Court Opinion

ID: 9960943
Source: CourtListenerOpinion
Date Created: 2024-04-17 16:11:05.777086+00
Date Added: 2024-06-11T08:20:05.395611
License: Public Domain

72                     April 17, 2024                No. 238

             IN THE COURT OF APPEALS OF
                 THE STATE OF OREGON

In the Matter of the Compensation of Thomas K. Cardoza,
                       Claimant.
                  Andrew TEITELMAN,
        Personal Representative of the Estate of
             Thomas K. Cardoza, Deceased.
                       Petitioner,
                            v.
                  SAIF CORPORATION
        and Werner Gourmet Meat Snacks, Inc.,
                      Respondents.
               Workers’ Compensation Board
                1906431, 2003506; A176678

     Argued and submitted October 6, 2022.
   Bennett P. Dalton argued the cause and filed the briefs for
petitioner. Also on the reply brief was The Dalton Law Firm.
   Daniel Walker argued the cause and filed the brief for
respondents.
  Before Ortega, Presiding Judge, Powers, Judge, and
Hellman, Judge.
     POWERS, J.
     Reversed and remanded.
Cite as 332 Or App 72 (2024)                               73

        POWERS, J.
        At issue in this workers’ compensation case is
whether the worker, Thomas K. Cardoza, was eligible for a
Worker Requested Medical Examination (WRME). Cardoza,
who died during the pendency of this judicial review proceed-
ing and whose personal representative has been substituted
as claimant, requested a WRME following the denial of his
claim and nonconcurring medical opinions as to whether
his injury was work-related. The Workers’ Compensation
Division denied Cardoza’s WRME request, concluding that
the denial was not “based” on an independent medical
examination or IME as required by ORS 656.325(1)(e) and
the applicable administrative rule. On Cardoza’s challenge,
both an administrative law judge (ALJ) and the Workers’
Compensation Board upheld the denial. As explained below,
we conclude that, when an insurer submits an IME report as
evidence to support its denial of a worker’s claim, the denial
is “based” on an IME such that the worker is eligible for a
WRME under the terms of ORS 656.325(1)(e). Accordingly,
we reverse and remand.
         The facts are primarily procedural and are not
in dispute. While working for employer Werner Gourmet
Meat Snacks, Inc., Cardoza filed a claim for a back injury.
Employer’s insurer, SAIF, denied the claim, concluding that
Cardoza “did not sustain a compensable injury arising out
of, or in the course of, [his] employment.” Cardoza sought
a hearing to challenge that denial, and SAIF requested
that Cardoza submit to an IME conducted by Dr. Ballard.
See ORS 656.325(1)(a) (requiring any worker entitled to
receive compensation to submit to a medical examination, if
requested). Ballard’s IME report supported the denial, con-
cluding that preexisting conditions, and not a work incident,
were the major cause of any disability or need for treatment.
        Cardoza then submitted to an examination by his
own attending physician, Dr. Mitchell, who disagreed with
Ballard’s opinion, and concluded in his written report that
Cardoza’s work injury was the major cause of his need for
treatment. Citing the nonconcurrence between the reports,
Cardoza submitted a request to the division for authoriza-
tion of a WRME. The division denied Cardoza’s request,
74                                            Teitelman v. SAIF

