Hopper v. SAIF

For a claimant to prevail after denial on a claim for failure to cooperate, the claimant must prove one of three things: (1) that claimant, in fact, "fully and completely cooperated with the investigation"; (2) that claimant "failed to cooperate for reasons beyond the [claimant's] control"; or (3) that SAIF's "investigative demands were unreasonable"; to satisfy number (2), the claimant must prove that any failure to cooperate was because of--in other words, causally connected to--reasons beyond the worker's control.

SAIF Corporation (SAIF) denied claimant's claim for workers' compensation benefits for failure to cooperate with its investigation of her claim after claimant did not comply with SAIF's multiple requests that she complete an interview with its investigator. The Workers' Compensation Board (the board) upheld that denial under ORS 656.262(15), determining that claimant failed to prove that her failure to cooperate was "for reasons beyond [her] control." Claimant did not participate in the investigatory process. Claimant's brother died during the process, and she was also in a car accident. The ALJ found these were circumstances beyond her control. However, on review, the board found that these were not the reasons for the Claimant's failure to comply, and it was in fact her "lack of diligence" in the process. Claimant sought judicial review. Under ORS 656.262(15) when an insurer or self-insured employer denies a claim for failure to cooperate, a claimant may request a hearing for the purpose of demonstrating that the denial should be set aside. ORS 656.262(15). To prevail, the claimant must prove one of three things: (1) that claimant, in fact, "fully and completely cooperated with the investigation"; (2) that claimant "failed to cooperate for reasons beyond the [claimant's] control"; or (3) that SAIF's "investigative demands were unreasonable." Claimant did not provide sufficient evidence to support that her car accident or the death of her brother constituted "reasons beyond her control." Affirmed.