Court Opinion

ID: 9633026
Source: CourtListenerOpinion
Date Created: 2023-08-22 11:31:42.531084+00
Date Added: 2024-06-11T18:08:27.300984
License: Public Domain

GRABER, J.,
concurring in part and dissenting in part.
I concur fully in the majority’s resolution of the first issue presented in this workers’ compensation case. The Court of Appeals complied with ORS 2.570(4), which requires the “concurrence of two judges * * * to pronounce judgment.”
I dissent, however, from the majority’s abandonment of established principles of statutory construction in its resolution of the second issue. In my view, ORS 656.386(1) does not allow an award of attorney fees when an employer or *223insurer pays medical bills late but does not deny the compen-sability of, or its responsibility for, the claimant’s injury or condition.
The starting point is the principle that, in workers’ compensation cases, an award of attorney fees can be made only pursuant to statutory authorization. Forney v. Western States Plywood, 297 Or 628, 632, 686 P2d 1027 (1984); SAIF v. Curry, 297 Or 504, 511, 686 P2d 363 (1984). As this court explained in Forney, 297 Or at 632, in holding that no attorney fees could be awarded under the terms of the workers’ compensation statute involved:
“It is fundamental that the legislature provides rights and remedies for workers and employers. This court cannot exceed the legislative limitations even though an inequity to the employe or to the employer might result. Unless a specific statute authorizes an award of attorney fees to a claimant, this court cannot award them.” (Emphasis added.)
Similarly, in Curry, 297 Or at 510-11, this court
“recognize[d] that this result [no fees in the situation presented] is harsh for claimant’s attorney in this case. * * * In this instance his work will go uncompensated; however, our ability to award attorney fees in workers’ compensation cases is limited to the authority granted hy statute. In this case we have no authority and must refuse to make an award.”
In the absence of clear legislative authorization, then, no fees are available.
The statute under which claimant seeks fees in this case is ORS 656.386(1), which provides:
“In all cases involving accidental injuries where a claimant finally prevails in an appeal to the Court of Appeals or petition for review to the Supreme Court from an order or decision denying the claim for compensation, the court shall allow a reasonable attorney fee to the claimant’s attorney. In such rejected cases where the claimant prevails finally in a hearing before the referee or in a review by the board itself, then the referee or board shall allow a reasonable attorney fee. If an attorney is instrumental in obtaining compensation for a claimant and a hearing by the referee is not held, a *224reasonable attorney fee shall be allowed. Attorney fees provided for in this section shall be paid by the insurer or self-insured employer.”
Claimant relies specifically on the third sentence of ORS 656.386(1) — providing for fees when no hearing is held — to support the fee award in this case. The Legislative Assembly added that sentence to the statute in 1991. Or Laws 1991, ch 312, § 1.
In interpreting a statute, the court seeks to discern the intent of the legislature. PGE 0v. Bureau of Labor and Industries, 317 Or 606, 610, 859 P2d 1143 (1993). At the first level of analysis, the court considers the text and the context of the statutory provision at issue, including other provisions of the same statute and other statutes relating to the same subject. Id. at 610-11. If the intent of the legislature is not clear from that inquiry, the court considers the legislative history of the statute. Id. at 611-12. Additionally, when this court has construed a statute, that construction is part of the statute as if written therein. Stephens v. Bohlman, 314 Or 344, 350 n 6, 838 P2d 600 (1992).
On appeal and on review, the parties do not dispute that a “decision denying the claim for compensation” is a prerequisite to a claimant’s obtaining a fee under the third sentence of ORS 656.386(1). Their arguments focus on the question of what the legislature meant when it used the phrase “decision denying the claim for compensation” in ORS 656.386(1). Claimant contends that failure to pay a medical bill on time is an instance of a “decision denying the claim for compensation,” because compensation “includes all benefits, including medical services, provided for a compen-sable injury,” ORS 656.005(8). SAIF asserts that a “decision denying the claim for compensation” in ORS 656.386(1) means
“a decision by the insurer not to pay compensation on the ground that the injury or condition for which compensation is claimed is not compensable or otherwise does not give rise to an entitlement to compensation.” (Emphasis in original; footnote omitted.)
