Opinion

Johnson v. SAIF

  • 369 Or. 579
  • 507 P.3d 1277
Court
Oregon Supreme Court
Filed
Apr 21, 2022
Status
Published
On the bench
Nelson
Cited by
6 cases
Authority
More cited than 75.8%

The opinion

579

Argued and submitted June 24, 2021; decision of Court of Appeals affirmed,

order of Workers’ Compensation Board reversed April 21, 2022

Marisela JOHNSON,

Respondent on Review,

v.

SAIF CORPORATION

and The Terrace Corporation,

Petitioners on Review.

(SAIF 12-01864, 12-02168)

(CA A160491) (SC S068208)

507 P3d 1277

Claimant injured her left hand in a work-related incident and SAIF accepted

her workers’ compensation claim. A short time later, claimant sought to modify

the claim to include additional injuries to her left forearm, shoulder, and upper

back. SAIF denied the request as to some of those injuries after it found that

the injuries were not compensably related to the work incident. Prior to clos-

ing claimant’s accepted claim, an examination indicated that claimant suffered

permanent impairment, including decreased grip strength that was attributed

50 percent to the accepted, compensable conditions and 50 percent to the denied

conditions. At claim closure, SAIF apportioned claimant’s permanent partial

disability award and reduced the award based on the percentage caused by the

denied conditions. The Workers’ Compensation Board upheld the apportionment

of claimant’s award, but the Court of Appeals reversed. SAIF sought review of

that decision. Held: Under ORS 656.214, a claimant is entitled to compensation

for the full measure of impairment that is due in material part to, and resulting

in material part from, the compensable industrial injury unless the insurer or

self-insured employer avails itself of the statutory process for apportionment of

combined conditions.

The decision of the Court of Appeals is affirmed. The order of the Workers’

Compensation Board is reversed.

On review from the Court of Appeals.*

Daniel Walker, Appellate Counsel, SAIF Corporation,

argued the cause and filed the briefs for petitioners on review.

Jodie Phillips Polich, Law Offices of Jodie Anne Phillips

Polich, PC, Milwaukie, argued the cause for respondent on

review. Donald M. Hooten, Beaverton, filed the brief.

______________

* On judicial review of an order of the Workers’ Compensation Board. 307 Or

App 1, 475 P3d 465 (2020).

580 Johnson v. SAIF

Benjamin Debney, Wallace, Klor, Mann, Capener &

Bishop, P.C., Lake Oswego, filed the brief for amicus curiae

Wallace, Klor, Mann, Capener & Bishop, P.C.

Rebecca A. Watkins, Sather Byerly & Holloway, LLP,

Portland, filed the brief for amici curiae Oregon Business &

Industry and Providence Health & Services.

Sommer E. Tolleson, Tolleson Conratt Nielsen Maher

& Replogle LLP, Tigard, filed the brief for amicus curiae

Associated General Contractors – Oregon Columbia Chapter.

Julene M. Quinn, Portland, filed the brief for amicus curiae

Oregon Trial Lawyers Association.

Before Walters, Chief Justice, and Balmer, Flynn, Duncan,

Nelson, and Garrett, Justices, and Nakamoto, Senior Judge,

Justice pro tempore.**

NELSON, J.

The decision of the Court of Appeals is affirmed. The

order of the Workers’ Compensation Board is reversed.

______________

** DeHoog, J., did not participate in the consideration or decision of this case.

Cite as 369 Or 579 (2022) 581

NELSON, J.

The dispute in this workers’ compensation case con-

cerns the meaning of the word “impairment” within the con-

text of the workers’ compensation statutory scheme and

whether a claimant is entitled to compensation for the full

measure of impairment where it is caused in material part,

but not solely, by a compensable injury. Under ORS 656.214

(1)(a), impairment is defined as “the loss of use or function

of a body part or system due to the compensable indus-

trial injury.” This case involves impairment—claimant’s

loss of grip strength—that was determined to be caused in

material part by an accepted, compensable condition and,

in part, by a denied condition. Claimant contends that ORS

656.214 entitles an injured worker to compensation for the

full measure of impairment due in material part to, and

resulting in material part from, the compensable injury,

including any impairment stemming from the denied condi-

tion, if applicable. SAIF disagrees, arguing that the defini-

tion of impairment does not include loss caused by a denied

condition because it is not “due to” the “compensable indus-

trial injury.”

For the reasons that follow, we conclude that claim-

ant was entitled to the full measure of her impairment.

Accordingly, we affirm the decision of the Court of Appeals.

I. BACKGROUND

A. Key Terminology and Statutory Background

We begin with an overview of the key terminology

and the workers’ compensation claims process to set the con-

text for the issues presented in this case. After a workplace

injury occurs, the worker is generally required to provide

written notice of the injury to the employer within 90 days

of the accident. See ORS 656.265(1)(a) (“Notice of an accident

resulting in an injury or death shall be given immediately

by the worker or a beneficiary of the worker to the employer,

but not later than 90 days after the accident. The employer

shall acknowledge forthwith receipt of such notice.”). During

its investigation and evaluation of a submitted claim, the

insurer or self-insured employer must determine if the

claimant’s claim is compensable. “The burden of proving

582 Johnson v. SAIF

that an injury or occupational disease is compensable and

of proving the nature and extent of any disability resulting

therefrom is upon the worker.” ORS 656.266(1). “A ‘compen-

sable injury’ is an accidental injury * * * arising out of and

in the course of employment requiring medical services or

resulting in disability or death.” ORS 656.005(7)(a).

After the insurer or self-insured employer makes

a determination about whether the claim is compensable,

then the employer is required to issue a written acceptance

or denial of the claim to the employee. See ORS 656.262

(6)(a) (“Written notice of acceptance or denial of the claim

shall be furnished to the claimant by the insurer or self-

insured employer within 60 days after the employer has

notice or knowledge of the claim.”). If the claim is accepted,

then the required notice of acceptance must comply with

the requirements set forth in ORS 656.262(6)(b), including

a specification of the exact conditions that are compensable

and a statement of the claimant’s rights and responsibili-

ties for returning to work. By contrast, if the insurer or self-

insured employer investigates the claim and determines

that the claim is not compensable, then the employer must

issue a written notice of its decision to deny the claim. ORS

656.262(9). The notice of denial must “stat[e] the reason for

the denial” and inform the worker of their rights to a hear-

ing to contest the denial. ORS 656.262(9).

