payment of medical expenses under ORS 656.245 following filing of claim does not amount to acceptance and does not estop employer or insurer from contesting claim. Jacobson v. SAIF, 36 Or App 789, 585 P2d 1146 (1978), Sup Ct review denied

Increased loss of earning capacity is not prerequisite to aggravation claim. Webster v. SAIF, 52 Or App 957, 630 P2d 375 (1981)

In claim for increased compensation for unscheduled disability, worker need not show decreased ability to work in present employment, but must prove decreased ability to work in broad field of general occupations, resulting in loss of earning power. Smith v. SAIF, 302 Or 396, 730 P2d 30 (1986)

For purpose of commencing acceptance period, insurer has “notice or knowledge” of claim beginning with date claim notice is received by insurer. Barr v. EBI Companies, 88 Or App 132, 744 P2d 582 (1987)

Psychologist is “physician” capable of providing medical verification of inability to work. Crooke v. Gresham Transfer, 88 Or App 246, 744 P2d 1316 (1987)

In order to obtain increased award of permanent disability, worker must show that worsening of health condition resulted from original injury. Stepp v. SAIF, 304 Or 375, 745 P2d 1207 (1987); Nethercott v. SAIF, 126 Or App 210, 867 P2d 566 (1994)

Worker who had returned to work while claim remained open was entitled to receive temporary total disability benefits for later inability to work although no worsening of condition was shown, because worsening is required only after claim has initially been closed. Hallmark Fisheries v. Harvey, 100 Or App 657, 788 P2d 471 (1990)

Worker needs to prove only that worsening has resulted in loss of earning capacity, not actual wage loss. International Paper Co. v. Hubbard, 109 Or App 452, 820 P2d 35 (1991)

Worsened condition is rated under system existing at time of worsening, not rating system existing at time of initial claim closure. Buddenberg v. Southcoast Lumber, 112 Or App 148, 826 P2d 1062 (1992), aff’d 316 Or 180, 850 P2d 360 (1993)

Limitation for filing claim for injury that has been “in nondisabling status for one year” applies only where injury is nondisabling at time of injury and remains nondisabling for one year following time of injury. SM Motor Co. v. Mather, 117 Or App 176, 843 P2d 998 (1992)

Where claimant’s injury was initially disabling, it was subject to limitation of five years from first determination or first notice of closure. SM Motor Co. v. Mather, 117 Or App 176, 843 P2d 998 (1992)

Where injury was reclassified from nondisabling to disabling more than one year after injury and claimant failed to establish that injury became disabling within one year after injury date, claimant was subject to aggravation of claims limit of five years from injury date. Normandeau v. Aetna Casualty & Surety Co., 120 Or App 184, 851 P2d 217 (1993)

Aggravations are measured by same standard that made condition originally compensable. Fred Meyer, Inc. v. Farrow, 122 Or App 164, 857 P2d 189 (1993)

Claimant is not required to prove diminished capacity to work in order to pursue claim for additional medical services. Meyers v. Darigold, Inc., 123 Or App 217, 861 P2d 352 (1993), Sup Ct review denied

Once claimant establishes that compensable injury is material contributing cause to injury, employer claiming that off-the-job injury is major cause of aggravated condition has burden of proof. Fernandez v. M & M Reforestation, 124 Or App 38, 860 P2d 898 (1993); Asplundh Tree Expert Co. v. Hart, 132 Or App 494, 888 P2d 1082 (1995), Sup Ct review denied

Medical verification of inability to work must come from attending physician to trigger insurer obligation to commence payment of aggravation claim benefits. SAIF v. Christensen, 130 Or App 346, 882 P2d 125 (1994)

Claim must be accepted and classified as nondisabling before it can be in “nondisabling status.” Liberty Northwest Ins. Corp. v. Koitzsch, 140 Or App 194, 914 P2d 1102 (1996)

“Actual worsening” of compensable condition means worsening of pathological condition as determined by direct medical evidence, not by worsening of symptoms. SAIF v. Walker, 145 Or App 294, 930 P2d 230 (1996), aff’d 330 Or 102, 996 P2d 979 (2000)

