SAIF v. Traner

Under ORS 656.262, when a workers' compensation claimant requests acceptance of a new or omitted medical condition, the insurer must clearly either accept or deny the claim within 60 days, or else the insurer may be required to pay the claimant's attorney fees even if no compensation or penalties are assessed.

SAIF appealed an order from the Workers’ Compensation Board (Board) awarding attorney fees to claimant due to SAIF’s unreasonable failure to accept a claim for a new or omitted medical condition under ORS 656.267(1). Because the Board finally determined that the claim was merely for a symptom of a prior accepted injury, and not a new or omitted medical condition unto itself, SAIF argued that (1) SAIF was not required to respond to a new claim that is merely a symptom of a prior claim, (2) attorney fees are not permitted where no penalty is assessed, and (3) SAIF was not “unreasonable” by failing to respond within 60 days because of the uncertain state of the law at the time of the claim. On review, the Court held that (1) under ORS 656.262(7)(a), an insurer must expressly either accept or deny a claim for a new or omitted medical condition; (2) under ORS 656.262(11)(a), the Board may require the insurer to pay the claimant’s attorney fees when no penalty or compensation is awarded; and (3) SAIF was unreasonable in its action because the law was adequately settled that only an acceptance or denial was permissible under ORS 656.262(1). Affirmed.