For the reasons that follow, I agree with SAIF.
*225First, the text of ORS 656.386(1) itself makes SAIF’s interpretation more likely. The statute uses the phrase “denying the claim for compensation” (emphasis added), rather than the phrase “denying compensation.” Failure or refusal to pay a medical hill for an accepted injury or condition denies compensation, by denying the particular amount of benefits sought, but it generally does not deny the claim for compensation.1 Claimant’s interpretation of the statute thus reads the phrase “the claim for” out of the statute. By contrast, SAIF’s interpretation gives meaning to all words in the statute. See ORS 174.010 (in construing a statute, the court is “not to * * * omit what has been inserted; and where there are several provisions or particulars such construction is, if possible, to be adopted as will give effect to all”).
Second, the statutory context reinforces SAIF’s reading. Several sections of the workers’ compensation law differentiate between a claimant’s entitlement to compensation (compensability) and the amount of compensation owed for the claim if accepted (benefits). For example, ORS 656.266 provides that “[t]he burden of proving that an injury * * * is compensable and of proving the nature and extent of any disability resulting therefrom is upon the worker.” (Emphasis added.) Further, ORS 656.262(10)(a)2 expressly differentiates between unreasonably delaying or unreasonably refusing “to pay compensation” (benefits), on the one hand, and unreasonably delaying “acceptance or denial of a claim” (compensability), on the other.
*226Third, this court’s prior cases recognized that “denying the claim for compensation” in ORS 656.386(1) means asserting that the injury is not compensable at all. In Peterson v. Compensation Department, 257 Or 369, 477 P2d 216 (1970), the insurer denied compensability of the claimant’s claim for an injury. A referee upheld the denial, but the Board reversed and remanded the case to the referee for further proceedings relating to the denial. This court held that the claimant was not entitled to a fee at the time of the remand, under ORS 656.386(1), because the claimant had not yet prevailed. Id. at 374. In discussing the history and development of the statute, the court said that “the right to an attorney fee [under ORS 656.386(1)] has been and is dependent on establishing the right to compensation after an original rejection of the claim.” 257 Or at 375. See also Cavins v. SAIF, 272 Or 162, 164-65, 536 P2d 426 (1975) (the claimant was entitled to attorney fees under ORS 656.386(1) when the insurer had denied a request for surgery on the ground that the surgery was not causally related to the accepted injury and thus had denied compensability of the condition for which the claimant sought compensation); Ohlig v. FMC Marine & Rail Equipment, 291 Or 586, 595-98, 633 P2d 1279 (1981) (the claimant was entitled to a fee under ORS 656.386(1) for overcoming the employer’s “partial denial,” when the employer had accepted compensability for an ankle injury but denied liability for a low back condition; denying the claim for compensation relates to a condition for which compensation is claimed); Forney v. Western States Plywood, supra, 297 Or at 632 (the claimant could not obtain attorney fees under ORS 656.386(1), because her “only claim was for the amount of compensation due on her aggravation claim,” as distinct from “responsibility” for an unaccepted condition); Short v. SAIF, 305 Or 541, 545, 754 P2d 575 (1988) (this court distinguished between the amount of compensation or the extent of disability, on the one hand, and the question “whether the claimant’s condition was caused by an industrial injury,” on the other; ORS 656.386(1) does not apply to the former).3
*227In the aggregate, the text, context, and prior interpretations suggest that a “decision denying the claim for compensation” within the meaning of ORS 656.386(1) is a decision not to pay compensation on the ground that the injury or condition is not compensable or otherwise does not entitle the claimant to compensation.4 However, because the legislature’s intent in that regard is not completely clear after the foregoing inquiry, I also examine the legislative history of the 1991 amendment to the statute.
The 1991 amendment to ORS 656.386(1) was enacted as part of Senate Bill 540. The legislative history of Senate Bill 540 demonstrates that the amendment was enacted for the purpose of overruling Duane L. Jones, 42 Van Natta 875 (1990), aff’d in Jones v. OSCI, 107 Or App 78, 810 P2d 1318, on recons 108 Or App 230, 814 P2d 558 (1991),5 and for the purpose of authorizing attorney fees when the compensability of a claim for workers’ compensation has been denied and the employer or insurer rescinds the denial through the efforts of the claimant’s lawyer.
