Title: SAIF v. Dubose

State: oregon

Issuer: Oregon Supreme Court

Document:

FILED: AUGUST 7, 2003
IN THE SUPREME COURT OF THE STATE OF OREGON
In the Matter of the Compensation of
Jodie M. Dubose, Claimant.
SAIF CORPORATION
and EVERGREEN RESTAURANT GROUP,
Respondents on Review,
	v.
JODIE M. DUBOSE,
Petitioner on Review.
(WCB 97-01993; CA A103853; SC S47731)
	On review from the Court of Appeals.*
	Argued and submitted September 10, 2001.
	Edward J. Harri, Salem, argued the cause for petitioner on
review.  With him on the brief was James C. Egan, Albany.
	Julene M. Quinn, Salem, argued the cause and filed the brief
for respondents on review.
	Before Carson, Chief Justice, and Gillette, Durham, Riggs,
De Muniz, and Balmer, Justices.**
	RIGGS, J.
	The decision of the Court of Appeals is reversed, and the
case is remanded to the Court of Appeals for further proceedings.
	*Judicial review from the Workers' Compensation Board. 166 Or App 642, 999 P2d 529 (2000).
	**Leeson, J., resigned January 31, 2003, and did not
participate in the decision of this case. 
	RIGGS, J.
	In this workers' compensation case, SAIF Corporation
(SAIF), the insurer, denied a claim for benefits because claimant
had failed to cooperate with SAIF's investigation.  Claimant
requested a hearing, using the standardized form that the
Workers' Compensation Board (board) provides for such requests,
but she did not check a box on the hearing request form to
indicate that SAIF had denied her claim for "worker
noncooperation."  Instead, claimant checked the box to indicate
that SAIF had denied her claim on "compensability - complete
claim denial" grounds.  At the hearing, SAIF argued that claimant
was not entitled to a hearing on the denial of her claim because
she had failed to request an "expedited hearing" on the denial of
her claim on noncooperation grounds.  The administrative law
judge (ALJ) and, later, the board held that claimant had failed
to attend an insurer medical examination (IME), (1) but that her
failure to attend was for reasons beyond her control.  The Court
of Appeals reversed, holding that claimant had been required to
request an "expedited hearing" and that, by checking the
incorrect box on the hearing request form, she had failed to do
so.  SAIF v. Dubose, 166 Or App 642, 999 P2d 529 (2000).  For the
reasons that follow, we reverse the decision of the Court of
Appeals and remand to that court for further proceedings.
	We take the following undisputed facts from the opinion
of the Court of Appeals and the record:
		"Claimant filed a claim for workers' compensation
benefits based on a diagnosis of carpal tunnel syndrome
and situational anxiety, the cause of which she
attributed to her work as an assistant manager of a
McDonald's restaurant.  SAIF scheduled claimant for an
independent medical examination (IME), notified her of
the date, time, and place of the IME, and reminded
claimant of her obligation to cooperate and assist in
the investigation of her claim.  See ORS 656.262(14). 
Claimant did not attend the IME.  On January 24, 1997,
the Department of Consumer and Business Services (DCBS)
notified claimant that it would be suspending her
compensation benefits for 'noncooperation' based on her
failure to attend the IME.  DCBS later issued an order
suspending benefits and allowing SAIF to deny the claim
unless claimant cooperated within 30 days of the
January 24 notice.  Claimant did not appeal that order. 
Nor did she communicate with DCBS or SAIF during the
30-day period.  SAIF denied the claim on February 25,
1997, citing claimant's failure to cooperate as the
sole reason for the denial.
		"On March 5, 1997, claimant requested a hearing on
SAIF's denial by filling out a standardized form
provided by the Board.  That form stated:  'A hearing
is requested for the reason(s) checked below.'  
Claimant checked 'DENIAL' and, as the reason for the
denial, marked 'Compensability--complete claim denial.' 
Claimant did not check the box identifying a denial
based on 'Worker noncooperation.'
