Title: Lewis v. CIGNA Ins. Co.
Citation: N/A
Docket Number: S51710
State: Oregon
Issuer: Oregon Supreme Court
Date: September 29, 2005

FILED:  September 29, 2005
IN THE SUPREME COURT OF THE STATE OF OREGON
In the Matter of the Compensation of
Marvin E. Lewis, Claimant.
MARVIN E. LEWIS,  
Petitioner on Review,
v.
CIGNA INSURANCE CO.;
and ACTIVE TRANSPORTATION CO.,
Respondents on Review.
(CC No. 97-05360, 97-05050; CA A106117; SC S51710)
On review from the Court of Appeals.*
Argued and submitted June 21, 2005.
Linda C. Love, of Williams Love O'Leary Craine &amp; Powers,
P.C., Portland, argued the cause for petitioner on review.  With
her on the briefs were Michael L. Williams and Brian S. Campf.
Richard D. Barber, Jr., of Scheminske &amp; Lyons, LLP, Lake
Oswego, argued the cause and filed the briefs for respondents on
review.  
Before Carson, Chief Justice, and Gillette, Durham, Riggs,
De Muniz, and Balmer, Justices.**
DE MUNIZ, J.
The decision of the Court of Appeals and the order of the
Workers' Compensation Board are reversed.  The case is remanded
to the Workers' Compensation Board for further proceedings. 
*Appeal from Workers' Compensation Board. 192 Or App 658, 87 P3d 698 (2004).
**Kistler, J., did not participate in the consideration or
decision of this case.
DE MUNIZ, J. 
In this workers' compensation case we examine the kinds
of sanctions that are available when a claimant refuses to
participate in an insurer medical examination (IME).  After
claimant was summoned but failed to appear for two IMEs, the
Department of Consumer and Business Services (department)
approved the denial of his claims under ORS 656.262(13) and (14)
(former ORS 656.262(14) and (15) (1999)).  An Administrative Law
Judge (ALJ) concluded that the department could not impose a
sanction of denial, but could only suspend the claims under ORS
656.325(1)(a), because that statute applied specifically to lack
of cooperation in an IME.  The Workers' Compensation Board
(board), in a divided decision, reversed the ALJ's order and
approved the denial of the claim.  The Court of Appeals affirmed
the board's decision.  Lewis v. CIGNA Ins. Co., 192 Or App 658,
87 P3d 698 (2004).  On review, we conclude that only the sanction
of suspension under ORS 656.325(1)(a), not the sanction of claim
denial under ORS 656.262(13) and (14), applies to a claimant's
noncooperation in an IME.  We therefore reverse the decision of
the Court of Appeals.
The Court of Appeals set out the following facts:
"Claimant filed claims [in 1997] for compensation
following back injuries.  Insurer arranged for claimant
to take an IME.  He failed to appear.  Insurer
rescheduled the IME and again [claimant] failed to
appear.  Further, on instructions from his attorney,
[claimant] walked out of a deposition before opposing
counsel had finished questioning him.  As a result of
these acts, insurer denied his claims under former ORS
656.262(14) and (15) (1999). * * * ORS 656.262(14)
requires injured workers "to cooperate * * * in the
investigation of claims for compensation," and ORS
656.262(15) allows an insurer to deny a claim if the
claimant continues noncooperation for 30 days after
notice.
"Claimant requested a hearing to contest the
denial.  In doing so, he did not explicitly indicate
that he was requesting an expedited hearing.  When his
nonexpedited appeal reached the board, he made two
arguments:  First, that his conduct at the deposition
did not amount to noncooperation; and second, that
failure to attend an IME was not noncooperation under
ORS 656.262(14) and (15) -- rather, it was
noncooperation under ORS 656.325(1)(a), and under that
statute the maximum penalty was suspension of benefits
as opposed to outright denial.  Insurer, for its part,
argued that claimant had forfeited his right to a
hearing on noncooperation because ORS 656.262(15)
allowed either an expedited hearing, which [claimant]
did not request, or no hearing at all.