When an accepted, compensable condition becomes

medically stationary—that is, when “no further material

improvement would reasonably be expected from medical

treatment, or the passage of time[,]” ORS 656.005(17)—then

the claim is subject to claim closure and any award of per-

manent partial disability, if applicable in the claimant’s

case, is calculated.1 See generally ORS 656.268 (describing

the claim closure process). At that point, ORS 656.262(7)(c)

sets out the procedure for closing the claim:

1

Permanent partial disability is defined within the workers’ compensa-

tion statutes as either “[p]ermanent impairment resulting from the compen-

sable industrial injury or occupational disease” or “[p]ermanent impairment

and work disability resulting from the compensable industrial injury or occu-

pational disease.” ORS 656.214(1)(c). Permanent partial disability benefits

are to be calculated in accordance with the rules and procedures set out in

ORS 656.214.

Cite as 369 Or 579 (2022) 583

“When an insurer or self-insured employer determines

that the claim qualifies for claim closure, the insurer or self-

insured employer shall issue at claim closure an updated

notice of acceptance that specifies which conditions are com-

pensable. * * * Any objection to the updated notice or appeal

of denied conditions shall not delay claim closure pursuant

to ORS 656.268. If a condition is found compensable after

claim closure, the insurer or self-insured employer shall

open the claim for processing regarding that condition.”

The claimant may then accept the closure and the payment

of benefits or, if the claimant objects to the terms of the notice

of closure or the scope of the award, the worker may request

reconsideration. See generally ORS 656.268(5)(c) (describ-

ing the requirements of the notice of closure, including a

statement regarding the claimant’s right to request consid-

eration). If the claimant’s physical impairment is in dispute

on reconsideration, then the Director of the Department of

Consumer and Business Services (DCBS) must appoint a

medical arbiter to consider the claim. See ORS 656.268(8)(a)

(“If the basis for objection to a notice of closure issued under

this section is disagreement with the impairment used in

rating of the worker’s disability, the director shall refer

the claim to a medical arbiter appointed by the director.”).

As before, the claimant has the burden of establishing the

nature and extent of the impairment and its relationship to

the compensable injury. ORS 656.266.

B. Facts and Procedural History

With that background in mind, we turn to the facts

of this case. The issue in this case centers on the insurer’s

calculation of claimant’s impairment award for permanent

partial disability. The relevant facts of this case are not in

dispute and are taken from the Court of Appeals’ opinion

in the decision now on review, that court’s earlier consider-

ation of this same case, Johnson v. SAIF, 291 Or App 1, 418

P3d 27 (2018) (Johnson I), and the record from the Workers’

Compensation Board.

In July 2011, claimant, a housekeeper, was injured

at work when her left hand was caught in a closing eleva-

tor door. Claimant filed a workers’ compensation claim, and

SAIF accepted the claim for contusions to the distal left

584 Johnson v. SAIF

third, fourth, and fifth fingers, and an abrasion to the distal

left middle finger.

In August 2011, after receiving treatment for the

initial injury, claimant sought treatment for additional pain

in her left forearm, shoulder, and upper back. Claimant

attributed the need for the additional treatment to the work-

place incident, specifically claiming that it occurred when

she pulled her hand back out of the closing elevator door. An

MRI revealed a partial thickness tear of the supraspinatus

tendon in claimant’s left shoulder.

In October 2011, claimant’s attending physician

conducted an examination of claimant’s left hand and

determined that claimant’s workplace injury to that hand

had resolved. The physician confirmed that claimant’s left

finger injuries were medically stationary as of October 28,

2011, and those conditions had resolved without any rat-

able permanent impairment. SAIF closed the claim for the

injury to the left hand and, pursuant to the process laid out

above and detailed in the workers’ compensation statutes

and accompanying administrative rules, determined that

claimant was not entitled to any award for permanent par-

tial disability. Claimant requested reconsideration and the

appointment of a medical arbiter.

Meanwhile, claimant continued to seek treatment

for the additional pain to her left forearm, shoulder, and

upper back. Claimant filed a new or omitted medical condi-

tion claim for a left rotator cuff tear, left upper arm sprain,

left elbow sprain, and cervical disc disorder. In January

2012, SAIF modified its initial order of acceptance to include

benefits for sprains of the left shoulder and the left trapezius

muscle, but it issued a denial of the claim for a left rota-

tor cuff tear, left upper arm, forearm, and elbow sprain,

and cervical disc disorder. In denying those claims, SAIF

explained that the conditions were not compensably related

to the work injury. Claimant requested a hearing before the

Workers’ Compensation Board on the denied claim.

In March 2012, a medical arbiter performed an

examination to determine claimant’s permanent impair-

ment related to the accepted left finger contusions and abra-

sion. The medical arbiter listed his “Impression” of claimant’s

Cite as 369 Or 579 (2022) 585

conditions as: “(1) Crush injuries left index, long, ring, and

possibly little fingers left hand. (2) Claimed rotator cuff tear,

partial tear or aggravation, left shoulder.” The medical arbi-

ter documented limited range of motion and decreased grip

strength in claimant’s left fingers. He attributed 100 per-

cent of the loss of range of motion to the accepted conditions.

As to the loss of grip strength, however, the medical arbiter

only partially attributed the impairment to the accepted

conditions (50 percent) and partially to the denied shoulder

condition (50 percent). Describing the loss of grip strength,

the medical arbiter noted that it was “a combined condition

related to her shoulder, her hand, and to disuse.”

In April 2012, an Order on Reconsideration mod-

ified SAIF’s earlier notice of closure. The reconsideration

order acknowledged that SAIF had denied the left rotator

cuff tear, left upper arm sprain, left elbow sprain, and cer-

vical disc disorder as noncompensable. It also further noted

that SAIF had accepted, after the claim closure was issued,

a left shoulder sprain and left trapezius muscle strain.

