Brown v. SAIF

The correct test in determining a combined condition claim is whether claimant's work-related injury incident is the major contributing cause of the combined condition.

Claimant sought review of an order of the Workers' Compensation Board upholding the denial of his combined-condition claim based on the board's determination that SAIF Corporation (SAIF) had established that claimant's accepted lumbar strain was no longer the major contributing cause of his combined condition. Claimant experienced various back injuries prior to his employment as a truck driver. In 2008, Claimant was injured on the job. Dr. Edmund Frank at SAIF determined as of August 18, 2009 the work related injury was no longer the major contributing cause of Claimant's disability or need for treatment for the combined condition. Claimant acknowledged that the "accepted condition" of lumbar strain was no longer the major contributing cause of his combined condition, but he contended that there was no evidence to the effect that the "accidental injury" was no longer the major contributing cause of his disability or need for treatment. Under ORS 656.005(7)(a)(B) a "combined condition" is subject to the heightened, "major contributing cause" standard of proof, in contrast to the "material contributing cause" standard for other work-related injuries. There is no statutory provision that expressly links the compensability of a combined condition to its relationship to an "accepted condition"; rather, the compensability of the combined condition depends on its relationship to the "otherwise compensable injury." Furthermore, as noted, "compensable injury" is specifically defined in ORS 656.005(7)(a) as an "accidental injury * * * arising out of and in the course of employment requiring medical services or resulting in disability or death." That injury-incident-based definition of "compensable injury" does not make the compensability of an injury dependent on the insurer's acceptance of particular conditions. The denial of a combined condition does not depend on the "accepted condition" being the major contributing cause of the combined condition. Reversed and remanded.