"The board rejected insurer's argument that
claimant had forfeited his right to a hearing.  On the
merits of his claim, however, it concluded that his
failure to appear at IMEs amounted to noncooperation
under ORS 656.262(14).  Because that incident of
noncooperation sufficed to justify the insurer's
denial, the board did not reach claimant's argument
that his conduct at the deposition did not amount to
noncooperation."
Lewis, 192 Or App at 660-61 (emphasis in original; footnoted
omitted).
Claimant sought judicial review.  Insurer
cross-petitioned, arguing that the board lacked authority to
consider claimant's challenge to the noncooperation denials.  The
Court of Appeals agreed with insurer.  Lewis v. CIGNA Ins. Co.,
174 Or App 531, 26 P3d 165 (2001).  On review of that decision,
this court concluded that the Court of Appeals erred, vacated
that decision, and remanded the case in light of SAIF v. Dubose,
335 Or 579, 74 P3d 1072 (2003).  Lewis v. CIGNA Ins. Co., 336 Or
125, 79 P3d 882 (2003).
On remand, claimant argued that the insurer could
suspend, but could not deny, his claim based on claimant's
noncooperation at the IME because ORS 656.325(1)(a) specifically
authorized only the sanction of suspension for a refusal to
submit to an IME.  He conceded that a more general statute, ORS
656.262, authorized a sanction of denial, but argued that that
statute applied to noncooperation with less intrusive discovery
techniques such as a deposition.  Applying the maxim of statutory
construction that, between inconsistent statutes, the more
specific statute controls the more general statute, the Court of
Appeals determined that suspension of the payment of compensation
of the claimant's claim under ORS 656.325 was not inconsistent
with the sanction of dismissal under ORS 656.262:
"Claimant's argument fails because the two
statutes are not inconsistent.  As the board noted, the
general statute, ORS 656.262(14) and (15), applies to
initial claims that involve compensability or the
reopening of an aggravation claim, whereas the specific
statute applies to any failure to attend an IME, for
example, one requested in order to determine the
propriety of proposed treatment.  It is true that in
the circumstances where the two statutes overlap –-
failure to cooperate in an IME for an initial claim --
the two statutes provide different remedies.  However,
they are not inconsistent remedies.  ORS 656.325(1)(a)
requires suspension of benefits for noncooperation at
an IME.  ORS 656.262(14) and (15) permit an insurer to
deny the claim in those circumstances.  Thus, a worker
who fails adequately to cooperate at an IME involved in
an initial claim faces two sanctions, but they are not
mutually exclusive:  His benefits will definitely be
suspended, and, if he continues noncooperation, they
may be denied outright."
Lewis, 192 Or App at 666 (emphasis in original).  The Court of
Appeals concluded that both statutes could apply and therefore
affirmed the denial of claimant's claim.  We allowed claimant's
petition for review.
In this court, claimant argues that his nonattendance
at the examinations was reasonable but that, even if his
nonattendance was not reasonable, the maximum statutorily
authorized sanction that he faced was only a suspension of his
right to compensation until the examination occurred, not a
denial of his claims.  Because we find the latter argument to be
well taken, we confine our discussion to that issue.
Two statutory schemes address distinct categories of
claimant noncooperation in regard to claims for workers'
compensation, and they specify distinct sanctions for each
category.  ORS 656.325(1)(a), which deals specifically with IMEs, 
provides:
"Any worker entitled to receive compensation under
this chapter is required, if requested by the Director
of the Department of Consumer and Business Services,
the insurer or self-insured employer, to submit to a
medical examination at a time reasonably convenient for
the worker as may be provided by the rules of the
director.  However, no more than three examinations may
be requested except after notification to and
authorization by the director.  If the worker refuses
to submit to any such examination, or obstructs the
same, the rights of the worker to compensation shall be
suspended with the consent of the director until the
examination has taken place, and no compensation shall
be payable during or for account of such period.  The
provisions of this paragraph are subject to the
limitations on medical examinations provided in ORS
656.268."
(Emphasis added.)  That statute applies to a refusal to submit to
or obstruction of an IME.  If one of those events occurs, a
worker faces a suspension of his or her right to compensation. 