None of those injuries was subject to the reconsideration

order, which was limited to the left finger contusions and

abrasion. Based on the medical arbiter’s findings regard-

ing those conditions, claimant was awarded benefits for a

left-hand impairment value of seven percent whole person

impairment. That value included benefits for the loss of grip

strength, apportioned to the accepted left-hand claim at

50 percent, per the medical arbiter’s findings.

Both parties requested a hearing before the

Workers’ Compensation Board (board). The board upheld

the medical arbiter’s findings and affirmed the apportion-

ment of claimant’s permanent partial disability award.2

Claimant sought judicial review of that decision, arguing

that her entire impairment from the loss of grip strength,

which she claimed was caused in material part by the com-

pensable hand injury, is compensable and should have been

rated, without apportionment, for the permanent partial

2

The Workers’ Compensation Board did reverse a portion of the findings

below, related to an increase in claimant’s whole person impairment and an

award of attorney fees. Those decisions are not in dispute before this court on

this claim.

586 Johnson v. SAIF

disability award. In the Court of Appeals’ initial consider-

ation of this case, that court relied on this court’s opinion

in Schleiss v. SAIF, 354 Or 637, 317 P3d 244 (2013), which

is described in detail below, to reject claimant’s argument

and uphold the order of the Workers’ Compensation Board.

Johnson I, 291 Or App at 7.

Claimant petitioned this court for review, advanc-

ing the same arguments as before. While that petition for

review was pending, this court issued its decision in Caren

v. Providence Health System Oregon, 365 Or 466, 446 P3d

67 (2019). This court allowed claimant’s petition for review,

vacated the Court of Appeals’ decision, and remanded the

case to the Court of Appeals for reconsideration in light of

that decision. Johnson v. SAIF Corporation, 365 Or 657, 451

P3d 1014 (2019).

On remand, the Court of Appeals reversed its ear-

lier decision. Johnson v. SAIF, 307 Or App 1, 5, 475 P3d 465

(2020) (Johnson II). Relying on this court’s decision in Caren,

the Court of Appeals explained that, when a worker’s impair-

ment is due to a combination of the compensable injury and a

preexisting condition, “the legislature intended that injured

workers would be fully compensated for new impairment if

it is due in material part to the compensable injury, except

where an employer has made use of the statutory process for

reducing liability after issuing a combined condition denial.”

Johnson II, 307 Or App at 4 (quoting Caren, 365 Or at 468).

Because apportionment between different injuries can only

occur in a combined condition claim, and because claimant’s

impairment was not the result of a combined condition, that

court concluded that claimant was entitled to the full mea-

sure of her impairment, without regard to SAIF’s previous

denial of the rotator cuff injury. Id. at 5.

SAIF petitioned for review, arguing that the Court

of Appeals decision conflicts with the plain language of ORS

656.262(2). That statute provides that compensation for a

claim is to be paid upon an employer’s notice or knowledge of

that claim, “except where the right to compensation is denied

by the insurer or self-insured employer.” ORS 656.262(2).

SAIF contends that the decision below improperly extends

this court’s decision in Caren beyond the combined conditions

Cite as 369 Or 579 (2022) 587

process specific to that case. As we understand SAIF’s view,

impairment does not include loss due to a condition that

has been denied as “noncompensable” and, accordingly, any

award for permanent partial disability should be adjusted

to reflect only the portion of the impairment that claimant

is entitled to based solely on the accepted condition.

We allowed review to consider the extent to which

the workers’ compensation statutes, and specifically ORS

656.214, require an insurer or self-insured employer to

award benefits for the full measure of an injured worker’s

impairment when that impairment may be apportioned,

at least in part, to a previously denied, noncompensable

condition.

II. ANALYSIS

On review, SAIF argues that the Court of Appeals

was incorrect in applying Caren to this case and that that

court’s conclusion demonstrates what SAIF describes as a

“fundamental confusion” about the meaning of “compen-

sable industrial injury” in cases, like this one, involving

denied conditions. Instead, SAIF argues that the statu-

tory scheme of the workers’ compensation statutes and the

case law interpreting those statutes supports the proposi-

tion that benefits—including awards for permanent partial

disability—are not intended to flow from specifically denied

conditions. In SAIF’s view, when an insurer issues a par-

tial denial of a medical condition, the denied condition is not

subject to an award of permanent partial disability unless

the condition is later determined to be compensable, and the

denial is overturned. Here, SAIF argues that claimant was

not entitled to an award for impairment attributable to the

denied left rotator cuff tear because claimant never estab-

lished that that injury was compensable and SAIF had spe-

cifically denied the claim.3

3

Amici Oregon Business & Industry (OBI) and Providence Health & Services

write in support of SAIF, reiterating many of the same arguments and specifi-

cally arguing that the definition of impairment in ORS 656.214 makes clear that

“[a] denied condition is expressly not a compensable condition” and, accordingly,

“a worker should not receive disability awards for impairment due to a denied

condition.” Additionally, Associated General Contractors – Oregon Columbia

Chapter and Wallace, Klor, Mann, Capener & Bishop, P.C., have each submitted

an amicus curiae brief in support of SAIF. Oregon Trial Lawyers Association

wrote in support of claimant.

588 Johnson v. SAIF

For her part, claimant acknowledges that Caren

involved consideration of a combined condition and agrees

with SAIF that there was no combined condition in this

case. Both parties recognize that the combined condition

analysis in Caren is inapplicable here and, to the extent that

the Court of Appeals relied on it below, contend that that

reliance was misplaced. Claimant, however, agrees with the

Court of Appeals that she was entitled to the full measure

of impairment due to the compensable injury and disputes

SAIF’s assertion that the decision below improperly forces

an insurer to pay benefits for a denied condition. Instead,

in claimant’s view, the decision below recognizes that con-

ditions that are not compensable—here, the previously

denied left rotator cuff tear—can contribute to impairment

that is part of the compensable injury. Claimant argues

that an injured individual is entitled the full measure of

impairment—even where a portion of that impairment may

have been caused, in part, by a noncompensable or denied

condition—where the accepted condition is at least a mate-

rial contributing cause of the impairment. It is claimant’s

position that the Court of Appeals properly determined that

claimant was entitled to compensation for her loss of grip

strength, the impairment value at issue here.

