Harvey v. SAIF

When the Board is determining whether the findings of a Claimant’s attending physician are more accurate than those of medical arbiter under OAR 436-035-0007(5), the Board must provide substantial reason, as well as substantial evidence, on how its factual findings lead to the legal conclusions on which the order is based. Hicks v. SAIF, 196 Or App 146 (2004).

Claimant sought review of an order from the Workers’ Compensation Board (“Board”) upholding a reduction of her permanent partial disability cognitive impairment rating from a Class 2 to a Class 1, based on the opinion of medical arbiters. Claimant assigned error to the Board’s reliance on the medical arbiters’ impairment ratings instead of her attending physician’s. On appeal, Claimant argued the Board did not articulate substantial reason, based on the record, for the finding that her attending physician was not more accurate than the medical arbiters, and that there was no substantial evidence for the Board’s finding. SAIF contended the Board adequately explained its reasons for relying on the medical arbiters’ opinions, and that substantial evidence supported the Board’s finding that Claimant’s impairment satisfied the Class 1 criteria. When the Board is determining whether the findings of a Claimant’s attending physician are more accurate than those of medical arbiter under OAR 436-035-0007(5), the Board must provide substantial reason, as well as substantial evidence, on how its factual findings lead to the legal conclusions on which the order is based. Hicks v. SAIF, 196 Or App 146 (2004). Because the Board’s order did not interpret the medical arbiters’ evaluations, the Court of Appeals concluded the order lacked substantial reason, such that the Court of Appeals could not review for substantial evidence. Reversed and remanded for reconsideration.