		"A hearing was scheduled for June 2, 1997, almost
three months after claimant's hearing request.  At the
beginning of the hearing, the ALJ identified the issues
before it as 'compensability of the claim and a
carrier-paid fee if claimant prevails.'  SAIF clarified
that its denial was not based on noncompensability but
was based, instead, on claimant's noncooperation.  SAIF
argued that claimant should not be allowed to proceed
because she had failed to request an expedited hearing
as required by ORS 656.262(15), which provides, in
part:
		'[T]he insurer * * * may deny the claim
because of the worker's failure to cooperate. 
* * *  After such a denial, the worker shall
not be granted a hearing or other proceeding
under this chapter on the merits of the claim
unless the worker first requests and
establishes at an expedited hearing under ORS
656.291 that the worker fully and completely
cooperated with the investigation, that the
worker failed to cooperate for reasons beyond
the worker's control or that the
investigative demands were unreasonable.'  
	(Emphasis added.)  The ALJ did not consider claimant's
failure to request an expedited hearing to 'be of
significance' and determined that claimant should be
allowed to present evidence establishing the
reasonableness of her failure to attend the IME. 
Claimant put on evidence that she was unable to attend
the IME due to hazardous weather conditions, and the
ALJ concluded that claimant's failure to cooperate was
beyond her control.  Accordingly, the ALJ set aside
SAIF's denial and ordered that SAIF process the claim.
		"On review of the ALJ's order, the Board agreed
with SAIF that a worker first must challenge a
noncooperation denial before he or she is entitled to a
hearing on the merits of the claim for compensation. 
The Board determined, however, that ORS 656.262(15)
does not provide that an expedited hearing is the
'only' avenue for challenging a noncooperation denial. 
Specifically, the Board said:
			'For instance, the statute does not
provide that "the worker first requests and
establishes only at an expedited
hearing * * *."  In the absence of such
limiting language, we find that the statute
shows that an expedited hearing is an option,
not a requirement.
			'* * * Under ORS 656.291 and OAR
438-013-0010(1)(c), the Board assigns certain
cases to the Expedited Claims Service.  In
other words, there is no statutory procedure
for the worker to request an expedited
hearing.'
	(Emphasis in original.)  Thus, the Board concluded that
a worker need only make a generic request for a hearing
and that the Board has the option, but not a mandatory
duty, to provide a hearing on an expedited basis.  The
Board therefore affirmed the ALJ's order."
Dubose, 166 Or App at 644-46 (footnote omitted).  SAIF sought
judicial review.
	The Court of Appeals reversed.  The court first
rejected the board's conclusion that ORS 656.262(15) did not
mandate an expedited hearing.  The court also rejected the
board's conclusion that a claimant has no duty to request an
expedited hearing if the insurer denied the claim for worker
noncooperation.  The court noted that the statutory text "plainly
places a burden on the worker to make an effective request for
the necessary hearing."  166 Or App at 647.  The court concluded
that the board provided a reasonable means for claimants to
request an expedited hearing on a noncooperation denial: 
checking the appropriate box on the standardized form that the
board provided.  As the court reasoned, claimant here did not
check the correct box and, therefore, did not receive an
expedited hearing.  "Given claimant's failure to do the minimum
necessary to request an expedited hearing, and because an
expedited hearing in fact was not held, SAIF was entitled to have
the noncooperation denial upheld."  Id.at 648.  Claimant
petitioned this court for review.
	As the foregoing summary reveals, this case requires
that we determine what steps the pertinent statutes required
claimant to take to obtain a hearing after SAIF denied her claim
on the ground of worker noncooperation.  For the reasons set out
below, we conclude that claimant does not have a duty to specify
for the board that the hearing requested is an expedited one. 
	In construing the relevant statutes, we use the
methodology that this court summarized in PGE v. Bureau of Labor
and Industries, 317 Or 606, 610-12, 859 P2d 1143 (1993).  At the
first level of analysis, we examine the text and context of the
statute, giving words of common usage their plain, natural, and
ordinary meaning.  Id.  If that examination reveals the clear
intent of the legislature, then our inquiry is complete.  Id. at
611.