During consideration of Senate Bill 540, a member of the workers’ compensation claimants’ bar who was the principal witness at the Senate and House hearings testified:
“[Senate Bill 540] requires that insurers or self-insured employers pay an attorney’s fee over and above any compensation when a denial is rescinded prior to the matter going to hearing. As I say, that was the law and that was the practice in workers’ compensation until the Workers’ Compensation *228Board issued a case about a year ago csHeáDuane Jones. * * * Kit’s my belief that this bill only reverses the Duane Jones case.” Tape Recording, Senate Committee on Labor, March 20, 1991, Tape 4Q, Side A.
The same witness made similar comments to the House Committee on Labor, emphasizing that this bill applies when the insurer or self-insured employer “rescinds their denial.” Tape Recording, House Committee on Labor, May 27,1991, Tape 148, Side B. See also Tape Recording, House Committee on Labor, May 29, 1991, Tape 154, Side B (statement of Representative Mannix supporting that testimony, that lawyers who “succeedO in convincing the insurance company that the claim was good before going to hearing would be awarded an attorney fee”).
On the floor of the Senate, Senator Kerans stated that “Senate Bill 540 reverses what’s known as the Jones decision” and permits attorney fees where a lawyer worked ‘ ‘to advance your claim, even though it had been denied by the insurer, if the insurer, even up to the minutes before a hearing was held, reversed field and said, okay, we will no longer resist your claim, but, in fact, accept it.” Tape Recording, Senate Floor Debate, March 27,1991, Tape 50, Side A.
Those statements of legislators and of the principal witness are couched in terms of denial versus acceptance of compensability of the underlying claim. And, the Jones case, which Senate Bill 540 was designed to overrule, was a case in which the compensability of the underlying claim had been denied. The legislative history thus confirms what the text, context, and prior interpretations suggest. A “decision denying the claim for compensation” within the meaning of ORS 656.386(1) is a decision not to pay compensation on the ground that the injury or condition is not compensable or otherwise does not entitle the claimant to compensation.
Claimant’s final contention is that the failure to pay medical bills, or at least to respond definitively to a written request to pay medical bills, within the time set by statute6 is *229a “de facto” denial of the underlying claim for compensation. I disagree.
I note, first, that the legislature has drawn a distinction between delay and denial. ORS 656.262(10)(a) provides for a penalty when an “insurer or self-insured employer unreasonably delays or unreasonably refuses to pay compensation, or unreasonably delays acceptance or denial of a claim.” If delay in paying compensation were the equivalent of denial of a claim, the two phrases in that statute would be redundant. The statutory context, therefore, weighs against claimant’s suggested interpretation of the concept of denying a claim.
Second, and more fundamentally, this claim could not have been denied by silence when claimant submitted the medical bills in question, because the claim already had been accepted. In Bauman v. SAIF, 295 Or 788, 790, 670 P2d 1027 (1983), this court held that the version of ORS 656.262(6) then in effect barred an employer from denying a claim that previously had been accepted. See also Johnson v. Spectra Physics, 303 Or 49, 58, 733 P2d 1367 (1987) (“An insurer’s failure to respond to a claim or one aspect of a claim is neither acceptance nor denial”). ORS 656.262(6) has been amended to provide in part that,
“if the insurer or self-insured employer accepts a claim in good faith but later obtains evidence that the claim is not compensable or evidence that the paying agent is not responsible for the claim, the insurer or self-insured employer, at any time up to two years from the date of claim acceptance, may revoke the claim acceptance and issue a formal notice of claim denial.” (Emphasis added.)
Thus, denial of a claim that previously had been accepted requires specific formalities, which did not occur in this case. Mere silence on receipt of a medical bill did not become a denial of the claim.
In this case, SAIF agreed that claimant’s injury was compensable, and a binding order made SAIF responsible for claimant’s neck condition. SAIF paid a number of medical bills (totaling over $11,400) related to that accepted condition, before claimant submitted the four bills at issue. The late payment of those four medical bills was not a denial of the *230claim and, therefore, did not entitle claimant to attorney fees under ORS 656.386(1).
