Court Opinion

ID: 9883249
Source: CourtListenerOpinion
Date Created: 2023-10-06 01:38:58.29088+00
Date Added: 2024-06-11T07:48:17.352279
License: Public Domain

WOLLHEIM, J.,
dissenting.
The majority opinion ignores case law that existed before the adoption of ORS 656.262(4)(g) and case law after its adoption. The majority opinion acknowledges that the Board’s interpretation of the relevant statutes is reasonable. *55The Board’s statutory interpretation is not only reasonable, it is also the correct interpretation. For this reason, I dissent.
The primary question is whether ORS 656.262(4)(g) abolished the distinction between procedural and substantive temporary disability benefits. Although it has its basis in the statutes, the “substantive/procedural” terminology is not found in ORS chapter 656. The distinction has been described in case law. Lebanon Plywood v. Seiber, 113 Or App 651, 833 P2d 1367 (1992). The substantive entitlement for temporary total disability benefits is set forth in ORS 656.210, which provides that “[w]hen the total disability is only temporary, the worker shall receive during the period of that total disability compensation equal to 66-2/3 percent of wages * * Temporary total disability benefits are awarded to replace lost wages due to a compensable temporary disability. Cutwright v. Weyerhaeuser Co., 299 Or 290, 295, 702 P2d 403 (1985). Substantive time loss is the temporary total disability award, which the injured worker is entitled to receive at the time of closure by virtue of proof that the injured worker experienced a period of temporary total disability before claim closure. SAIF v. Taylor, 126 Or App 658, 660-61, 870 P2d 245 (1994).
An injured worker’s procedural entitlement to time loss is the temporary total disability benefits that the employer or insurer is obligated to pay on an open claim by virtue of the procedures of claim processing before the injured worker becomes medically stationary. The ability to obtain payment of benefits for temporary total disability while the claim is open is dependent on the satisfaction of a number of conditions, most of which are set forth in ORS 656.262. In Atchley v. GTE Metal Erectors, 149 Or App 581, 585, 945 P2d 557, rev den 326 Or 133 (1997), we said:
“[T]he general distinction between a substantive and procedural entitlement is that a substantive benefit is one that is made explicit and unconditional by statute, while a procedural benefit is conditional, arising solely from the vagaries of claim processing.”
A substantive award of temporary disability at the time of closure may exceed or be less than the procedural time-loss payments to which an injured worker was entitled *56during the time when the claim was open. That is, an employer or insurer may be required to pay additional time-loss payments or may be entitled to an offset for any overpaid time-loss benefits. To this date, this court has not construed the condition for payment of benefits for time loss, as set forth in ORS 656.262, as creating limitations on the award of benefits to which the injured worker is entitled under ORS 656.210 at the time of closure. This court has not held that a failure to carry out the procedures necessary to obtain payment of temporary total disability benefits while a claim is open bars an award for the entire period of disability at the time of closure.
I agree with the majority that we must first examine the text and context of ORS 656.262(4)(g). PGE v. Bureau of Labor and Industries, 317 Or 606, 610, 859 P2d 1143 (1993); Deluxe Cabinet Works v. Messmer, 140 Or App 548, 553, 915 P2d 1053, rev den 324 Or 305 (1996). I disagree with the majority in that I believe the text and context of ORS 656.262(4)(g) support the Board’s decision. Because I believe the legislative intent is clear from the text and context of ORS 656.262(4)(g), I do not consider the legislative history. A review of the relevant portions of ORS 656.262 follows.
