Court Opinion

ID: 9550768
Source: CourtListenerOpinion
Date Created: 2023-08-07 18:42:10.859423+00
Date Added: 2024-06-11T15:22:21.107238
License: Public Domain

WARREN, J.,
dissenting.
The Board found that SAIF accepted claimant’s claim for carpal tunnel syndrome (CTS) solely because its claim representative indicated that the claim had been accepted on an 801 form. However, there is no evidence that SAIF ever notified claimant that it was accepting that claim. The majority affirms, on the basis of its conclusion that ORS 656.262(6) “presumes that acceptance has already occurred when it requires that notice of the acceptance be furnished to the claimant.” 113 Or App at 454. Because Oregon precedents hold that acceptance cannot occur without notice to the claimant, I dissent.
Claimant contends that SAIF cannot deny compensability or responsibility for her CTS, because it had previously accepted a claim for that condition. In Bauman v. SAIF, 295 Or 788, 790, 670 P2d 1027 (1983), the court held that, once an insurer has accepted a claim, it cannot subsequently deny the compensability of that claim. In Johnson v. Spectra Physics, 303 Or 49, 733 P2d 1367 (1987), the court clarified that rule, saying:
“Bauman applies only to a claim ‘specifically’ or ‘officially’ accepted by the insurer. 295 Or at 793-94. ORS 656.262(6) requires that the insurer or self-insured employer furnish the claimant "with ‘[wjritten notice of acceptance or denial of the claim * * * within 60 days after the employer has notice or knowledge of the claim.’ An insurer must accept a particular claim in writing * * * before Bauman applies.” 303 Or at 55. (Emphasis supplied.)
Because an insurer must “furnish” the claimant with notice before the rule of Bauman applies, we have held that an acceptance cannot occur in the absence of written notice to the claimant. For example, in EBI Ins. Co. v. CNA Insurance, 95 Or App 448, 769 P2d 789 (1989), a prior employer argued that a subsequent employer had accepted a claimant’s aggravation claim by indicating that the claim had been accepted on a status report to the Workers’ Compensation Division. We disagreed, and said:
“Official notice of acceptance or denial is described by ORS 656.262(6) and must include certain information and advice to the claimant. We conclude that the information on the *456Form 1502 was not an official notice of acceptance.” 95 Or App at 451.
Similarly, in Stevenson v. Blue Cross of Oregon, 108 Or App 247, 814 P2d 185 (1991), the claimant filed an 801 form with SAIF that listed her disease as tendinitis. SAIF indicated on that form that it was accepting her claim for that condition; however, the notice that it sent to the claimant specified that it was only accepting a claim for “cellulitis/ eczema; contact dermatitis.” 108 Or App at 248. Subsequently, the claimant filed an aggravation claim, seeking compensation for disabilities resulting from her tendinitis. SAIF denied that claim.
The claimant argued that SAIF improperly denied her aggravation claim, because it had previously accepted her tendinitis condition by marking that it was accepted on the 801 form. We rejected that argument, saying that the “[cjlaimant had to show that SAIF specifically accepted her tendinitis claim and officially notified her of that acceptance. ’ ’ 108 Or App at 251. We then concluded that the claimant did not satisfy that burden merely by showing that SAIF indicated that the claim was accepted on the 801 form.
“[A]n insurer’s silence regarding one aspect of a claim is neither acceptance nor denial of that aspect of the claim.” Johnson v. Spectra Physics, supra, 303 Or at 55. From claimant’s perspective, a check mark on the 801 form that she never saw was silence just the same as if SAIF never marked the form at all. Moreover, to say that silence means anything would inject the instability into the workers’ compensation system that the court sought to eliminate in Bauman. Claimants or insurers would be at liberty to raise the issue of compensability months and years after an injury occurs or disease becomes disabling, merely by asserting there was or was not a response to a claim.
Nevertheless, the majority holds that SAIF accepted claimant’s CTS claim by indicating its acceptance on an 801 form. It bases that holding on its conclusion that ORS 656.262(6) presumes that acceptance has occurred before the insurer furnishes a notice of acceptance. It does not explain why essentially the same act did not constitute an acceptance in Stevenson v. Blue Cross of Oregon, supra, or EBI Ins. Co. v. *457CNA Insurance, supra. Neither does it explain why we should ignore the admonition that the rule of Bauman does not apply unless the insurer furnishes the claimant with written notice of acceptance or denial of the claim. Johnson v. Spectra Physics, supra, 303 Or at 55. Because the majority offers no reason, other than its abject distaste for the result, for us to depart from the controlling precedents on this issue, I dissent.
Joseph, C. J., joins in this dissent.