	We begin with ORS 656.262.  One part of that statute
imposes on a claimant a duty to cooperate with the insurer's
investigation of a claim for workers' compensation benefits.  ORS
656.262(14). (2)  A second part of that statute sets out the
consequences of a claimant's failure to cooperate and provides,
in part:
		"(15) If the director finds that a worker fails to
reasonably cooperate with an investigation involving an
initial claim to establish a compensable injury or an
aggravation claim to reopen the claim for a worsened
condition, the director shall suspend all or part of
the payment of compensation after notice to the worker. 
If the worker does not cooperate for an additional 30
days after the notice, the insurer or self-insured
employer may deny the claim because of the worker's
failure to cooperate. * * *  After such a denial, the
worker shall not be granted a hearing or other
proceeding under this chapter on the merits of the
claim unless the worker first requests and establishes
at an expedited hearing under ORS 656.291 that the
worker fully and completely cooperated with the
investigation, that the worker failed to cooperate for
reasons beyond the worker's control or that the
investigative demands were unreasonable.  If the
Administrative Law Judge finds that the worker has not
fully cooperated, the Administrative Law Judge shall
affirm the denial, and the worker's claim for injury
shall remain denied.  If the Administrative Law Judge
finds that the worker has cooperated, or that the
investigative demands were unreasonable, the
Administrative Law Judge shall set aside the denial,
order the reinstatement of interim compensation if
appropriate and remand the claim to the insurer or
self-insured employer to accept or deny the claim."
ORS 656.262(15) (emphasis added).
	The emphasized wording of ORS 656.262(15) indicates
that, if an insurer denies a claim because of a claimant's
failure to cooperate, then the claimant "shall not" receive any
further proceedings on the merits of the claim "unless the worker
first requests and establishes at an expedited hearing under ORS
656.291" one of the facts set out in the statute that
demonstrates the claimant's cooperation or justifies or excuses
the claimant's noncooperation.  The wording of that condition,
viewed in isolation, does not make clear whether the word
"requests" requires a claimant specifically to request an
expedited hearing or whether the claimant need request only a
hearing and then must establish the pertinent facts at the
disposition of the claim under ORS 656.291.
	That potential ambiguity disappears, however, when we
consider that statute together with ORS 656.291, which provides,
in part:
		"(1) The Workers' Compensation Board, by rule,
shall establish an Expedited Claim Service to provide
for prompt, informal disposition of claims.
		"(2) The board shall assign to the service those
claims:
		"(a) For which a hearing has been requested when
the only matters unresolved do not include
compensability of the claim and the amount in
controversy is $1,000 or less * * *."
	ORS 656.291(2)(a) imposes on the board the obligation
to assign to the Expedited Claim Service (ECS) claims that meet
three requirements.  First, a party must have requested a
hearing.  Second, the matters unresolved must not include the
compensability of the claim.  Third, the amount in controversy
must be $1,000 or less.
	Under that subsection, the board's assignment
responsibility depends on the occurrence of a single procedural
act:  the submission of a request for a hearing by a party. 
Nothing in the wording of the statute indicates that the
requesting party has any pleading obligation to request an
expedited hearing under ORS 656.291(2)(a).  In that respect, the
legislature's procedure for requesting a hearing under ORS
656.291(2)(a) resembles the procedure for requesting "a hearing
on any matter concerning a claim" under ORS 656.283(1), in which
a claimant also has no statutory duty to request a particular
kind of hearing.
	ORS 656.291(2)(a) also does not characterize the second
and third criteria identified in that statutory provision as
pleading requirements that the party who requests the hearing
must satisfy.  Rather, they are facts that the board must
address.  If they are true, then the board's assignment
responsibility under the statutory provision arises.