As explained above, the workers’ compensation

statutes provide for a specific process that must be adhered

to following a workplace injury. When an accepted, com-

pensable injury becomes medically stationary, and proper

notice has been issued to the claimant, then the insurer or

self-insured employer calculates the amount of disability

benefits due to the claimant. See ORS 656.268. Our under-

standing of the primary disagreement between the parties

is that the dispute centers around the meaning of the word

“impairment” and whether that term includes loss that is

caused in part by a previously denied condition and in part

by the accepted compensable injury, but where neither party

contends that a combined condition exists. The meaning of

the word impairment, and what that word encompasses, is a

question of statutory construction.

When we are confronted with an issue of statutory

construction, we resolve that issue following the established

Cite as 369 Or 579 (2022) 589

statutory interpretation framework laid out in PGE v.

Bureau of Labor and Industries, 317 Or 606, 610-12, 859 P2d

1143 (1993), and State v. Gaines, 346 Or 160, 171-72, 206

P3d 1042 (2009). Our primary goal in interpreting statutory

provisions is to determine the intent of the legislature at the

time it enacted the relevant statutes. See Gaines, 346 Or at

171 (“This court remains responsible for fashioning rules of

statutory interpretation that, in the court’s judgment, best

serve the paramount goal of discerning the legislature’s

intent.”). To determine whether the legislature intended for

injured workers to receive the full measure of impairment

caused in part by a compensable injury, even if such impair-

ment was also caused in part by a previously denied condi-

tion, we examine the workers’ compensation statutes as a

whole and our prior judicial interpretations of those stat-

utes. See Caren, 365 Or at 472 (citing Brown v. SAIF, 361 Or

241, 283, 391 P3d 773 (2017)). With that in mind, we turn to

the statutes at issue in this case.

A. Textual Analysis and Prior Judicial Construction

We begin with key definitions from the workers’

compensation statutes themselves. A compensable injury is

“an accidental injury, * * * arising out of and in the course

of employment requiring medical services or resulting in

disability or death.” ORS 656.005(7)(a). This court has con-

strued “arising out of,” as used in the definition of “com-

pensable injury,” to mean that a workplace injury must be

a material contributing cause of disability or the need for

medical treatment in order for the injury to be compensable.

Olson v. State Ind. Acc. Com., 222 Or 407, 414, 352 P2d 1096

(1960). We explained that “arising out of” does not necessi-

tate that the injury be the sole cause of the need for treat-

ment, “but is sufficient if the labor being performed in the

employment is a material, contributing cause which leads to

the unfortunate result.” Olson, 222 Or at 414-15. The mate-

rial contributing cause standard remains the accepted test

for establishing the existence of a compensable injury under

ORS 656.005(7)(a). See Schleiss, 354 Or at 643 (describing

the test for establishing a compensable injury); see also

Hopkins v. SAIF Corp., 349 Or 348, 351, 245 P3d 90 (2010)

(same).

590 Johnson v. SAIF

“Impairment” is specifically defined as “the loss of

use or function of a body part or system due to the compen-

sable industrial injury.” ORS 656.214(1)(a) (emphasis added).

“Permanent partial disability” is “[p]ermanent impairment

resulting from the compensable industrial injury or occu-

pational disease.” ORS 656.214(1)(c). Thus, combining those

definitions, an award for permanent partial disability is

based on permanent loss of use or function of a body part

or system resulting from the compensable industrial injury.

Impairment benefits awarded under the workers’ compensa-

tion statutes, including benefits for permanent partial dis-

ability, are expressed as a percentage of a whole person and

calculated according to the process laid out in the workers’

compensation statutes and accompanying administrative

rules. See generally ORS 656.214(3) (stating that impair-

ment benefits “shall be expressed as a percentage of the

whole person” and laying out procedures for calculation of

those benefits).

We have previously addressed the meaning of

“impairment,” the causes that contribute to it, and how

impairment impacts the calculation of awards of permanent

partial disability in several cases. Although those cases do

not answer all the questions presented in this case, each

provides insight and context for understanding our decision

today. We review those cases now.

1. Barrett I and Barrett II

This court considered the relationship between

impairment and the causes contributing to it in a case that

explained the method for calculating awards for permanent

partial disability under ORS 656.214. See Barrett v. D & H

Drywall, 300 Or 325, 709 P2d 1083 (1985) (Barrett I), adh’d

to on recons, 300 Or 553, 715 P2d 90 (1986) (Barrett II). In

the Barrett cases, the claimant injured his back after falling

from a ladder at work. Barrett I, 300 Or at 327. The work

injury combined with a preexisting, asymptomatic arthritic

condition in the claimant’s low back. Id. The employer

accepted responsibility for the portion of the back injury

that resulted from the work accident but denied liability

for the preexisting arthritic condition under ORS 656.214

Cite as 369 Or 579 (2022) 591

(1985).4 This court held that the calculation of permanent

partial disability should consider impairment related to the

claimant’s preexisting osteoarthritis, explaining that

“[t]he oft-expressed maxim still applies: An employer takes

the worker as he finds him. Whether the worker suffers

greater permanent partial disability (measured by the loss

of earning capacity) because of a preexisting condition is

irrelevant in deciding the amount of loss of earning capac-

ity caused by a new injury superimposed on a preexisting

condition.”

Barrett I, 300 Or at 328 (footnote omitted). That holding

acknowledged that it is difficult, if not impossible at times, to

separate out the individual components of impairment when

a compensable injury is superimposed on a preexisting con-

dition. Id. at 331. Accordingly, compensation for a claimant’s

impairment is calculated considering the full symptoms

caused by the compensable injury. Id.

