Nava v. SAIF

Claimant sought judicial review of a Workers' Compensation Board decision that denied a penalty and attorney fees. Claimant argued that SAIF unreasonably delayed compensation for one of his injuries, asserting that SAIF had no legitimate doubt about its obligation to pay. ORS 656.262(11)(a) provides for an insurer to pay a penalty and attorney fee only when the insurer "unreasonably delays or unreasonably refuses to pay compensation, attorney fees or costs, or unreasonably delays acceptance or denial of a claim." "An insurer 'unreasonably delays' payment of compensation for purposes of ORS 656.262(11) if, at the time compensation is due, the insurer had no legitimate doubt regarding its liability for the compensation." Snyder v. SAIF, 287 Ore. App. 361. The Court found that ORS 656.262(6)(b)(F) was correctly construed as requiring an insurer to modify the notice of acceptance when it receives unrebutted medical evidence that contradicts the original notice. The Court reasoned that the Board had substantial evidence supporting its conclusion that SAIF had legitimate doubt about its liability because the text of ORS 656.262(6) (b)(F) was unclear, and other provisions of the law put the burden on claimants to alert the insurer to new or omitted conditions. The Court held that the Board was correct in not imposing a penalty and fee under ORS 656.262(11)(a) and affirmed the ruling.