	The hearing procedure on a noncooperation denial
described in ORS 656.262(15) similarly begins with a single
procedural act:  the submission of a request for a hearing by the
worker.  There are obvious distinctions in the subject matter of
the hearings described in ORS 656.262(15) and ORS 656.291(2)(a). 
However, those distinctions have nothing to do with, and
therefore do not undermine, the significance of the similarity of
the procedural step that the legislature chose for the initiation
of hearings under each statute.  
	ORS 656.262(15) and ORS 656.291(2)(a) each specify the
statutory criteria that govern whether a claim qualifies for an
expedited hearing.  Under ORS 656.262(15), the board must resolve
through an expedited hearing all claims for which the claimant
requests a hearing if the insurer or employer has denied the
claim due to the claimant's failure to cooperate.  As noted
above, ORS 656.291(2)(a) lists the criteria that the board must
assess (specifically, no compensability issue is present and the
amount in controversy must be $1,000 or less), but requires the
board to assign to the ECS each claim that meets the listed
criteria.
	In this case, the board focused on the symmetry,
discussed above, in the procedural operation of ORS 656.262(15)
and ORS 656.291(2)(a).  The board concluded that, under ORS
656.262(15), a claimant must request a hearing after an insurer
denies a claim for noncooperation and that, following a request
for a hearing, "if appropriate, it is the Board's duty to assign
the case to [the ECS]."
	That reasoning is persuasive.  Under the two statutes
discussed above, the responsibility to provide an expedited
hearing arises from the board's application of statutory criteria
to the parties' dispute, not from any pleading burden that the
statutes impose.  SAIF's contrary construction would alter, and
significantly reduce, the board's responsibility under ORS
656.262(15) by allowing the form of the claimant's request for
hearing, rather than the board's assessment of the nature of the
dispute, to determine whether the board shall schedule an
expedited hearing under ORS 656.291.  That construction might
permit a claimant, by artful pleading, to force the board to
proceed directly to a hearing on the merits and undermine the
legislature's declaration in ORS 656.262(15) that an expedited
hearing on a noncooperation denial must precede "a hearing or
other proceeding under this chapter on the merits of the claim * * *."
	The foregoing discussion of the context of ORS
656.262(15) satisfies us that the legislature did not intend to
impose under that statute a pleading burden requiring a claimant
to request a hearing that is expedited.  The statutory term
"requests" refers to a request for a hearing, not to a request
for a particular kind of hearing.  As the board correctly
concluded, once the claimant requests a hearing, the obligation
to schedule an expedited hearing under that statute rests with
the board.  Because the legislature's intent is clear from the
statutory text and context, our interpretive task is at an end.  
	Here, the board determined that claimant had requested
a hearing and that no statute required her specifically to
request an expedited hearing.  The board's construction of ORS
656.262(15) in that regard was correct.  The Court of Appeals
erred in reaching a contrary conclusion.
	SAIF also contends that claimant in this case did not
actually receive "an expedited hearing under ORS 656.291" and
that ORS 656.262(15) bars further proceedings on the merits
unless the claimant received such a hearing. We agree that
ORS 656.262(15) contemplates that the board will assign to the
ECS each claim in which a claimant requests a hearing on a
noncooperation denial.  The board erred in concluding that its
assignment obligation was only an option.  We also agree with
SAIF that the board did not assign this claim to the ECS. 
Instead, the ALJ conducted a conventional hearing limited to the
worker cooperation issues identified in ORS 656.262(15), decided
that claimant had failed to cooperate for reasons beyond her
control, set aside SAIF's noncooperation denial, and remanded the
claim for further processing.  On review, the board affirmed.
	SAIF is unable to identify any aspect of the board's
substantive decision that departed from the issues that an
expedited hearing under ORS 656.262(15) must resolve.  The board
addressed only the issue of claimant's alleged noncooperation and
made no determination regarding the merits of the claim.  ORS
656.262(15) does not require the board, in an expedited hearing,
to reach any other disposition of the claim. 
