Sedgwick CMS, Inc. v. Dover

“[T]he third-party statutes, understood together, require that a paying agency is an insurer that is responsible for paying benefits on a compensable claim at the time of settlement with a third-party tortfeasor.” Sedgwick CMS, Inc. v. Dover, 318 Or App 38, 50 (2022).

Claimant filed a petition with the board, seeking an order that Sedgwick, which was the assigned claims agent that had paid Claimant’s benefits, was not entitled to reimbursement. On appeal, Claimant argued that Sedgwick and the division are not “paying agencies” for purposes of reimbursement under ORS 656.576. In response, Sedgwick argued that the board misinterpreted the relevant statutes, and they are a “paying agency” as articulated in ORS 656.576. Because Sedgwick did not remain responsible for paying benefits after it denied the claim, the court determined that it was freed from its responsibility to pay benefits. "[T]he third-party statutes, understood together, require that a paying agency is an insurer that is responsible for paying benefits on a compensable claim at the time of settlement with a third-party tortfeasor.” Sedgwick CMS, Inc. v. Dover, 318 Or App 38, 50 (2022). As such, Sedgwick lost its right under the third-party law to seek reimbursement from a third-party settlement as a paying agency. Affirmed.