ORS 656.262(4)(a) describes generally how benefits to time loss are paid, with the first installment due “no later than the 14th day after the subject employer has notice or knowledge of the claim, if the attending physician authorizes the payment of temporary disability compensation.” The initial payment of time-loss benefits is due upon authorization by the attending physician. With the exception of ORS 656.262(4)(f), which relates to the compensability of medical services, each subsequent subparagraph of subsection (4) relates to a circumstance affecting the payment of temporary total disability benefits while the claim is open. ORS 656.262(4)(d) is the first subsection to speak about “verification” of disability, as distinct from authorization of benefits. Temporary total disability is not due and payable during the period of time where the attending physician’s verification of an inability to work has been requested but not received, unless the claimant has been unable to receive treatment for reasons outside the claimant’s control.1 In Taylor, this court *57interpreted that subsection, then numbered (4)(b), and held that the requirement for verification of disability is a procedural limitation on the payment of benefits when the claim is open and does not alter the claimant’s substantive entitlement to an award of benefits for the entire period of disability. We said that even if medical verification is not provided, as required under subsection (4)(d), and benefits are not due and payable while the claim is open, the benefits to which the claimant is substantively entitled become due and payable at the time of closure:
“As we held in Sandoval v. Crystal Pine, 118 Or App 640, 848 P2d 1224, rev den 317 Or 0272 (1993), the suspension of benefits pursuant to ORS 656.262(4)(b) due to the absence of medical verification of an inability to work does not terminate the claimant’s substantive entitlement to benefits. The benefits to which the claimant is substantively entitled become due and payable when the claim is closed.” 126 Or App at 661.
Under ORS 656.262(4)(e), the claimant’s failure to attend an appointment with the attending physician may allow the employer or insurer to suspend the payment of benefits. ORS 656.262(4)(f) does not concern the payment of time-loss benefits.
Under ORS 656.262(4)(g), the disputed provision, no benefits are “due and payable pursuant to ORS 656.268” after the attending physician ceases to authorize them or for any period not authorized. Further, no authorization by a physician “under ORS 656.268” may retroactively authorize more than 14 days of benefits. From this brief summary, it can be readily determined that ORS 656.262(4) is primarily about the payment of benefits on an open claim, i.e., when payment must be made, when payment is not due and payable, and when payment may be unilaterally suspended. As the statute’s repeated reference to the subject bears out, the *58legislature considers authorization of benefits and verification of disability to be prerequisites to obtaining payment of temporary disability benefits on an open claim. Authorization of benefits and verification of disability, or the lack thereof, are determinative under ORS 656.262(4) for the purpose of obtaining temporary disability benefits while a claim is open and before being processed for claim closure. I presume that the legislature’s use of “not due and payable” and the unilateral suspension of benefits is intentional and, further, that the legislature used different language because it intended different meanings. Dale v. Electrical Board, 109 Or App 613, 616, 820 P2d 868 (1991).
The process for awarding benefits on a claim at the time of closure, as distinct from paying benefits for time loss before closure, is set forth in ORS 656.268. See Fazzolari v. United Beer Distributors, 91 Or App 592, 595, 757 P2d 857, adhered to 93 Or App 103, 761 P2d 6, rev den 307 Or 236 (1988) (ORS 656.268 only deals with the processing of claims). For example, ORS 656.268(5)(a) provides that when the department receives the medical and vocational reports concerning an accepted disabling injury claim, the claim shall be examined and “further compensation, including permanent disability award, if any, [be] determined * * *.” This implies that an injured worker may be entitled to further compensation for temporary disability beyond what was due and payable while the claim was open. ORS 656.268(13) provides:
“Any determination or notice of closure made under this section may include necessary adjustments in compensation paid or payable prior to the determination or notice of closure, including * * * crediting temporary disability payments against current or future permanent or temporary disability awards or payments and requiring the payment of temporary disability payments which were payable but not paid.”
Under ORS 656.268(15)(a), an employer or insurer may offset any compensation payable to the worker to recover an overpayment from a claim with the same employer or insurer. Each of the described subsections sets forth how an award of compensation, either an additional or lesser amount, must be made in the closure order.
*59ORS 656.268(3) describes the circumstances under which temporary disability benefits continue unless a specified event first occurs. ORS 656.268(3) provides:
“Temporary total disability benefits shall continue until whichever of the following events first occurs:
“(a) The worker returns to regular or modified employment;
“(b) The attending physician advises the worker and documents in writing that the worker is released to return to regular employment;
“(c) The attending physician advises the worker and documents in writing that the worker is released to return to modified employment, such employment is offered in writing to the worker and the worker fails to begin such employment; or
“(d) Any other event that causes temporary disability benefits to be lawfully suspended, withheld or terminated under ORS 656.262(4) or other provisions of this chapter.”