	That leaves SAIF to argue only that the hearing did not
occur within the expedited time frame identified in ORS
656.291(3)(b):
		"Cases assigned to the Expedited Claim Service
pursuant to subsection (2)(a) of this section shall be
heard within 30 days of the request for hearing, and an
order shall be issued within 10 days of the close of
the hearing."
We agree that, due to the board's failure to assign the case
under ORS 656.291(2), the parties suffered a delay of
approximately three and one-half months in the disposition of
SAIF's noncooperation denial.
	We conclude, however, that SAIF's argument presents a
dispute over procedure that lacks substantive content.  SAIF
contends, for example, that mental stress conditions can be
fleeting and that, in evaluating such claims, time is of the
essence.  We do not disagree with those general assertions, but,
in the context of this case, they are little more than
abstractions that fail to identify, from evidence in the record,
prejudicial error caused by the procedure that the board
followed.  SAIF's arguments are unresponsive to the only issue
before the ALJ and the board:  Did claimant fail to attend the
IME for reasons beyond her control?  SAIF points to nothing in
the record that demonstrates that the timing of the hearing or
the board's order had any effect on the board's resolution of
that issue. 
	SAIF cites two cases in support of its argument.  In
Mabon v. Myers, 329 Or 1, 984 P2d 278 (1999), this court
dismissed a petition to review a ballot title because the
petitioner, in violation of a statutory obligation, had failed to
notify the Secretary of State of the filing of the petition
within the time specified by law.  The court held that, under the
pertinent statutes, compliance with the notice requirement was a
prerequisite to obtaining review of a ballot title.  Id. at 4.
	In Norton v. Compensation Department, 252 Or 75, 448
P2d 382 (1968), this court affirmed a denial of workers'
compensation benefits because the claimant, in violation of the
applicable statute, had failed to request a hearing by the board
within the time permitted by law.  The relevant statute directed
the board not to grant a hearing or enforce the claim unless the
claimant timely filed a request for hearing.
	The cases on which SAIF relies are distinguishable. 
They involve enforcement of statutorily required consequences
that flow from a litigant's failure to timely request
administrative or judicial relief.  This case involves no similar
procedural default by a litigant.  Claimant did all that the law
required of her to request a hearing on SAIF's noncooperation
denial.  The board failed to assign the claim to the ECS, due
perhaps to the board's misunderstanding of its duty to do so. 
However, the ALJ conducted a hearing, and the board rendered a
decision that, on this record, is substantively identical to the
dispositon that the parties would have received if the board had
assigned the claim to the ECS.
	In the absence of a legislative pronouncement,
analogous to the statute addressed in Norton, of the consequence
that must result from the board's failure to assign the claim to
the ECS or from an untimely disposition of the claim by the
board, we examine whether the procedure followed below resulted
in prejudice to the party seeking relief on review.  SAIF makes
no showing on this record that the board's procedure in this case
caused prejudice of any kind to SAIF's legal position. 
Consequently, SAIF has not demonstrated that it is entitled to
relief on review from the board's order because of the board's
failure to assign the claim to the ECS.
	We remand the case to the Court of Appeals to permit
that court to consider SAIF's remaining assignments of error.
	The decision of the Court of Appeals is reversed, and
the case is remanded to the Court of Appeals for further
proceedings.



1. The ALJ and the board referred to the procedure as an
"independent" medical examination.  However, we refer to the
procedure described in ORS 656.325(1)(a) as an insurer medical
examination, because the Director of the Department of Consumer
and Business Services used that designation in OAR 436-010-0265,
the administrative rule that establishes procedures for medical
examinations that an insurer requires under ORS 656.325(1)(a).

2. ORS 656.262(14) provides, in part:
		"(14) Injured workers have the duty to cooperate
and assist the insurer or self-insured employer in the
investigation of claims for compensation.  Injured
workers shall submit to and shall fully cooperate with
personal and telephonic interviews and other formal or
informal information gathering techniques."