1995 amendments did not remove requirement that claimant prove loss of earning capacity as element of unscheduled disability aggravation claim. Intel Corp. v. Renfro, 155 Or App 447, 963 P2d 173 (1998)

Increased symptomatology beyond waxing and waning contemplated by previous award may be relied upon by physician in determining whether underlying condition has actually worsened. SAIF v. Walker, 330 Or 102, 996 P2d 979 (2000)

“Objective findings” supporting claim for aggravation must, at least as prima facie matter, evince worsening of claimant’s condition. Liberty Northwest Insurance Corp. v. Stapleton, 192 Or App 312, 84 P3d 1116 (2004)

Claimant may request hearing on aggravation claim without perfecting that claim where insurer has denied claim on merits. Ake v. SAIF, 192 Or App 617, 87 P3d 673 (2004)

Where claimant experiences pathological changes, proof of aggravation does not require opinion of medical expert that changes are due to worsening of compensable condition. Johnson v. SAIF, 194 Or App 689, 96 P3d 830 (2004)

If worsened condition is established, worker is once again entitled to broader suite of medical services required by worker’s compensation statutes for conditions caused in material part by original compensable injury. Basin Tire Service, Inc. v. Minyard, 240 Or App 715, 249 P3d 127 (2011)

Attorney General Opinions

In general

Constitutionality of application, (1976) Vol 37, p 1079; procedural quality of provisions, (1976) Vol 37, p 1079

