Opinion ID: 2606157
Heading Depth: 1
Heading Rank: 7

Heading: analysis

Text: The threshold issue tendered by EBI is whether the statutory entitlement to TTD, in the correct amount, involves a separate claim distinct from the claim for enforcement of various future rights to which the worker became entitled by reason of the initial allowance of the aggravation claim in 1984. [10] Those future rights included TTD whenever, as the referee ordered, the treating doctor authorized them. In its issue preclusion analysis, the Court of Appeals stated: We do not agree that the issue that claimant now seeks to litigate is a claim as that term is used in res judicata parlance. EBI had been paying temporary total disability and, consequently, there was no need to raise an issue of entitlement to it. The narrow issue involved is the amount of temporary total disability. More particularly, the question is what was the correct wage rate; that is an issue of fact, not a claim. 96 Or. App. at 4, 771 P.2d 285. We agree with the first sentence of the Court of Appeals' analysis  that the TTD was not by itself the claim for preclusion by former adjudication purposes. However, stating that a subject in controversy is an issue of fact, not a claim, fails to properly explain why issue or claim preclusion does not apply. EBI contends that the worker is impermissibly splitting his claim for compensation for a single injury. In support of that argument, EBI first urges that claim should be defined for preclusion purposes the same way it is defined in the workers' compensation statutes. Under ORS 656.005(6), `[c]laim' means a written request for compensation from a subject worker or someone on the worker's behalf, or any compensable injury of which a subject employer has notice or knowledge. The definition of the term claim provided in ORS 656.005(6) governs the construction of ORS chapter 656, unless the context requires otherwise. ORS 656.003. A statutory definition of claim is for use in interpreting the statutory scheme to which the definition expressly relates. Chapman Bros. v. Miles-Hiatt Investments, 282 Or. 643, 646, 580 P.2d 540 (1978). It does not govern claim or issue preclusion rules made by judges, State ex rel Huntington v. Sulmonetti, 276 Or. 967, 970-71, 557 P.2d 641 (1976), unless the legislature manifests its intent that the definition do so. Such an intent is not present here. The meaning of claim for purposes of claim preclusion was considered in Troutman v. Erlandson, 287 Or. 187, 598 P.2d 1211 (1979). This court stated: For res judicata purposes a `claim'    does not mean the particular form or proceeding by which a certain kind of relief is sought but, rather, a group of facts which entitled plaintiff to relief. 287 Or. at 201, 598 P.2d 1211. This court quoted at length a fresh approach to determining what is a `claim'    [in] the American Law Institute's Draft No. 5 of March 10, 1978, Restatement (Second) of the Law of Judgments, § 61. Id. at 205, 598 P.2d 1211. The court endorsed an expanded definition of claim to include all rights or remedies between the parties with respect to all or any part of a transaction, or series of connected transactions, out of which the action arose. Thereafter, this court has continued use of the transactional definition of claim. See Rennie v. Freeway Transport, supra, 294 Or. at 327, 656 P.2d 919; see also supra note 5. EBI relies upon Dean v. Exotic Veneers, Inc., 271 Or. 188, 531 P.2d 266 (1975), to buttress its argument that the worker is splitting the claim. That case holds that, where a previous claim for money due on an express contract to pay for services is denied by the circuit court and the denial is final, a second claim in a separate action based on quantum meruit for the reasonable value of the same services is precluded. 271 Or. at 200, 531 P.2d 266. The claim for value of the same services could not be split by founding the single contention concerning payment for the services involved on one theory in one action and on a different legal theory in a second action. Cf. Million II, supra, 45 Or. App. at 1102, 610 P.2d 285 (first decision, that shoulder condition was not related to traumatic injury to worker's hand, final on appeal before filing of second claim that same shoulder condition resulted from occupational disease); Kepford v. Weyerhaeuser Co., supra (finding entered in 1979 that preexisting disc disease was not permanently worsened by a 1974 back injury did not preclude a 1983 finding that work as a logger after 1979, together with the back injury, were the major causes of an occupational disease aggravating the preexisting disc condition and necessitating post-1979 surgery). In Kepford, the Court of Appeals explained that: There is no evidence, however, that in 1979 claimant's back condition had reached the point that it necessitated additional treatment. The evidence presented at the 1983 hearing, including the post-surgical findings regarding the cause of the worsened condition, constituted a new set of facts that could not have been litigated in 1979. 77 Or. App. at 366, 713 P.2d 625.
