Oregon Supreme Court Finds Treatment Can be Compensable for Injuries not Accepted

June 4, 2019

The Oregon Supreme Court reversed both the Workers’ Compensation Board and the Court of Appeals and ruled that an injured worker was entitled to diagnostic services by a psychologist even though no psychological injury had been accepted by the insurer.

In Garcia-Solis v. Farmers Insurance Co., the high court on Friday ruled en banc that an injured worker can be entitled to medical care even if it’s not for the specific conditions that were accepted by the employer or insurer. The decision will allow claimant Elvia Garcia-Solis to see a specialist to find out if she suffers from post-traumatic stress syndrome from her workplace accident.

Oregon attorneys were watching the case carefully because it gave the Supreme Court an opportunity to clarify its 2017 decision in Brown v. SAIF. The Court of Appeals had interpreted the Brown decision to mean “compensable injury” refers only to accepted conditions. While in some contexts that might be a correct conclusion, the Supreme Court found that the word “injury” is used to mean different things within the same workers’ compensation statute. The proper interpretation depends on the context.

“In short, ORS 656.245(1)(a) presents a situation where the same term—here, ‘injury’— is used in different ways, with apparently different meanings, within the same statutory provision,” the opinion states.

Elvia Garcia-Solis suffered numerous fractures in 2009 when high winds blew down a tent pole at an event where she was working as a server for Yeaun Corp. Farmers Insurance accepted numerous conditions, including lacerations to her skull, a fractured clavicle, ribs and vertebrae and chronic migraines.

Garcia-Solis’ physician referred her to a psychologist because she complained that she became frightened and tearful in times of strong wind. Farmers denied the visit because it had not accepted any psychological injury.

A workers’ compensation judge ruled that because her physician did not diagnose Garcia-Solis with PTSD, she was effectively trapped by Oregon statutes. She cannot undergo an evaluation to determine if she had a compensable mental health condition without a diagnosis on which to premise a new medical condition claim.

The Workers’ Compensation Board and the Court of Appeals both affirmed that finding based on Brown.

Defense attorney Kelsey Fleharty, with Reinisch Wilson Weier in Portland, wrote in a blog post that the Court of Appeals decision was good for employers by following the precedent set in the Brown decision.

“Therefore, claimants cannot secure diagnostic services, and presumably medical services as a whole, based upon a mere connection to the injury incident,” Fleherty wrote. “Instead, the burden is on the injured worker to file a new/omitted medical condition claim to reconcile any disagreement with the scope of acceptance.”

The Supreme Court, however, in its decision in Garcia-Solis refuted the insurer’s assertion that medical services are compensable only if they are for an accepted condition. The court said the Brown opinion is not clear if “compensable injury” means only accepted medical conditions. In that case, the court was analyzing whether a worker with combined conditions — some accepted and some not — was entitled to medical treatment.

The Garcia-Solis case is based on a different scenario, the court said. The court in Brown stated specifically that it was not addressing whether diagnostic services were compensable, so it offered no guidance.

“The Court of Appeals and board decisions depended entirely on the contrary conclusion of law, that ‘compensable injury’ in ORS 656.245(1)(a) means only ‘accepted conditions,'” the opinion states. “Because those holdings were in error, we reverse.”

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