Law Review Citations

In general

27 WLR 94 (1991); 32 WLR 217 (1996)

656.001
Short title
656.003
Application of definitions to construction of chapter
656.005
Definitions
656.006
Effect on employers’ liability law
656.008
Extension of laws relating to workers’ compensation to federal lands and projects within state
656.010
Treatment by spiritual means
656.012
Findings and policy
656.017
Employer required to pay compensation and perform other duties
656.018
Effect of providing coverage
656.019
Civil negligence action for claim denied on basis of failure to meet major contributing cause standard
656.020
Damage actions by workers against noncomplying employers
656.021
Coverage exception for laborers under contracts with construction and landscape contractor licensees
656.023
Who are subject employers
656.025
Individuals engaged in commuter ridesharing not subject workers
656.027
Who are subject workers
656.029
Obligation of person awarding contract to provide coverage for workers under contract
656.031
Coverage for municipal volunteer personnel
656.033
Coverage for participants in work experience or school directed professional training programs
656.035
Status of workers in separate occupations of employer
656.037
Exemption from coverage for persons engaged in certain real estate activities
656.039
Election of coverage for workers not subject to law
656.041
City or county may elect to provide coverage for adults in custody
656.043
Governmental agency paying wages responsible for providing coverage
656.044
State Accident Insurance Fund Corporation may insure liability under Longshoremen’s and Harbor Workers’ Compensation Act
656.046
Coverage of persons in college work experience and professional education programs
656.052
Prohibition against employment without coverage
656.054
Claim of injured worker of noncomplying employer
656.056
Subject employers must post notice of manner of compliance
656.070
Definitions for ORS 656.027, 656.070 and 656.075
656.075
Exemption from coverage for newspaper carriers
656.126
Coverage while temporarily in or out of state
656.128
Sole proprietors, limited liability company members, partners, independent contractors may elect coverage by insurer
656.132
Coverage of minors
656.135
Coverage of deaf school work experience trainees
656.138
Coverage of apprentices, trainees participating in related instruction classes
656.140
Coverage of persons operating equipment for hire
656.154
Injury due to negligence or wrong of a person not in the same employ as injured worker
656.156
Intentional injuries
656.160
Effect of incarceration on receipt of compensation
656.170
Validity of provisions of certain collective bargaining agreements
656.172
Applicability of and criteria for establishing program under ORS 656.170
656.174
Rules
656.202
Compensation payable to subject worker in accordance with law in effect at time of injury
656.204
Death
656.206
Permanent total disability
656.208
Death during permanent total disability
656.209
Offsetting permanent total disability benefits against Social Security benefits
656.210
Temporary total disability
656.211
“Average weekly wage” defined
656.212
Temporary partial disability
656.214
Permanent partial disability
656.216
Permanent partial disability
656.218
Continuance of permanent partial disability payments to survivors
656.222
Compensation for additional accident
656.225
Compensability of certain preexisting conditions
656.226
Cohabitants and children entitled to compensation
656.228
Payments directly to beneficiary or custodian
656.230
Lump sum award payments
656.232
Payments to aliens residing outside of United States
656.234
Compensation not assignable nor to pass by operation of law
656.236
Compromise and release of claim matters except for medical benefits
656.240
Deduction of benefits from sick leave payments paid to employees
656.245
Medical services to be provided
656.247
Payment for medical services prior to claim acceptance or denial
656.248
Medical service fee schedules
656.250
Limitation on compensability of physical therapist services
656.252
Medical report regulation
656.254
Medical report forms
656.256
Considerations for rules regarding certain rural hospitals
656.258
Vocational assistance service payments
656.260
Certification procedure for managed health care provider
656.262
Processing of claims and payment of compensation
656.263
To whom notices sent under ORS 656.262, 656.265, 656.268 to 656.289, 656.295 to 656.325 and 656.382 to 656.388
656.264
Compensable injury, denied claim and other reports
656.265
Notice of accident from worker
656.266
Burden of proving compensability and nature and extent of disability
656.267
Claims for new and omitted medical conditions
656.268
Claim closure
656.273
Aggravation for worsened conditions
656.277
Request for reclassification of nondisabling claim
656.278
Board has continuing authority to alter earlier action on claim
656.283
Hearing rights and procedure
656.285
Protection of witnesses at hearings
656.287
Use of vocational reports in determining loss of earning capacity at hearing
656.289
Orders of Administrative Law Judge
656.291
Expedited Claim Service
656.295
Board review of Administrative Law Judge orders
656.298
Judicial review of board orders
656.304
When acceptance of compensation precludes hearing
656.307
Determination of issues regarding responsibility for compensation payment
656.308
Responsibility for payment of claims
656.310
Presumption concerning notice of injury and self-inflicted injuries
656.313
Stay of compensation pending request for hearing or review
656.319
Time within which hearing must be requested
656.325
Required medical examination
656.327
Review of medical treatment of worker
656.328
List of authorized providers and standards of professional conduct for providers of independent medical examinations
656.331
Contact, medical examination of worker represented by attorney prohibited without written notice
656.340
Vocational assistance procedure
656.360
Confidentiality of worker medical and vocational claim records
656.362