Following a petition for reconsideration in that

case, we clarified that impairment “due to the compensa-

ble injury” included impairment that occurred because the

compensable injury triggered a preexisting asymptomatic

condition to become symptomatic. Barrett II, 300 Or at 555-

56. Specifically, we explained that the permanent partial

disability award should not directly compensate the claim-

ant for the osteoarthritis itself but, if the work injury caused

a preexisting “disease to produce symptoms where none

existed immediately prior to the accident,” and “those symp-

toms produced loss-of-earning capacity,” then the workers’

compensation statutes, as they existed at that time, required

that the claimant be compensated for that loss. Id.

This court later summarized the holding of the

Barrett cases clearly and succinctly: “Barrett determined

that the worker’s permanent partial disability was the full

amount of his new impairment, without reduction for the

portion of that loss attributable to his preexisting condition.”

Caren, 365 Or at 476. That explanation matches the rule

4

Under ORS 656.214(5) (1985), which was in place at the time the Barrett

cases were decided, the criterion for determining a rating of disability for per-

manent partial disability was “the permanent loss of earning capacity due to the

compensable injury.”

592 Johnson v. SAIF

proposed by claimant in this case, but our inquiry cannot

end there. As SAIF points out, the legislature overhauled a

large portion of the workers’ compensation statutes after the

Barrett cases were decided and the holding of those cases

do not carry the same relevance today as when they were

decided. This court has acknowledged as much in Schleiss, a

case presenting similar questions:

“Barrett is of doubtful utility here for another funda-

mental reason. When Barrett was decided in 1985, no stat-

ute addressed the role in [permanent partial disability]

award determinations of impairment that is attributable to

a preexisting condition that has combined with a compen-

sable injury. * * * However, the workers’ compensation stat-

utes now provide specific standards for determining how

and when conditions that ‘combine’ workplace injuries with

preexisting conditions are compensable and how and when

impairment caused by such conditions can be apportioned.

In light of those statutory changes, impairment attribut-

able to a legally cognizable preexisting condition now must

be apportioned in a [permanent partial disability] award

where a combined condition has been established, and the

compensable injury is no longer the major contributing

cause of the impairment or the need for medical treatment.”

Schleiss, 354 Or at 649-50. Additionally, even if the under-

lying proposition of Barrett remains the same, those cases

only answer part of the question posed here.

2. Schleiss

As noted, after Barrett—and, in part, because of

Barrett—the legislature significantly revised the statutory

scheme of Oregon’s workers’ compensation system during a

1990 special legislative session. See Caren, 365 Or at 476;

Brown, 361 Or at 265-66 (describing the 1990 special ses-

sion and the overhaul of the workers’ compensation statutes

that resulted); see also Or Laws 1990, ch 2, § 3 (Spec Sess)

(detailing the changes made during the legislative session).

One of the legislative changes that came out of that session

was the creation of the “combined condition” framework. See

Or Laws 1990, ch 2, § 3 (Spec Sess) (detailing the changes

made during the legislative session). The 1990 legislation

amended the definition of “compensable injury” to specify,

that when an “otherwise compensable injury” combines with

Cite as 369 Or 579 (2022) 593

a preexisting condition to create a new condition or need for

treatment, the combined condition “is compensable only if

* * * the otherwise compensable injury is the major contrib-

uting cause of the disability of the combined condition or

the major contributing cause of the need for treatment of

the combined condition.” See ORS 656.005(7)(a)(B). As we

would later explain, that amendment altered the material

contributing cause standard by creating a major contribut-

ing cause standard for combined conditions. The decisions of

this court that followed the 1990 legislative overhaul of the

workers’ compensation statutes provide additional context

for us in evaluating this case.

This court was presented with its first opportunity

to clarify the meaning of “impairment” and its contributing

causes under the revised workers’ compensation statutory

scheme in Schleiss. There, the claimant injured his back at

work and the insurer accepted his claim for a lumbar strain.

Schleiss, 354 Or at 639. At claim closure, the injured worker

claimed new impairment caused in part by the workplace

injury but also in part by a preexisting degenerative joint

disease and accelerated aging due to smoking. Id. at 639-40.

Mirroring part of the arguments made in this case,

the claimant in Schleiss challenged the award of perma-

nent partial disability. The claimant argued that because

“the compensable injury materially contributed to the total

impairment, all the impairment is ‘due to’ the compensa-

ble injury,” and should result in an award covering the full

measure of impairment without a reduction or apportion-

ment based on the estimated contribution of the preexisting

conditions. Id. at 643. The insurer rejected that argument

and instead asserted that the phrase “due to” referenced

“the percentage of the worker’s total impairment that was

caused by the compensable injury, so that the percentage of

the total impairment ‘due to’ any other contributing cause

must be excluded from the award.” Id. There, we observed

that,

“[o]n the surface of things, either of those proposed mean-

ings is plausible. The dictionary definition of ‘due to’ is

‘because of.’ Webster’s Third New Int’l Dictionary 699

(unabridged ed 2002). Consistently with that meaning, as

594 Johnson v. SAIF

claimant asserts, ‘due to’ could mean that a compensable

injury must have materially contributed to a worker’s total

impairment; alternatively, as SAIF contends, ‘due to’ could

refer instead to the percentage of a worker’s total impair-

ment to which the compensable injury contributed.”

Id. The insurer in that case also argued that the “claim-

ant had the burden of asserting and proving” a compen-

sable combined condition if the “claimant wished to have

an impairment caused in part by a preexisting condition”

included in the calculation of his permanent partial disabil-

ity award. Id. at 651.

Following a detailed examination of the surround-

ing statutory framework, and the meaning of “due to” within

the context of those statutes, this court concluded that it

was not necessary to resolve the dispute between the par-

ties concerning the meaning of “due to” within the newly

enacted combined condition framework because there was

“no evidence in the record that either of the contributing

causes on which the medical arbiter and the board relied

[was] a legally cognizable preexisting condition that would

authorize the apportionment of claimant’s impairment in a

combined condition claim.” Schleiss, 354 Or at 651. As we

explained, if a preexisting contributing cause of the injury

is not a legally cognizable “preexisting condition”—defined

as “any injury, disease, congenital abnormality, personality

disorder or similar condition that contributes to disability

or need for treatment, provided that * * * the worker has

been diagnosed with the condition, or has obtained medi-

cal services for the symptoms of the condition regardless of

diagnosis,” ORS 656.005(24)(a)—then it does not qualify for

apportionment under the combined condition framework.