concluding that he “[did] not meet the eligibility require-
ments under statute and rule.” The division cited the three
requirements for WRME eligibility: (1) a timely request
for a hearing; (2) the denial of the worker’s claim be based
on an IME; and (3) the attending physician’s statement of
nonconcurrence with the IME. See ORS 656.325(1)(e); OAR
436-060-0147(1). Although the division’s order agreed that
Cardoza had timely requested a hearing and successfully
submitted a nonconcurrence report from his attending phy-
sician, it concluded that he had not met the requirement
that the denial be “based” on an IME. The division reasoned
that, because SAIF denied Cardoza’s claim before the IME
occurred, the denial could not be “based” on the IME under
the applicable statute and administrative rule.
         Cardoza challenged the division’s order and also
sought an interim order requiring SAIF to amend the
denial because, in his view, the denial was based on an IME
report, or, alternatively, to withdraw the IME report as a
hearing exhibit. See OAR 436-060-0140(8)(a) (requiring a
denial notice to specify if it was based in whole or in part
on an IME). The ALJ denied that request and, following a
hearing, upheld the denial. In particular, the ALJ’s order
cited the IME report as “persuasive” evidence that Cardoza’s
claim was not compensable
        Cardoza appealed the ALJ’s order to the board,
challenging both the denial of compensability and the
request for WRME authorization. The board affirmed the
ALJ’s order on both issues. Regarding Cardoza’s eligibility
for a WRME, the board agreed with the division and ALJ,
concluding:
     “At the time of SAIF’s October 2019 denial, no IME had
     been conducted. As such, because SAIF’s denial was not
     based in whole or in part on an IME, it did not include any
     of the language concerning claimant’s WRME entitlement
     required by OAR 436-060-0140(8)(b). Because an IME had
     not occurred at the time the denial issued, the denial was
     not based on an IME.”
         Cardoza seeks judicial review of the board’s order.
We review the board’s order for substantial evidence and
errors of law. ORS 183.482(8)(a), (c); see also ORS 656.298(7)
Cite as 332 Or App 72 (2024)                                     75

(review of board orders “shall be as provided in ORS
183.482(7) and (8)”). Whether the board correctly inter-
preted a statute is a question that we review for legal error
under ORS 183.482(8)(a). Travelers Ins. Co. v. Arevalo, 296
Or App 514, 520, 437 P3d 1153 (2019).
          On judicial review, claimant, as the personal rep-
resentative of Cardoza’s estate, argues that the board erred
in its interpretation of ORS 656.325(1)(e). He contends that,
although the IME was requested and occurred after SAIF’s
initial denial of his claim, the denial is still “based” on the
IME because the statute makes no distinction between
IMEs that occur before a denial and those that occur after.
That is, claimant asserts that the denial of a claim is an
ongoing action, and that when an insurer submits an IME
as evidence to support its denial of a claim, that is enough
to meet the statute’s requirement that the denial be “based”
on an IME. To hold otherwise, claimant argues, would allow
insurers to deny all claims prior to requesting an IME, thus
frustrating the statute’s intended purpose of leveling the
playing field between workers and insurers.
         SAIF and employer argue that the text, context, and
legislative history support the board’s determination that a
claim denial cannot be “based” on an IME if the IME occurs
after the issuance of the denial. The parties’ arguments pres-
ent a straightforward issue of statutory interpretation, viz.,
whether the legislature intended that a denial can be “based”
on a post-denial IME. Accordingly, we resolve the issue
through our customary statutory interpretive framework
articulated in State v. Gaines, 346 Or 160, 171, 206 P3d 1042
(2009), under which our “paramount goal” is to ascertain the
intent of the legislature that enacted the disputed provision.
We determine that intent by examining the text, in context,
as well as the legislative history “where that legislative his-
tory appears useful to the court’s analysis.” Id. at 172.
        A worker’s eligibility for WRME authorization is
established by ORS 656.325(1)(e), which provides:
       “If the worker has made a timely request for a hearing
   on a denial of compensability as required by ORS 656.319
   (1)(a) that is based on one or more reports of examinations
   conducted pursuant to paragraph (a) of this subsection
76                                             Teitelman v. SAIF