The majority turns ORS 656.262(6) on its head. As just noted, that statute provides that an insurer or self-insured employer who has accepted a claim in good faith, but who “later obtains evidence that the claim is not compensable or evidence that the paying agent is not responsible for the claim,” may, within two years, “revoke the claim acceptance and issue a formal notice of claim denial.” Also, as just noted, SAIF accepted claimant’s claim, and a binding order made SAIF responsible for it. When SAIF disagreed with four of claimant’s many medical bills and failed to pay them within 90 days of receipt, SAIF did not “revoke the claim acceptance and issue a formal notice of claim denial.” The reason was, of course, that SAIF did not then, and does not now, assert that the claim is not compensable or that it is not responsible for the claim; it simply disagreed with the amount of four of claimant’s many medical bills and paid them more than 90 days after receiving them.
The majority holds that, because SAIF failed to follow ORS 656.262(6), it did actually “revoke the claim acceptance” and was subject to paying attorney fees for doing so. 320 Or at 209-19. That reasoning is backwards. This was an accepted claim. When SAIF did not follow the procedure set forth in ORS 656.262(6) for “revoking the claim acceptance,” the claim acceptance was not revoked, and the claim remained an accepted claim. There was no denial of the claim. Perhaps the convoluted reasoning of the majority stems from an effort to avoid the fact that ORS 656.262(6) uses the term “the claim” in the same manner as I assert it is used in ORS 656.386(1) — to mean the original claim for compensation regarding the overall injury or condition.7
*231Even using the majority’s definition of “claim,” under which each of the medical bills was a “claim,” there was no denial. There was only late payment, for which a penalty is exclusive of attorney fees. See ORS 656.262(10)(a) (penalty is exclusive of attorney fees for late payment of benefits).
A related, and equally fundamental, error of the majority is its use of the usual statutory definitions of “claim” and “compensation.” 320 Or at 201-05. This court construed ORS 656.003 in Astleford v. SAIF, 319 Or 225, 232-33, 874 P2d 1329 (1994):
“With respect to ORS 656.003, this court implicitly concluded in SAIF v. Stephen, [308 Or 41, 774 P2d 1103 (1989),] that the legislature did not seek uniformity of definitions unless a different definition is compelled, but rather sought uniformity only so far as it is appropriate to the sensible functioning of the workers’ compensation system as a whole. See Webster’s Third New Int’l Dictionary 1929 (unabridged ed 1993) (‘require’ means, among other things, ‘to call for as suitable or appropriate in a particular case’). See also Stephens v. Bohlman, 314 Or 344, 350 n 6, 838 P2d 600 (1992) (when Supreme Court construes a statute, that construction becomes part of the statute). Thus, under ORS 656.003, ‘the context * * * requires’ that a given statutory definition not apply when the context — including the structure and purpose of the workers’ compensation scheme as a whole — demonstrates that the use of that given definition would be inappropriate, because the result of such use would conflict with one or more aspects of that structure or purpose. We proceed to apply that standard to the question at hand.”
Under the Astleford standard, “the context * * * requires,” ORS 656.003, that the statutory definitions of “claim” and “compensation” not apply here. There are at least two reasons why “the context * * * requires” that those definitions not apply in this case:
ORS 656.386(1) refers to a “decision denying i/ie claim for compensation.” (Emphasis added.) The use of “the” before “claim” implies that there is a single, previously *232defined “claim” being referred to — the original claim for the injury or condition, rather than every medical bill thereafter sent in on the accepted claim.
This court already had construed the phrase “denying the claim for compensation” in the other sentences in ORS 656.386(1) definitively to mean the original claim for the injury or condition, before the disputed third sentence was added to that section. Because of those decisions concerning the other sentences in ORS 656.386(1), the majority’s reading puts claimants who prevail before a hearing begins in a different and more favorable position than claimants who prevail after a hearing takes place. The legislature sought parity, not disparity.
To summarize, there was no “decision denying the claim for compensation” in this case. Claimant is not entitled to an attorney fee under ORS 656.386(1), and I dissent from the majority’s contrary holding.
Carson, C. J., and Gillette, J., join in this opinion.