Schleiss, 354 Or at 651. Accordingly, the claimant’s case was

remanded to the board for reconsideration under the mate-

rial contributing cause standard discussed above. See id. at

655 (“The decision of the Court of Appeals is reversed, and

the case is remanded to the Workers’ Compensation Board

for further proceedings.”).

Our holding in Schleiss reflects the principle that,

even after the legislature created the combined condition

framework, apportionment is only appropriate in cases that

Cite as 369 Or 579 (2022) 595

fall under the ambit of the combined condition process—

i.e., cases presenting an otherwise compensable condition

that combines with a legally cognizable preexisting con-

dition. We understand Schleiss to confirm that where no

legally cognizable preexisting condition exists, the general

rule remains that, where an accepted, compensable injury is

a material contributing cause of the claimant’s impairment,

then the claimant is entitled to the full measure of com-

pensation for that impairment, not just the percentage of

impairment caused solely by the compensable injury. That

general rule, initially announced in the Barrett cases, was

at least implicitly confirmed again in Schleiss.

3. Caren

Not long after Schleiss, this court was presented

with an opportunity to address an actual combined condi-

tion. In Caren, the claimant injured her back at work and

the employer issued a notice of acceptance that listed the

accepted condition as a “lumbar strain.” 365 Or at 470. During

claim closure, after the claimant had received treatment for

her injury, the physician determined that the claimant suf-

fered from a diminished range of motion in her lumbar area.

Id. at 471. That same physician also noted that the claimant

appeared to suffer from preexisting arthritis in the lumbar

spine and attributed part of the claimant’s impairment to

the preexisting arthritis, but part to the accepted workplace

injury.5 Id. The claimant never requested, and the employer

never considered, apportionment according to the combined

condition process. Id. Nonetheless, the claimant’s perma-

nent partial disability award was reduced according to the

percentage of her impairment that was determined to be

caused by her preexisting arthritis. Id.

This court allowed review of that case to determine

whether the legislature intended the “combined condition”

process to modify the rule for calculating permanent partial

5

Initially, the physician and an evaluator attributed the diminished lum-

bar range of motion at 50 percent the result of the preexisting arthritis and

50 percent the result of the workplace injury. Caren, 365 Or at 471. The DCBS

medical arbiters later estimated that the claimant’s arthritis was actually

responsible for 70 percent of the impairment to her lumbar range of motion.

Id. That estimate was used to calculate, and reduce accordingly, the claimant’s

award for permanent partial disability. Id.

596 Johnson v. SAIF

disability—the material contributing cause rule—in every

case where the employer identifies a claimant’s preexisting

condition, or if the apportionment benefits are limited to

instances where a specific combined condition is identified,

formally denied, and closed according to the statutory pro-

cess. Caren, 365 Or at 480. In other words, this court sought

to determine whether apportionment was a limited excep-

tion, available only when the claimant or employer follows

the combined condition process, or if that limited liability is

also available where a combined condition is denied.

To answer that question, this court examined the

text, context, and legislative history of the statute that lays

out the process for apportionment of a combined condition,

ORS 656.268(1). See Caren, 365 Or at 472. ORS 656.268(1)

provides that an insurer or self-insured employer is required

to close a claimant’s claim and determine the extent of per-

manent partial disability when

“[t]he accepted injury is no longer the major contributing

cause of the worker’s combined or consequential condition

or conditions pursuant to ORS 656.005(7). When the claim

is closed because the accepted injury is no longer the major

contributing cause of the worker’s combined or consequen-

tial condition or conditions, and there is sufficient infor-

mation to determine permanent disability, the likely per-

manent disability that would have been due to the current

accepted condition shall be estimated.”

This court explained that the traditional method for calcu-

lating a permanent partial disability award before examin-

ing how, and under what conditions, the combined condition

framework changes that process. Ultimately, this court con-

cluded that

“the legislature intended the combined condition process to

create an exception to the general rule that employers pay

compensation for the full measure of the workers’ perma-

nent impairment if the impairment as a whole is caused in

material part by the compensable injury, and * * * that the

legislature intended that employers would obtain the bene-

fit of that exception only by issuing a denial of a ‘combined

condition’ and following the process that the legislature

has specifically provided in ORS 656.268(1)(b) for reducing

the workers’ permanent partial disability.”

Cite as 369 Or 579 (2022) 597

Caren, 365 Or at 473. As this court understood the legisla-

tive amendments creating the combined condition process,

the changed statutory provisions were intended to limit

an employer’s liability for preexisting conditions, but only

where the employer follows the specific process laid out in

ORS 656.268(1)(b) for reducing a worker’s permanent par-

tial disability award. Caren, 365 Or at 487. In short, we con-

cluded that the legislature intended apportionment in com-

bined condition cases to be a limited exception to the general

rule that a worker is entitled to compensation for the full

measure of the workers’ impairment where the impairment

is caused in material part by the compensable injury.

B. Application of Barrett, Schleiss, and Caren to This Case

Each of those cases—Barrett, Schleiss, and Caren—

provides insight into our past interpretations of the phrase

“due to the compensable injury” and the definition of “impair-

ment” in ORS 656.214. There are two primary propositions

that those cases provide that guide us here. First, Barrett

and Schleiss stand for the basic, underlying rule that, when

an accepted, compensable injury is a material contributing

cause of the claimant’s impairment, then the claimant is

entitled to the full measure of compensation for that impair-

ment. See Barrett II, 300 Or at 555-56; Schleiss, 354 Or

at 651. That general rule remains true today. The second

proposition that bears emphasis is that apportionment may

only be used by an insurer to reduce benefits for impair-

ment where the legislature has identified an exception to, or

limitation on, the material contributing cause standard. An

example of such an exception occurs where the impairment

is caused by a legally cognizable preexisting condition that

the insurer formally denied as a combined condition prior

to claim closure. See Caren, 365 Or at 487 (“We conclude

that employers obtain the benefit of that exception only by

issuing a denial of the ‘combined condition’ and following

the process that the legislature has specifically provided in

ORS 656.268(1)(b) for reducing the worker’s permanent par-

tial disability.”). Both of those rules are consistent with our

understanding of the workers’ compensation scheme, flow

from our prior interpretations of ORS 656.214, and provide

a preliminary basis upon which we analyze this case.