     and the worker’s attending physician or nurse practitioner
     authorized to provide compensable medical services under
     ORS 656.245 does not concur with the report or reports,
     the worker may request an examination to be conducted by
     a physician selected by the director from the list described
     in ORS 656.328. The cost of the examination and the exam-
     ination report shall be paid by the insurer or self-insured
     employer.”
The referenced “reports of examination conducted pursu-
ant to paragraph (a)” refer to IMEs. See ORS 656.325(1)(a).
Eligibility for the WRME process is also guided by OAR
436-060-0147, which provides, in part:
        “(1) Eligibility. The worker is eligible for a worker
     requested medical examination if:
        “(a) The worker has made a timely request for a board
     hearing on a denial of compensability;
       “(b) The denial is based on one or more independent
     medical examination reports; and
         “(c) The attending physician or authorized nurse prac-
     titioner does not concur with the report or reports.”
          In our view, nothing in the statute’s or rule’s text
or context requires that an IME be performed before the
denial of a compensation claim. First, we agree with claim-
ant’s argument that the phrase in ORS 656.325(1)(e) that
the compensability denial “is based on one or more” IME
reports suggests a legislative intent that does not limit eli-
gibility to predenial IMEs. That is, we agree with claimant’s
argument that, as a practical matter, there is little reason
that there would be multiple predenial IMEs. Instead, the
inclusion of the phrase “one or more” suggests an intent to
include IMEs that occur after the initial denial. Second, if
the legislature’s intent was to limit eligibility to predenial
IMEs, it could have phrased the requirement more precisely.
For example, the legislature could have used the past tense
such that a denial “was” based on an IME to be more precise
that IMEs after a denial do not trigger the WRME autho-
rization. See, e.g., Martin v. City of Albany, 320 Or 175, 181,
880 P2d 926 (1994) (explaining that the “use of a particular
verb tense in a statute can be a significant indicator of the
legislature’s intention”); V. L. Y. v. Board of Parole, 338 Or
Cite as 332 Or App 72 (2024)                                77

44, 50, 106 P3d 145 (2005) (focusing on the legislature’s use
of “is” and “exhibits” to conclude that the statute defines a
concept as a present condition). The legislature, however, did
not provide more explicit language limiting eligibility to the
interpretation that SAIF and employer urge us to adopt.
         The context of the statute further supports claim-
ant’s interpretation. See, e.g., Kohring v. Ballard, 355 Or
297, 304, 325 P3d 717 (2014) (explaining that a court exam-
ines “word usage in context to determine which among com-
peting definitions is the one that the legislature more likely
intended”); Stevens v. Czerniak, 336 Or 392, 401, 84 P3d 140
(2004) (explaining that “text should not be read in isolation
but must be considered in context”). The purpose of allow-
ing a worker to request a WRME is to obtain an additional
professional opinion where there are at least two competing
reports, or, as in this case, the first two medical examina-
tions are not in concurrence. That purpose would be frus-
trated where a worker submits to two competing profes-
sional examinations and timely requests that the division
make a determination on the claim based on those examina-
tions. That is particularly so, when, as here, the insurer sub-
mits the IME report as evidence supporting the denial of a
claim, and the reviewing authority considers that report as
evidence in deciding whether to affirm or reverse the denial.
In such cases, we conclude that the denial is “based” on an
IME, and that the legislature intended that the worker be
authorized to obtain a WRME that would provide additional
information on the compensability of the claim.
         Finally, the parties’ arguments cite extensively to
the legislative history surrounding the statute’s enactment
and amendments. We do not find persuasive for the pur-
pose of resolving the narrow issue presented in this case.
Moreover, we are not aware of any legislative history that
calls into question our conclusion based on the text and con-
text of ORS 656.325(1)(e). See ORS 174.020(3) (explaining
that courts “shall give the weight to the legislative history
that the court considers to be appropriate”); see also State v.
Rainey, 294 Or App 284, 291, 431 P3d 98 (2018) (explaining
that “whatever the legislative history may show the legis-
lature intended by the enactment of a statute, the wording
78                                                       Teitelman v. SAIF

ultimately enacted must be capable of carrying out that
intention”). In short, given the text and context of the WRME
statute and rule, we conclude that SAIF’s denial was based
on an IME. Accordingly, the board erred in affirming the
denial of Cardoza’s request for a WRME.1
           Reversed and remanded.

    1
      In the motion practice substituting Cardoza’s personal representative,
neither party suggested that this judicial review proceeding was moot, and no
party articulated what the proper procedure would be if we ruled in claimant’s
favor. Accordingly, we leave it to the parties and the board to address in the first
instance the effect of Cardoza’s death while this judicial review proceeding was
pending.