Subsection (3)(d) refers to ORS 656.262(4) and authorizes a discontinuance of temporary disability benefits based on “[a]ny other event that causes temporary disability benefits to be lawfully suspended, withheld or terminated under ORS 656.262(4) * * *.” However, subsection (3)(d) does not include the language from ORS 656.262(4)(g) of “not due and payable.”
This court previously interpreted ORS 656.262(4)(g) not to require an employer to pay the claimant more than two years of retroactive temporary disability benefits while the claim was open. Jensen v. Conagra, Inc., 152 Or App 449, 954 P2d 822 (1998). We rejected the claimant’s arguments that ORS 656.262(4)(g) did not apply to open claims. Id. at 452-53.
ORS 656.262(4)(g), in turn, refers to ORS 656.268 in stating its requirement for authorization of time loss. The question here is whether the requirement for authorization of time loss applies for purposes of the award of benefits at the time of closure and, if so, whether the limitation on retroactive authorization also applies to the award of benefits.
*60ORS 656.262(4)(g) twice refers to ORS 656.268:
“Temporary disability compensation is not due and payable pursuant to ORS 656.268 after the worker’s attending physician ceases to authorize temporary disability or for any period of time not authorized * * *. No authorization * * * by the attending physician under ORS 656.268 shall be effective to retroactively authorize the payment of temporary disability more than 14 days prior to its issuance.” (Emphasis added.)
The Board interpreted the references in ORS 656.262(4)(g) to ORS 656.268 to relate only to ORS 656.268(3)(d), rather than to ORS 656.268 in its entirety. It held that the limitations expressed in ORS 656.262(4)(g) are additional procedural restrictions on the payment of time-loss benefits while a claim is open, but that they do not restrict an award of benefits at the time of closure. The majority disagrees.
The placement of ORS 656.262(4)(g) among the sub-paragraphs, which we have previously held relate only to procedural limitations on the payment of time-loss benefits, supports claimant’s and the Board’s interpretation. To adopt the majority’s interpretation would be a significant departure from prior statutes and our case law interpreting them. Taylor; Sandoval; Fazzolari; Vip’s Restaurant v. Krause, 89 Or App 214, 748 P2d 164, adhered to 91 Or App 472, 756 P2d 47, rev den 306 Or 414 (1988). I am unwilling to assume that the legislature intended such a departure without very clear statutory language that it did so.
The language of ORS 656.268(4)(g) does not support the majority’s interpretation. The first sentence of subsection (4)(g) is expressly limited to temporary disability benefits not due and payable “pursuant to ORS 656.268.” That statute is only a procedural statute. Fazzolari, 91 Or App at 595. Because temporary disability benefits suspended under the first sentence of subsection (4)(g) are, by definition, being paid pursuant to ORS 656.268, this sentence is limited to the procedural entitlement to temporary disability benefits. The second sentence of subsection (4)(g) expressly refers to an attending physician’s authorization of temporary disability benefits “under ORS 656.268.” The explicit reference to ORS 656.268 limits the application of this sentence of (4)(g) to the *61procedural entitlement of temporary benefits while the claim is open. I cannot ignore the legislature’s explicit reference to ORS 656.268 by omitting what the legislature inserted. ORS 174.010. Thus, like the first sentence, the second sentence of subsection (4)(g) is also limited to the procedural entitlement to temporary disability benefits.
The distinction between procedural and substantive benefits applies only to temporary disability benefits. There are no procedural permanent disability benefits, no procedural medical benefits, nor procedural vocational assistance benefits. Under the majority’s reading of ORS 656.262(4)(g), the distinction between procedural and substantive temporary disability benefits no longer exists. No employer or insurer would ever be required to pay temporary benefits more than 14 days before the attending physician’s authorization.
