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Cary Wing Edmunson, PC

More on further medical care

April 23, 2009 | By Thomas Cary

In my first posting below, "Much ink from the Court," I discussed SAIF v. Sprague, a case concerning coverage for medical treatment in an Oregon workers' compensation claim. The Oregon Court of Appeals later relied on that case in SAIF Corp. v. Martinez, 219 Or App 182 (2008). Martinez upheld the Workers' Compensation Board's decision. The board rejected the insurer's argument that the injured worker must first obtain formal acceptance of another medical condition in his knee as a precondition of further surgery. The board instead found the proposed surgery was intended to (1) treat continued symptoms related to the injury, even though there was a likelihood the surgeon would also surgically treat a condition in the knee that had not been accepted in the claim, and (2) would help determine the extent of the "compensable injury" accepted in the claim. In its review, the court stated that "the condition for which treatment is sought need not be the accepted condition; however, the treatment must be necessitated in material part by the 'compensable injury,' which, we said in Sprague, is the condition previously accepted." This case does not completely clarify the relationship between the portion of the statute the court interpreted and another portion that limits medical services for "consequential" medical conditions to those caused in "major part", not merely "material" part, by the injury. Martinez does appear to help those injured workers whose symptoms may well be due, at least in part, to some conditions not accepted in the claim, but which cannot definitely be diagnosed except by surgery. Stay tuned.

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