598 Johnson v. SAIF

Here, the board upheld SAIF’s determination that

claimant was not entitled to an award of permanent partial

disability for any of her impairment that was caused by the

denied conditions. That approach effectively reduced claim-

ant’s award in the same way that apportionment would

reduce her award in a combined condition case. As explained

above, claimant received an award for seven percent whole

person impairment for the injuries to her left hand. Within

that value, the impairment for the loss of grip strength was

apportioned only 50 percent to the accepted compensable

hand claim. The award for permanent partial disability

was reduced accordingly. Because the board’s decision uti-

lized a method to apportion, and ultimately reduced claim-

ant’s impairment award, and because we have previously

explained that apportionment is only authorized by statute

as a limited exception to the general rule that a claimant is

entitled to the full measure of impairment, available only

when specific conditions are met, we first address whether

the combined condition statutory framework allowed for

apportionment in this case.

As we explained in Caren, and have reiterated here,

an employer or insurer may only avail itself of the ability to

apportion awards in combined condition cases. To qualify

for the limited combined condition exception, there must be

a legally cognizable preexisting condition that has combined

with the otherwise compensable injury. See Caren, 365 Or at

483 (“ ‘[L]egally cognizable preexisting condition is only one

requirement for reducing the worker’s impairment under

ORS 656.268(1)(b) to account for a combined condition; it also

requires that the condition has combined with the ‘other-

wise compensable injury’ and that the employer can meet

‘its burden of proof to establish the otherwise compensable

injury is not, or is no longer, the major contributing cause

of the disability of the combined condition.’ ” (First quoting

ORS 656.005(7)(a)(B); then quoting ORS 656.266(2)(a))). As

a reminder, a legally cognizable “preexisting condition” is

“any injury, disease, congenital abnormality, personality

disorder, or similar condition that contributes to disability

or need for treatment, provided that * * * the worker has

been diagnosed with such condition, or has obtained med-

ical services for the symptoms of the condition regardless

Cite as 369 Or 579 (2022) 599

of diagnosis.” ORS 656.005(24)(a). Here, both parties agree

that this case does not present a combined condition and

that this court’s analysis in Caren is inapplicable.6 There is

no combined condition presented in this case because there

was no evidence in the record to suggest that claimant’s

denied left rotator cuff tear was previously diagnosed or

treated prior to the workplace injury.

As explained, usually, when no combined condition

exists, the general rule that a claimant is entitled to the

full measure of impairment where the accepted condition

is a material contributing cause of the disability applies.

The text of ORS 656.214, and our prior decisions discussed

above, support that proposition. That leaves two ques-

tions that must be answered in order to resolve this case:

(1) whether the full measure of impairment is calculated as

the percentage of the impairment that is directly caused by

the compensable injury or as a whole and (2) whether there

is a limited exception to the general rule that allows for

apportionment when there is a specific, previously denied

condition. Those questions are left unanswered by our previ-

ous decisions and are implicated directly in this case.

C. Further Analysis

We begin by addressing the first question. Here, the

parties disagree about the meaning of “due to” within the

definition of impairment. SAIF argues that the phrase “due

to” within the definition of impairment limits the employer’s

liability to only compensate the claimant for impairment

that is caused by the compensable injury. Claimant, on the

other hand, maintains that the workers’ compensation stat-

utes, and our prior cases interpreting those statutes, make

6

The Court of Appeals also acknowledged that Caren was not directly

applicable to this case: “Caren did not explicitly address the issue presented

here—whether a worker should be compensated for the ‘full measure’ of impair-

ment caused in material part by a work injury in combination with a noncog-

nizable preexisting condition that the employer had previously denied outright.”

Johnson II, 307 Or App at 4. That court, nonetheless, used this court’s reasoning

in Caren to conclude that claimant was entitled to the full measure of impair-

ment for her injury. Id. at 5 (“Although SAIF denied claimant’s shoulder con-

dition, SAIF has not denied the combined condition that was identified by the

medical arbiter and that resulted in claimant’s range-of-motion impairment in

her hand. Accordingly, under Caren, claimant is entitled to be awarded the ‘full

measure’ of impairment.”).

600 Johnson v. SAIF

clear that a worker is entitled to the full measure of impair-

ment so long as the worker’s accepted and compensable

injury is a material contributing cause of the impairment.

That question was deliberately left unanswered in Schleiss.

In this case, we must answer that question with regard to a

denied condition that arose with the compensable injury.

Here, claimant injured her left hand in a work-

related incident. After investigating and evaluating the

claim, SAIF determined that it was compensable and issued

a notice of acceptance. Later, claimant sought to amend

the claim and a portion of that modification—the left rota-

tor cuff tear, left upper arm and elbow sprain, and cervical

disc disorder—was denied as not compensably related to the

accepted workplace injury. Accepting the conclusion that the

denied conditions were not compensably related to the work-

place injury,7 we first note that it is correct that impairment

values that stem solely for those conditions should not lead

to an award of permanent partial disability. In other words,

if claimant sought benefits for the left rotator cuff tear,

left upper arm and elbow sprain, and cervical disc disor-

der, there would be no compensation. Those conditions were

denied. That principle alone, however, does not sufficiently

answer the question posed here. The impairment at issue in

this case is not the damage to the rotator cuff tear, upper

arm and elbow, or cervical disc per se—those are claimant’s

noncompensable conditions. The impairment at issue is the

loss of grip strength in claimant’s left hand. The question

is whether claimant is entitled to the full measure of that

impairment where the accepted conditions—the injuries

to claimant’s left fingers and sprains to her left shoulder

area—are a material contributing cause of the impairment

as a whole. As we understand the statutes and the record in

this case, the answer is yes.