In ORS 656.325(1)(a), the legislature specifically prescribed a
suspension sanction under those circumstances, rather than the
more punitive denial sanction.
Two subsections of another statute, ORS 656.262(13) and
(14), address an injured worker's duty to cooperate with and
assist insurers with respect to the more general topic of 
investigation of claims, and the sanctions that apply to a
worker's failure to reasonably cooperate in claims investigation. 
Those subsections provide:
"(13) 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.  Injured
workers who are represented by an attorney shall have
the right to have the attorney present during any
personal or telephonic interview or deposition. 
However, if the attorney is not willing or available to
participate in an interview at a time reasonably chosen
by the insurer or self-insured employer within 14 days
of the request for interview and the insurer or self-insured employer has cause to believe that the
attorney's unwillingness or unavailabilty is
unreasonable and is preventing the worker from
complying within 14 days of the request for interview,
the insurer or self-insured employer shall notify the
director.  If the director determines that the
attorney's unwillingness or unavailability is
unreasonable, the director shall assess a civil penalty
against the attorney of not more than $1,000.
"(14) 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.  The obligation of the insurer or
self-insured employer to accept of deny the claim
within 60 [formerly 90] days is suspended during the
time of the worker's noncooperation.  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 of deny the claim."
ORS 656.262(13), (14) (emphasis added).
Subsection (13) thus imposes a duty to cooperate in the
investigation of claims, and imposes specific obligations on the
claimant regarding submitting to and cooperating "with personal
and telephonic interviews and other formal or informal
information gathering techniques."  It also expressly entitles
the claimant to have an attorney present during "any personal or
telephonic interview or deposition."
Subsection (14) provides the remedy for a failure "to
reasonably cooperate with an investigation involving an initial
claim to establish a compensable injury[.]"  (Emphasis added.) 
Under subsection (14), the director may suspend the payment of
compensation.  After 30 days of continued noncooperation, the
insurer or self-insured employer may deny the claim.
In this case, the board divided respecting the question
of how the foregoing statutes worked together.  The majority, in
effect, focused on the denial sanction in ORS 656.262(14) and
imposed it as a consequence of claimant's failure to attend two
IMEs, reasoning that that sanction was proper because an IME is
one of the "formal or informal information gathering techniques"
under ORS 656.262(13).  The dissent disagreed, asserting that ORS
656.262(13) and (14) did not apply because ORS 656.325(1)(a) set
out a discrete policy regarding the duty to submit to an IME and
the sanction that applied to a refusal to submit or obstruction
of such an examination.
In affirming the board's decision, the Court of Appeals
rejected claimant's argument that the sanction of suspension
under ORS 656.325(1)(a) applied specifically to IMEs, while ORS
656.262(14) applied to other forms of information gathering.  As
noted, that court held that the two sanctions were not
inconsistent because ORS 656.325(1)(a) contemplates suspension
for noncooperation in an IME and ORS 656.262(14) contemplates
suspension followed by denial of the claim during information
gathering.  Lewis, 192 Or App at 665.  For the reasons that
follow, we disagree with the Court of Appeals.
We begin with the rule of statutory interpretation
expressed in ORS 174.020 (1997):
"In the construction of a statute the intention of
the legislature is to be pursued if possible; and when
a general and particular provision are inconsistent,
the latter is paramount to the former.  So a particular
intent shall control a general one that is inconsistent
with it." (1)
With respect to the above-mentioned rule, this court has
observed:
"[W]hen one statute deals with a subject in general
terms and another deals with the same subject in a more
minute and definite way, the two should be read
together and harmonized, if possible, while giving
effect to a consistent legislative policy.  However, if
the two statutes cannot be harmonized, 'the specific
statute is considered an exception to the general
statute.'"
State v. Guzek, 322 Or 245, 268, 906 P2d 272 (1995) (citation
omitted).
In ORS 656.325(1)(a), the legislature provided a
specific sanction, suspension, for resisting one form of
discovery, an IME.  The legislature elsewhere provided a general
sanction for a claimant's noncooperation with various forms of
claim investigation, which arguably also could be said to embrace
an IME.  However, the effect of allowing the use of a denial in
connection with the failure to cooperate in an IME inescapably
would require ignoring the specific legislative direction that
suspension, not denial, should control a claimant's
noncooperation in an IME.