 The submission of a medical bill concerning an injury or condition that has not already been accepted can constitute the claim for compensation. See ORS 656.005(3) (defining “claim”); ORS 656.262 (providingprocedure to process claims); ORS 656.265(2) (notice of accident resulting in an injury need not be in any particular form). Moreover, an insurer or self-insured employer can use a benefit claim as an opportunity to deny the injury or condition for which benefits are sought. See ORS 656.262(6) (providingprocedure to process claims). In those situations, the submission of a medical bill can give rise to a denial of “the claim for” compensation. Neither of those situations is involved in this case, however.

 ORS 656.262(10)(a) provides, in part:
“If the insurer or self-insured employer unreasonably delays or unreasonably refuses to pay compensation, or unreasonably delays acceptance or denial of a claim, the insurer or self-insured employer shall be liable for an additional amount up to 25 percent of the amounts then due. * * * The entire additional amount shall be paid to the worker if the worker is not represented by an attorney. If the worker is represented by an attorney, the worker shall be paid one-half the additional amount, in lieu of an attorney fee.”

 The only case in which this court arguably took the view that claimant urges on us is Ellis v. McCall Insulation, 308 Or 74, 775 P2d 316 (1989). In that case, the insurer stopped paying for the claimant’s chiropractic treatments several years after a compensable injury, which the insurer had accepted, on the ground that they were *227not related to the compensable injury. This court held that the insurer’s failure to respond in a timely manner was not an acceptance of responsibility for payment of the bills. In so holding, this court “assume[d] that [claimant’s] unpaid chiropractic bills were ‘claims’ under ORS 656.262(6).” Id. at 77 (footnote omitted). That assumption was not a holding, however.

 Other bases for denying compensation could include, for example, that the particular employer is not responsible for the compensable injury or that the claim was filed too late.

 In Duane L. Jones, 42 Van Natta 875 (1990), aff’d in Jones v. OSCI, 107 Or App 78, 810 P2d 1318, on recons 108 Or App 230, 814 P2d 558 (1991), the Board and the Court of Appeals held that the former version of ORS 656.386(1) “provide[d] no basis for an award of insurer-paid attorney fees to a claimant when the employer withdraws its denial of the claim after the claimant’s request for hearing has been filed but before the referee has decided the matter.” 108 Or App at 232. The underlying issue in the Jones case was compensability of the claimant’s injury. 107 Or App at 82.

 ORS 656.262(6) requires that an employer or insurer respond within 90 days to claims for compensation in the first instance. The Board has applied the time limit in ORS 656.262(6) to claims for payment of medical services since 1983, Billy J. Eubanks, 35 Van Natta 131 (1983). This court assumed the correctness of that application in Ellis v. McCall Insulation, supra note 3, 308 Or at 77.

 The text of ORS 656.262(6) makes clear that the legislature used the term “claim” in that provision to mean the original claim for compensation regarding the overall injury or condition. The text of that provision also distinguishes between “a claim” and “medical benefits.” For example, ORS 656.262(6) provides in part:
“However, if the worker requests a hearing on such [formal backup] denial, the insurer or self-insured employer must prove by clear and convincing evidence that the claim, is not compensable or that the paying agent is not responsible for the claim. * * * Pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits or burial expenses. * * * The notice of acceptance shall:
*231“(a) Specify what conditions are compensable.
“(b) Advise the claimant whether the claim is considered disabling or nondisabling.” (Emphasis added.)