Simi v. LTI Inc. - Lynden Inc.

Under ORS 656.262(7)(c), “If a condition is found compensable after claim closure, the insurer or self-insured employer shall reopen the claim for processing regarding that condition.”

Claimant tore his rotator cuff and filed a worker’s compensation claim against Employer. Claimant argued that pursuant ORS 656.262(7)(c), Employer was required to reopen the claim when the administrative law judge (ALJ) found that tendon tears were encompassed in the original claim. Claimant fell at work in 2010 and Employer accepted a claim for a “right rotator cuff tear.” The claim was closed after Claimant’s procedure repaired the shoulder, but years later the tears reappeared and were “likely work related.” Claimant attempted to reopen the original 2010 claim to include the recurring tears. Employer denied the claim and the ALJ set aside the denial, the Court of Appeals agreed. Under ORS 656.262(7)(c), “If a condition is found compensable after claim closure, the insurer or self-insured employer shall reopen the claim for processing regarding that condition.” The Court held that under ORS 656.262(7)(c), the claim must be reopened following the ALJs set aside to grant Claimant straightforward access to compensation because the words of the statute are plain. The decision of the Court of Appeals is reversed. The order of the Workers’ Compensation Board is reversed, and the case is remanded to the Workers’ Compensation Board for further proceedings.