Garcia-Solis v. Farmers Ins. Co.

“For every compensable injury, the insurer *** shall cause to be provided medical services for conditions caused in material part by the injury ***” ORS 656.245(1).

Claimant appealed from the Court of Appeal’s affirmation that the cost of a psychological referral for PTSD-like symptoms resulting from a workplace injury was not covered by workers’ compensation. Claimant assigned error to the Worker’s Compensation Board’s determination that diagnostic medical services are not a compensable injury because they did not relate to a medical condition accepted by Insurer. On appeal, Claimant argued that the use of “compensable injury” in ORS 656.245(1) is not to be defined to mean insurer-accepted conditions, but the actual workplace accident resulting in the need for treatment. In response, Insurer argued that “compensable injury” is not to be defined as the actual workplace accident but as an accepted medical condition. “For every compensable injury, the insurer *** shall cause to be provided medical services for conditions caused in material part by the injury *.” ORS 656.245(1). The Court found that, throughout the worker’s compensation statutes, the word “injury” is context-dependent. The Court held that the causal relationship in the wording “conditions caused in material part by the injury” indicated that the word “injury” is meant to refer to the workplace accident. Thus, “compensable injury” also meant the workplace accident. Reversed and remanded.