Saif v. Miguez

Under OAR 436-035-0007(12), an appellate review unit must explain what observations led to its findings of invalidity, how these observations contradict the validity of the findings, and why the observations are medically significant before it may invalidate a medical examiner's findings.

SAIF Corporation (SAIF) appealed the Worker's Compensation Board's order to increase a claimant's whole person impairment award. The claimant (Miguez) injured his shoulder. After an independent examination, SAIF rated the independent medical examiner's (IME) range-of motion findings at 25 percent whole person impairment. However, based on the inconsistent opinion of the attending physician and the IME regarding the validity of the IME's range-of-motion findings, SAIF immediately requested reconsideration. A medical arbiter panel reviewed the record, examined Miguez, and rated his impairment, but found this rating invalid. The Appellate Review Unit (ARU), consequently reduced Miguez's award to 15 percent. Miguez requested a hearing. The ALJ agreed with Miguez's argument that the ARU erred. Pursuant to OAR 436-035-0007(12), the ALJ held the arbiter's panel did not adequately explain its conclusion that the panel's findings were invalid. The ALJ increased Miguez's award to 26 percent. SAIF appealed to the Court of Appeals, which affirmed the ALJ's decision, holding that an arbiter panel must explain what observations led to its finding of invalidity, how these observations contradict the validity of the findings, and why the observations are medically significant. Affirmed.