Akins v. SAIF 286 Or App 70 (2017)

Under ORS 656.267, a workers’ compensation claimant is allowed to obtain acceptance of conditions that are not included in the scope of an insurer’s acceptance of the claimant’s claim, which must “[s]pecify what conditions are compensable,” ORS 656.262(6)(b)(A), that are “new” or “omitted” in regards to a notice of acceptance.

Claimant petitioned for review of the Workers’ Compensation Board final order denying Claimant’s “new and omitted condition” claims, ORS 656.267 and Claimant’s “combined condition” claim, ORS 656.262(6)(c). On appeal, Claimant argued that “SAIF was required to accept conditions that were not included in the scope of an insurer’s acceptance, even if the claims were included within the previously accepted condition, and that SAIF’s denials of claimant’s ‘new and omitted condition’ claims under ORS 656.267 were therefore erroneous.” Under ORS 656.267, a workers’ compensation claimant is allowed to obtain acceptance of conditions that are not included in the scope of an insurer’s acceptance of the claimant’s claim, which must “[s]pecify what conditions are compensable,” ORS 656.262(6)(b)(A), that are “new” or “omitted” in regards to a notice of acceptance.  In this case, the Court of Appeals determined that there was no support for Claimant’s argument that the statute requires an insurer to reaccept and reprocess a condition that has already been accepted. Therefore, the Court held that the Board correctly concluded that “SAIF properly denied [C]laimant’s claims under ORS 656.267 because the conditions for which [C]laimant sought acceptance were not, in fact, new or omitted conditions within the meaning of ORS 656.267.”  Affirmed.