In Barrett I, this court acknowledged the long-

standing guideline that an employer takes the worker as

he finds him. 300 Or at 328; see also Surratt v. Gunderson

Bros., 259 Or 65, 74, 485 P2d 410 (1971) (emphasizing that

7

The denial of the left rotator cuff tear, left upper arm and elbow sprain, and

cervical disc disorder is not in dispute in this case, other than the impact of that

denial on the calculation of claimant’s award for permanent partial disability.

Cite as 369 Or 579 (2022) 601

“the individual workman is taken as the industrial acci-

dent finds him with all his apparent defects”); Keefer v.

State Indus. Acc. Commission, 171 Or 405, 412, 135 P2d 806

(1943) (“The Oregon Workmen’s Compensation Law, as that

of many of the other states prescribes no standard of phys-

ical fitness to which the employee must conform, and com-

pensation is not based on any implied warranty of perfect

health.”). Although the legislature significantly overhauled

the workers’ compensation statutes following our decision

in the Barrett cases, we do not understand those changes to

alter that tenet. Instead, those changes identified circum-

stances in which an employer’s liability for impairment can

be limited because of a legally cognizable preexisting condi-

tion that combines with a compensable condition. Outside of

those circumstances, however, an injured worker is entitled

to compensation for the full measure of their impairment

that is caused in material part by the compensable injury.

We pause here briefly, before concluding, to address

SAIF’s proposed interpretation of the workers’ compen-

sation statutes that discuss denied conditions. SAIF, and

amici supporting SAIF, maintain that a denial has the legal

effect of establishing that the specific denied condition is

not eligible for any benefits. SAIF argues that the Court of

Appeals’ decision in this case forces insurers to pay benefits

for denied conditions and instead advocates that this court

recognize an additional exception to the rule announced

above.

We agree with SAIF’s contention that benefits are

not intended to flow directly from denied conditions. ORS

656.262(2) makes clear that compensation for any claim

shall be paid promptly upon an employer’s notice or knowl-

edge of the claim, “except where the right to compensation is

denied by the insurer or self-insured employer.” (Emphasis

added.) The proposition that benefits do not flow from denied

conditions is also supported by ORS 656.268(15), which

states that “[c]onditions that are direct medical sequelae to

the original accepted condition shall be included in rating

permanent disability of the claim unless they have been spe-

cifically denied.” (Emphasis added.) Even in the context of

awarding attorney fees in workers’ compensation cases, the

legislature has recognized that a denied claim is “[a] claim

602 Johnson v. SAIF

for compensation which an insurer or self-insured employer

refuses to pay on the express ground that the injury or con-

dition for which compensation is claimed is not compensable

or otherwise does not give rise to an entitlement to any com-

pensation[.]” See ORS 656.386(1)(b)(A) (defining a denied

claim as it relates to awards for attorney fees).

The proposition that compensation should not flow

from a denied claim is also clear in the process specifically

laid out for claim closure and rating of permanent disability.

Under ORS 656.262(7)(c),

“[w]hen an insurer or self-insured employer determines

that the claim qualifies for claim closure, the insurer or

self-insured employer shall issue at claim closure an

updated notice of acceptance that specifies which condi-

tions are compensable. * * * Any objection to the updated

notice or appeal of denied conditions shall not delay claim

closure pursuant to ORS 656.268. If a condition is found

compensable after claim closure, the insurer or self-insured

employer shall reopen the claim for processing regarding

that condition.”

By the terms of that statute, the updated notice of acceptance

at claim closure defines the compensable conditions and spe-

cifically separates out a process for appeal of a denied con-

dition that is not subject to compensation. The claim closure

and rating of permanent disability are expected to proceed

without the denied conditions. As we understand that stat-

ute, there is no point at which the denied condition would be

subject to compensation unless, and until, it is determined

to be compensable.

We do not read any of those statutes, however, to

create another limited exception that authorizes appor-

tionment even where the accepted compensable condition

is a material contributing cause of the impairment. Unlike

the combined condition process, we do not understand the

legislature to have adopted or recognized any process that

authorizes apportionment of a claim in cases involving par-

tial denials. Certainly, we agree that, if a denied condition is

the sole cause of a claimant’s impairment, or if the accepted

condition is not even a material cause of the impairment,

then a denied condition operates to cut off compensation.

Cite as 369 Or 579 (2022) 603

But, if the material contributing cause standard is met as to

the accepted condition, the full value of impairment is due.

Our decision today acknowledges that an individu-

al’s impairment may have more than one contributing fac-

tor. Claimant’s situation demonstrates why the material

contributing cause standard exists. Although it is true that

claimant’s denied conditions—the left rotator cuff tear, left

upper arm and elbow sprain, and cervical disc disorder—

contributed to her overall loss of grip strength, that impair-

ment was caused in material part by the accepted, com-

pensable claim that arose from the work-related incident.

Claimant was entitled to the full measure of impairment for

her loss of grip strength and the permanent partial disability

award should not have been reduced due to apportionment.

III. CONCLUSION

Because we agree with claimant that ORS 656.214

entitles an injured worker to compensation for all of the

impairment due in material part to, and resulting in mate-

rial part from, the compensable injury, and because the com-

pensable injury was found to be a material cause of claim-

ant’s impairment, we find that claimant was entitled to the

full value of her total impairment, including the portion of

her loss of grip strength that may have been attributed to

the denied conditions. Apportionment of claimant’s award

for permanent partial disability, based on the percentage of

contribution to impairment by the compensable condition,

was not appropriate in this case. Accordingly, the board’s

decision to reduce claimant’s award based on the extent to

which the denied shoulder condition contributed to the loss

of grip strength was incorrect.

For the reasons discussed above, we agree with the

Court of Appeals that, absent a specifically identified com-

bined condition, claimant is entitled to the full measure of

impairment for her condition.

The decision of the Court of Appeals is affirmed.

The order of the Workers’ Compensation Board is reversed.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.

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