To reach this result, the majority overrules our recent decisions in both Shaw v. Rebholtz, 152 Or App 328, 954 P2d 190 (1998), and Santos v. Caryall Transport, 152 Or App 322, 954 P2d 187 (1998). Essential to the decision in Shaw, this court had to determine whether the legislature abolished the distinction between procedural and substantive benefits:
“Claimant insists that the distinction between his entitlement to temporary disability benefits during the pendency of the open claim and his entitlement to the benefits at closure relies on a distinction between ‘substantive’ and ‘procedural’ entitlements that has been legislatively overruled. We have rejected that argument.” 152 Or App at 333.
In Santos, the issue was whether the employer was required to pay time-loss benefits after the claimant was medically stationary. 152 Or App 322. The claimant argued that the amendments to ORS 656.268(3) were the only authority for the unilateral termination of time-loss benefits and that because being medically stationary was not one of the statutory grounds for the unilateral termination of time-loss benefits, the claimant was entitled to such benefits until the claim was closed. Id. at 325. We rejected the claimant’s arguments and held that the distinction between procedural *62and substantive entitlements was not changed by either the 1990 or the 1995 amendments to ORS chapter 656. Id. at 327.
The majority is correct that the holdings in Santos and Shaw are not directly on point. 159 Or App at 54. The majority and I disagree about the effect of this decision on Santos and Shaw. Essential to both decisions was that this court held the distinction between substantive and procedural entitlement to temporary disability benefits was not abolished by either the 1990 nor the 1995 amendments to ORS chapter 656. However, the majority here holds that the 1995 amendments to ORS 656.262(4)(g) abolished the distinction between substantive and procedural temporary disability benefits.
In summary, both sentences of ORS 656.262(4)(g) explicitly refer to ORS 656.268, the statute for processing and closing a claim. ORS 656.268 refers to procedural, not substantive, temporary disability benefits. Accordingly, I would hold that ORS 656.262(4)(g) applies only to procedural entitlement to temporary disability benefits. Here, the award of temporary disability benefits was substantive, and the Board’s order was proper.
There is another reason to affirm the Board: stare decisis. The rule of stare decisis was discussed by the Supreme Court in Multnomah County v. Sliker, 10 Or 65, 66 (1881):
“[T]he rule is said to be almost universal that in construing statutes and the constitution, [the courts] adhere to the doctrine of stare decisis [even though a different conclusion might be reached] * * * unless error is plainly shown to exist * *
This language was recently relied on by Judge Edmonds, dissenting in Newell v. Weston, 156 Or App 371, 383, 965 P2d 1039 (1998). The majority opinion ignores the rule of stare decisis and overrules two recent decisions by this court. I do not believe the majority has established that plain error exists. I fear this decision undermines an important policy of the appellate courts of this state: to afford certainty to the administration of justice. The changing of the goal posts by judicial fiat can only lead to uncertainty in the law and *63encourage litigants to question settled law. Nor can it be said that the law concerning ORS 656.262(4)(g) is even settled. Perhaps another litigant will raise this issue again, and this court, perhaps with different members, will reexamine this statute and decide that Santos and Shaw were correctly decided. Such changes do not promote the rule of stare decisis, nor do they promote the administration of justice.
Because I would affirm the Board’s decision, it would be necessary to reach employer’s second assignment of error. Employer asserted that the Board erred in determining that claimant was disabled during the period in question. I would hold that the Board’s determination is supported by substantial evidence.
I dissent.
De Muniz and Armstrong, JJ., join in this dissent.

 Explicit in ORS 656.262(4)(d) is the provision that the claimant may be entitled to temporary disability benefits that were not due and payable if the claimant *57can later establish that no treatment was received for reasons beyond the claimant’s control. Implicit in this subsection is that the claimant can later establish that fact when the claim is closed and the claimant is awarded temporary disability benefits. Under the majority’s analysis, a claimant would not be entitled to later receive time-loss benefits even if it was established that the reason the claimant was unable to receive treatment was outside the claimant’s control. Thus, the majority’s analysis renders subsection (4)(d) nugatory.