The terminology that the legislature employed in the
respective statutes is decidedly different.  ORS 656.262(13)
refers to "personal and telephonic interviews and other formal or
informal information gathering techniques."  As noted, the Court
of Appeals and the board decided that those terms were general
and all-inclusive of information gathering, including an expert
examination of the claimant's body.  In other words, the Court of
Appeals concluded that expert examination of the claimant's body
was a research technique akin to an interview.  That
understanding of the statutes is incorrect, for two reasons.  
First, ORS 656.262(13) lists "personal and telephonic
interviews" as examples of "formal and informal information
gathering techniques," which suggests that "information gathering
techniques" in this context share the basic characteristics of
personal and telephonic interviews.  "[W]hen the legislature
chooses to state both a general standard and a list of specifics,
the specifics do more than place their particular subjects beyond
the dispute; they also refer the scope of the general standard to
matters of the same kind, often phrased in Latin as 'ejusdem
generis.'"  Bellikka v. Green, 306 Or 630, 636, 762 P2d 997
(1988).  Under the principle of ejusdem generis, the scope of the
phrase "formal and informal information gathering techniques" in
this context is more limited than the phrase, standing alone,
would indicate. 
Second, we must view the terms in context, which
includes other related statutes.  See PGE v. Bureau of Labor &amp;
Industries, 317 Or 606, 611-12, 859 P2d 1143 (1993) (context
considered at first level of inquiry).  ORS 656.262 addresses the
general subject of claims processing and establishes standards
for gathering information at the initial stages of processing a
workers' compensation claim (e.g., talking to witnesses,
collecting medical records, etc.).  By contrast, ORS
656.325(1)(a) addresses only the subject of insurer medical
examinations.  The idea that the phrase "formal and informal
information gathering techniques" does not include a medical
examination of the claimant is consistent with our understanding
that the sanction of suspension in ORS 656.325(1)(a) operates in
a different and narrower context than the potentially harsher
sanctions in ORS 656.262(14).
Insurer argues that the statutes make a distinction
between claims that an insurer has not yet accepted and claims
that it has accepted.  According to insurer, ORS 656.262(13) and
(14) (with the denial sanction) govern information-gathering
during the investigatory stage, and ORS 656.325(1)(a) (describing
the suspension sanction) governs medical examinations in the
context of accepted claims only.  We disagree.  As we have
demonstrated, ORS 656.325(1)(a) specifically governs IMEs, yet
ORS 656.262(13)(14) does not refer to IMEs at all.  The statutes
thus demonstrate that the legislature intended to treat an IME
differently regardless of the claims processing stage at which
the insurer seeks the examination.
Based on the foregoing, we conclude that ORS
656.325(1)(a) and ORS 656.262(13)(14) make the legislature's
intent clear.  The legislature intended in ORS 656.325(1)(c) to
treat an IME as a unique investigative procedure that is separate
from other formal and informal information gathering techniques. 
In doing so, the legislature intended to limit the sanction for a
claimant's noncooperation to suspension of a claim during any
period of noncooperation.  The board and the Court of Appeals
erred in concluding that ORS 656.262(14) authorized the
department to deny claimant's claim for noncooperation with the
IME.  
Finally, we note that an unresolved issue exists
regarding whether claimant failed to cooperate in a deposition in
violation of ORS 656.262(14).  The board did not resolve that
issues and rested its reversal on the issue of noncooperation in
the IME.  Although claimant urges this court to address that
issue, claimant's petition for review presented only the issue
regarding the IME, and we shall not address a new issue at this
time.
The decision of the Court of Appeals and the order of
the Workers' Compensation Board are reversed.  The case is
remanded to the Workers' Compensation Board for further
proceedings.
1. 
That statute now states: "In the construction of a
statute, a court shall pursue the intention of the legislature if
possible.  * * *  When a general and particular provision are
inconsistent, the latter is paramount to the former so that a
particular intent controls a general intent that is inconsistent
with the particular intent."  ORS 174.020(1)(a) and (2).