Georgia-Pacific then sought judicial review of both decisions of the Board. The Court of Appeals applied this court's recent decision in Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987), and held that Georgia-Pacific properly denied the compensability of the ankylosing spondylitis condition. However, the court concluded that Georgia-Pacific's denial did not terminate its obligations under the determination order.
See ORS 656.262(6). The dissent reaches an issue that is not framed by SAIF's assignment of error; moreover, SAIF does not make the argument on which the dissent relies to hold that there was no acceptance. Also, the dissent's analysis is wrong. It relies on Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987), Stevenson v. Blue Cross of Oregon, 108 Or. App. 247, 251, 814 P.2d 185 (1991), and EBI Ins. Co. v. CNA Insurance, 95 Or. App. 448, 451, 769 P.2d 789 (1989), in support of its position. In Johnson, the Supreme Court reaffirmed that Bauman v. SAIF, supra, applies only to "specifically" or "officially" accepted claims.
Employer contends that the Board erred in ruling that it was barred from denying the compensability of claimant's Paget's Disease. Employer argues that its acceptance of the original claim was an acceptance of back strain only. It also argues that the only condition which it specifically and officially accepted by checking the boxes on the 801 form was the back strain described by the claimant on the form. See Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987). It argues that, because Paget's Disease was never accepted, Bauman v. SAIF, supra, does not apply. Claimant argues that employer knew from the medical records that Paget's Disease was part of his original claim.
Nevertheless, defendant contends that the context of preexisting case law demonstrates that ORS 656.019 applies only when an initial claim for compensation is denied on major contributing cause grounds. Defendant argues that the legislature's use of the term "claim" in ORS 656.019 was necessarily informed by this court's earlier discussion of claims in Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987), which described multiple conditions arising out of single work incident as "aspects of a single claim." Id. at 56, 733 P.2d 1367.
He also said: "[T]he Supreme Court has indicated that `[a]n insurer's failure to respond to a claim [as required by ORS 656.262 (6)] is neither acceptance [n]or denial.' Johnson v. Spectra Physics, 303 Or. 49, 58, 733 P.2d 1367 (1987). The issue in that case was whether an insurer's inaction could be construed as acceptance of a claim.
Remanded to Workers' Compensation Board August 26, 1987. On remand from the Oregon Supreme Court, Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987). Judicial Review from Workers' Compensation Board.
"If the insurer or self-insured employer unreasonably delays or unreasonably refuses to pay compensation, or unreasonably delays acceptance or denial of a claim, the insurer or self-insured employer shall be liable for an additional amount up to 25 percent of the amounts then due plus any attorney fees which may be assessed under ORS 656.382." In Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987), the insurer did not accept or deny one aspect of a claim for medical, surgical, and time-loss benefits within the 60 days set by ORS 656.262 (6). This court concluded that the failure to respond was "neither acceptance nor denial" and that inaction, in itself, did not render the insurer liable on the claim. Johnson v. Spectra Physics, supra, 303 Or at 58-59.
Because the employer's insurer did not "specifically accept" the claimant's claim in writing, the rule against "back-up denials" stated in Bauman v. SAIF, 295 Or. 788, 670 P.2d 1027 (1983), is not implicated in this case. Johnson v. Spectra Physics, 303 Or. 49, 55-56, 58, 733 P.2d 1367 (1987). The employer's insurer, may, however, be subject to penalties under ORS 656.262 (10) for not specifically responding to the claim within 60 days.
TriMet v. Wilkinson , 257 Or.App. 80, 85, 304 P.3d 46 (2013) ; SAIF v. Tull , 113 Or.App. 449, 454, 832 P.2d 1271 (1992) (en banc); Columbia Forest Products v. Woolner , 177 Or.App. 639, 34 P.3d 1203 (2001). Citing the Supreme Court's opinion in Johnson v. Spectra Physics , 303 Or. 49, 733 P.2d 1367 (1987), among other cases, claimant nonetheless contends that an acceptance occurred as a matter of law when the claims examiner "executed" the modified notice of acceptance. The notice closed with the claims examiner's typed name but did not include a signature.
Under Piwowar, if an employer accepts a claim that only describes symptoms, it accepts all conditions that caused those symptoms, even if those conditions are not work related. Piwowar's holding resulted from an analysis of two earlier workers' compensation cases: Bauman v. SAIF, 295 Or. 788, 670 P.2d 1027 (1983), and Johnson v. Spectra Physics, 303 Or. 49, 733 P.2d 1367 (1987). In Bauman, the court held that, once an employer accepts a claim, it cannot subsequently deny it without "a showing of fraud, misrepresentation or other illegal activity."