MEMORANDUM - Workers' Compensation



MEMORANDUM CREATEDATE \@ "MMMM d, yyyy" July 30, 2019To:Medical Advisory CommitteeFrom:Cathy Ostrand-Ponsioen, Legal Issues CoordinatorSubject:Oregon Supreme Court opinion regarding medical servicesOn May 31, 2019, the Oregon Supreme Court issued on opinion that affects the compensability of medical services in workers’ compensation claims. The case is Garcia-Solis v. Farmers Ins. Co.. The Workers’ Compensation Law provides: “For every compensable injury, the insurer … shall cause to be provided medical services for conditions caused in material part by the injury ….” Prior opinions held that the “injury” referred only to the conditions that had been accepted as part of the worker’s claim. The court has now concluded that the “injury,” in the context of medical services, means the workplace accident, not the accepted conditions.The facts of the Garcia-Solis case are as follows: The worker was working as a food server outdoors when she was hit on the head by a tent pole in high winds. The insurer accepted several physical conditions. The worker later began to experience psychological problems when it was windy outside. Her doctor recommended a psychological referral to address PTSD-like symptoms. The insurer did not authorize the referral on the ground that it was not causally related to any of the accepted conditions. The Administrative Law Judge, Workers’ Compensation Board, and a majority of the Court of Appeals all ruled in favor of the insurer. The Supreme Court reversed.As a result of the court’s opinion, the ORS 656.245(1)(a) is to be read as follows:“For every compensable injury, the insurer or the self-insured employer shall cause to be provided medical services for conditions caused in material part by the injury [the workplace accident] for such period as the nature of the injury [the medical condition that resulted from the workplace accident] or the process of the recovery requires, subject to the limitations in ORS 656.225, including such medical services as may be required after a determination of permanent disability. In addition, for consequential and combined conditions described in ORS 656.005 (7), the insurer or the self-insured employer shall cause to be provided only those medical services directed to medical conditions caused in major part by the injury [the workplace accident].”The Workers’ Compensation Division has reviewed language in its rules and publications that is specific to medical services, and is revising any language that is not consistent with the court’s opinion. The court’s opinion leaves open the question of whether “injury” means the workplace accident or the accepted conditions in contexts other than medical services and combined conditions (addressed by Brown v. SAIF in 2017). We expect to see more litigation on those issues. ................
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