Liability for disclosure of worker medical and vocational claim records
656.382
Penalties and attorney fees payable by insurer or employer in processing claim
656.383
Attorney fees in cases prior to decision or after request for hearing
656.385
Attorney fees in cases regarding certain medical service or vocational rehabilitation matters
656.386
Recovery of attorney fees, expenses and costs in appeal on denied claim
656.388
Approval of attorney fees required
656.390
Frivolous appeals, hearing requests or motions
656.403
Obligations of self-insured employer
656.407
Qualifications of insured employers
656.419
Workers’ compensation insurance contracts
656.423
Cancellation of coverage by employer
656.427
Termination of workers’ compensation insurance contract or surety bond liability by insurer
656.430
Certification of self-insured employer
656.434
Certification effective until canceled or revoked
656.440
Notice of certificate revocation
656.441
Advancement of funds from Workers’ Benefit Fund for compensation due workers insured by certain decertified self-insured employer groups
656.443
Procedure upon default by employer or self-insured employer group
656.445
Advancement of funds from Workers’ Benefit Fund for compensation due workers insured by insurer in default
656.447
Sanctions against insurer for failure to comply with contracts, orders or rules
656.455
Self-insured employers to process claims and make records available at authorized locations
656.502
“Fiscal year” defined
656.504
Rates, charges, fees and reports by employers insured by State Accident Insurance Fund Corporation
656.505
Estimate of payroll when employer fails to file payroll report
656.506
Assessments for programs
656.508
Authority to fix premium rates for employers
656.526
Distribution of dividends from surplus in Industrial Accident Fund
656.536
Premium charges for coverage of reforestation cooperative workers based on prevailing wage
656.552
Deposit of cash, bond or letter of credit to secure payment of employer’s premiums
656.554
Injunction against employer failing to comply with deposit requirements
656.556
Liability of person letting a contract for amounts due from contractor
656.560
Default in payment of premiums, fees, assessments or deposit
656.562
Moneys due Industrial Accident Fund as preferred claims
656.564
Lien for amounts due from employer on real property, improvements and equipment on or with which labor is performed by workers of employer
656.566
Lien on property of employer for amounts due
656.576
“Paying agency” defined
656.578
Workers’ election whether to sue third person or noncomplying employer for damages
656.580
Payment of compensation notwithstanding cause of action for damages
656.583
Paying agency may compel election and prompt action
656.587
Paying agency must join in any compromise
656.591
Election not to bring action operates as assignment of cause of action
656.593
Procedure when worker or beneficiary elects to bring action
656.595
Precedence of cause of action
656.596
Damage recovery as offset against compensation
656.602
Disbursement procedures
656.605
Workers’ Benefit Fund
656.612
Assessments for department activities
656.614
Self-Insured Employer Adjustment Reserve
656.622
Reemployment Assistance Program
656.625
Reopened Claims Program
656.628
Workers with Disabilities Program
656.630
Oregon Institute of Occupational Health Sciences funding
656.632
Industrial Accident Fund
656.634
Trust fund status of Industrial Accident Fund
656.635
Reserve accounts in Industrial Accident Fund
656.636
Reserves in Industrial Accident Fund for awards for permanent disability or death
656.640
Creation of reserves
656.642
Emergency Fund
656.644
Petty cash funds
656.702
Disclosure of records of corporation, department and insurers
656.704
Actions and orders regarding matters concerning claim and matters other than matters concerning claim
656.708
Hearings Division
656.709
Ombudsman for injured workers
656.712
Workers’ Compensation Board
656.714
Removal of board member
656.716
Board members not to engage in political or business activity that interferes with duties as board member
656.718
Chairperson
656.720
Prosecution and defense of actions by Attorney General and district attorneys
656.722
Authority to employ subordinates
656.724
Administrative Law Judges
656.725
Duties and status of Administrative Law Judges
656.726
Duties and powers to carry out workers’ compensation and occupational safety laws
656.727
Rules for administration of benefit offset
656.730
Assigned risk plan
656.732
Power to compel obedience to subpoenas and punish for misconduct
656.735
Civil penalty for noncomplying employers
656.740
Review of proposed order declaring noncomplying employer or nonsubjectivity determination
656.745
Civil penalty for inducing failure to report claims
656.751
State Accident Insurance Fund Corporation created
656.752
State Accident Insurance Fund Corporation
656.753
State Accident Insurance Fund Corporation exempt from certain financial administration laws
656.754
Manager
656.758
Inspection of books, records and payrolls
656.772
Annual audit of State Accident Insurance Fund Corporation by Secretary of State
656.774
Annual report by State Accident Insurance Fund Corporation to Secretary of State
656.776
Notice to Secretary of State regarding action on audit report
656.780
Certification and training of claims examiners
656.790
Workers’ Compensation Management-Labor Advisory Committee
656.794
Advisory committee on medical care
656.795
Informational materials for nurse practitioners
656.797
Certification by nurse practitioner of review of required materials
656.798
Duty of insurer, self-insured employer and self-insured employer group to provide information to director
656.799
Informational materials for other health care professionals
656.802
Occupational disease
656.804
Occupational disease as an injury under Workers’ Compensation Law
656.807
Time for filing of claims for occupational disease
656.850
License
656.855
Licensing system for worker leasing companies
656.990
Penalties
Green check means up to date. Up to date