The legislature enacted workers' compensation changes in 1990. We generally refer, in our following discussion, to the statutes as they were before that change. The workers' compensation statutes, in effect at the time of referee and Board orders, assist in determining what are separate claims to which claim preclusion applies. Those statutes described when more than one proceeding could be instituted to recover for a single injury at work. The statutes also implicitly provided when the finality requisite for claim or issue preclusion attached to a given decision on various issues. ORS 656.273 provided in part: After the last award or arrangement of compensation, an injured worker is entitled to additional compensation, including medical services, for worsened conditions resulting from the original injury.      (3) A physician's report indicating a need for further medical services or additional compensation is a claim for aggravation. ORS 656.268(2)(a) provided in part: [W]hen the injured worker's condition resulting from a disabling injury has become medically stationary    the insurer    shall    request the claim be examined and further compensation, if any, be determined. Amounts of compensation are subject to adjustment until final closure. ORS 656.268(10) stated: Any determination or notice of closure made under subsection (3), (4) or (5) of this section may include necessary adjustments in compensation paid or payable prior to the determination or notice of closure   . Medical benefits, including treatment temporarily incapacitating a worker from working, may continue even after claim closure, provided that the medical need was connected to a job-related injury. ORS 656.245(1) in part provided: For every compensable injury, the insurer or self-insured employer shall cause to be provided medical services for conditions resulting from the injury for such period as the nature of the injury or the process of the recovery requires.    The duty to provide such medical services [except for palliative care in certain circumstances] continues for the life of the worker. [11] ORS 656.283(1) in part provided: Subject to    ORS 656.319, any party or the director may at any time request a hearing on any question concerning a claim. ORS 656.283(1). An aggravation claim, for preclusion purposes and by statute, is a separate claim which is not precluded by the fact that an original claim for the work-related injury has been finally determined. A claim determination is not final until hearing and judicial review rights are barred or exhausted. The statutory scheme indicates that the finality requisite for claim or issue preclusion, against the worker, occurs only when a worker fails to timely request a hearing after a claim denial, a determination order, or a notice of claim closure, ORS 656.319, or by failure to file a timely appeal to the Board, ORS 656.289(3), or the courts. ORS 656.295(8). [12]
The 1984 hearing order allowed and opened an aggravation claim, reversing a denial by EBI. The claim was opened to provide additional medical treatment and to consider permanent disability following that treatment. The order expressly provided that future TTD be paid as authorized by    claimant's treating physician. When the aggravation claim was allowed, the statutory right to TTD compensation arose, applicable to any future period during which the worker was disabled by the 1984 surgery related to the work injury. ORS 656.210(1). This court is not authorized to modify that statute by reading it to not apply to an aggravation or worsening claim. The 1984 aggravation claim is presently before this court, following a determination order on October 7, 1985, a timely request for hearing, the 1986 referee's hearing and order, and the subsequent, statutorily provided, reviews by the Board, the Court of Appeals, and this court. The 1984 order and the 1986 order are but separate parts of the same aggravation claim, i.e., the orders were entered in the same administrative proceeding now before us on judicial review. The finality required to invoke claim preclusion has not yet attached to the compensation proceeding of which the 1984 hearing was a part. Like Kepford v. Weyerhaeuser Co., supra , the TTD entitlement in controversy here is for periods and amounts arising after the original claim was determined and after the 1984 hearing was concluded. Like North Clackamas School Dist. v. White, supra , the first hearing on the aggravation claim in 1984 established that the work injury produced the need for treatment. Treatment thereafter caused the time loss which triggered TTD entitlement. Only when the doctor later authorized TTD periods did the statutory entitlement to TTD take effect. And, at that point, the right to TTD arose anew as part of the aggravation claim, which is still open and now before this court. The question of the proper rate of TTD payment is but one of many issues involved in that ongoing claim for aggravation. No finality has yet been accorded the aggravation claim opened in 1984, and no splitting of that claim occurred. We conclude that neither issue nor claim preclusion applies to the TTD rate issue. [13] But could the Board have properly affirmed on the referee's theory that the contention was waived? No, the conditions required to bar a contention by waiver are not met in this case. First, ORS 656.262(9), in effect at that time, provided: [N]or shall mere acceptance of such compensation be considered a waiver of the right to question the amount thereof. Second, our cases hold that waiver is the intentional relinquishment of a known right. Brown v. Portland School Dist. #1, 291 Or. 77, 84, 628 P.2d 1183 (1981); see also Waterway Terminals v. P.S. Lord, 242 Or. 1, 26-27, 406 P.2d 556 (1965) (quoting a description of the rule of waiver in McMillan v. Montgomery, 121 Or. 28, 32, 253 P. 879 (1927)). The record before us provides no basis for concluding that claimant intentionally relinquished  i.e., waived  his right to seek the correct amount of temporary total disability by his silence on the subject in 1984. Payments would accrue, if ever, after the time of the hearing. In 1981 and 1984, the worker did not know of the mistake and, thus, could not have intentionally waived the right to correct it. The referee erred when she found that the right to seek a correction was waived. The Board erred when it affirmed the referee. The decision of the Court of Appeals is affirmed, and the order of the Workers' Compensation Board is remanded to the Board for further proceedings consistent with this opinion.