In re Compensation of Sabin, 050321 ORWC, 20-00081

Case DateMay 03, 2021
CourtOregon
73 Van Natta 379 (2021)
In the Matter of the Compensation of LORI L. SABIN, Claimant
WCB No. 20-00081
Oregon Worker Compensation
May 3, 2021
          Julene M Quinn LLC, Claimant Attorneys           SAIF Legal Salem, Defense Attorneys           Reviewing Panel: Members Ousey and Woodford.          ORDER ON REVIEW          Claimant requests review of Administrative Law Judge (ALJ) Naugle’s order that: (1) found that an aggravation claim for claimant’s low back condition had not been perfected; (2) did not award additional temporary disability benefits; and (3) declined to award penalties and attorney fees for allegedly unreasonable claim processing. On review, the issues are aggravation, temporary disability, penalties, and attorney fees.          We adopt and affirm the ALJ’s order with the following supplementation.          In March 2018, claimant compensably injured her low back. (Exs. 1, 21).          In April 2018, the SAIF Corporation accepted a low back sprain and enrolled claimant in a managed care organization (MCO). (Ex. 21). In August 2018, SAIF denied a new/omitted medical condition claim for a lumbar disc annular tear and radiculopathy. (Ex. 53-1).          In October 2018, Ms. Toomey, a nurse practitioner, diagnosed a lumbar strain and tear. (Ex. 55-1).          In January 2019, Dr. Thorsett examined claimant at SAIF’s request. (Ex. 59). Dr. Thorsett opined that claimant was medically stationary with no impairment due to the work injury. (Ex. 59-6). In February 2019, Ms. Toomey concurred with Dr. Thorsett’s opinion. (Ex. 60).          A February 2019 Notice of Closure awarded temporary disability, but no permanent disability, benefits. (Ex. 62). A May 2019 Order on Reconsideration rescinded the Notice of Closure, concluding that SAIF did not have sufficient information to close the claim. (Ex. 65). Specifically, the reconsideration order reasoned that Ms. Toomey’s concurrence did not qualify as an attending physician’s opinion because the MCO policy did not authorize her to provide compensable medical services after December 1, 2018. (Ex. 65-2).          [73 Van Natta 380] In May 2019, claimant changed her attending physician to Dr. Williams, who treated her from May to July 2019. (Exs. 66, 67, 69, 72 – 74). In July 2019, Dr. Williams opined that claimant was medically stationary, without impairment. (Exs. 69, 72 – 74).          A July 2019 Notice of Closure awarded temporary disability, but no permanent disability, benefits. (Ex. 76). An August 2019 Order on Reconsideration modified claimant’s temporary disability benefits, but otherwise affirmed the Notice of Closure. (Ex. 78-3). The reconsideration order also found that Dr. Williams was claimant’s attending physician at the time of claim closure. (Ex. 78-1).          In November 2019, Ms. Toomey noted claimant’s low back pain and left leg numbness, tingling, and weakness. (Ex. 81-1). That same day, claimant and Ms. Toomey completed an aggravation claim form. (Ex. 82).          Later that day, claimant sought an MRI from Dr. Vraniak, an emergency room physician. (Ex. 83). Because the MRI results did not indicate the need for further emergency care, Dr. Vraniak advised claimant to follow up with her primary care provider. (Ex. 83-4-5).          Approximately a week later, Ms. Holmberg, a physician’s assistant for Drs. Hadden and Yundt, noted left leg pain, numbness, and tingling. (Ex. 84-1).          Later in November 2019, SAIF informed claimant...

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