MATTER OF GRAVES, 57 Van Natta 2380 (Or. Work. Comp. 9/7/2005), WCB Case No. 04-03346.
| Decision Date | 07 September 2005 |
| Docket Number | WCB Case No. 04-03346. |
| Citation | 57 Van Natta 2380 |
| Parties | In the Matter of the Compensation of MAUREEN Y. GRAVES, Claimant. |
| Court | Oregon Workers' Compensation Division |
The SAIF Corporation requests review of Administrative Law Judge (ALJ) Myzak's order that "invalidated" its denial of claimant's injury claim for a triangular fibrocartilage tear. On review, the issue is the validity of SAIF's denial. We reverse.
We adopt the ALJ's "Findings of Fact," as summarized below.
In January 2003, claimant injured herself at work. (Exs. 1, 2). SAIF accepted a claim for head contusion, cervical thoracic sprains, and left elbow laceration. (Ex. 61).
In March 2004, claimant filed a new medical condition claim for a triangular fibrocartilage tear. (Ex. 57). Dr. Vessely, an orthopedic surgeon, performed a record review on SAIF's behalf. (Ex. 60). Based on Dr. Vessely's opinion, SAIF denied the claim, contending that "[t]he condition (s) you claim is/are not compensably related to your accepted injury." (Ex. 61). Claimant requested a hearing.
At hearing, SAIF stated that the triangular tear was not compensable because either it did not exist, or if it did exist, it was not caused by the accepted injury. (Tr. 5). After the hearing, claimant deposed her physician, Dr. Duncan. (Ex. 70). Dr. Duncan opined that he could not conclude that claimant sustained a triangular fibrocartilage tear without further testing. (Id. at 10, -11). Subsequently, claimant withdrew her claim, contending that she did not have the claimed condition. (Ex. 72).
The ALJ found that SAIF did not amend its denial to assert that claimant did not have the claimed condition. Reasoning that claimant could withdraw her claim at any time, the ALJ concluded that SAIF's denial, which was based on the lack of a causal relationship between the claimed condition and the compensable injury, was invalid.
On review, SAIF argues that its denial should not have been deemed invalid because claimant withdrew her claim after the hearing and only after she realized she would not prevail on the merits. For the following reasons, claimant's withdrawal of her claim does not invalidate an otherwise valid denial issued before claimant withdrew her claim.
A denial may be set aside as invalid or a nullity when a claimant withdraws a claim before a denial is issued, or when a denial is issued before the claimant requests formal acceptance of a condition. See Ralph L. Morris, 50 Van Natta 59, 71 (1998); William C. Becker, 47 Van Natta 1933, 1934 (1995) ().
In this case, claimant requested formal acceptance of a fibrocartilage tear. However, claimant withdrew her claim after SAIF had issued its denial, and after the hearing was convened. While we agree that claimant may withdraw her claim at anytime, this does not invalidate a denial issued after a claim was filed and before the claim was withdrawn. Although the non-existence of a claim for a new or omitted medical condition may certainly cause a denial of a condition to be found invalid, the non-existence of the claimed condition would not. The latter issue is discussed more fully below. Claimant's argument is mistakenly premised on the idea that the non-existence of a claim for new or omitted medical condition is the same as the non-existence of the claimed condition.
Claimant argues that SAIF's denial is invalid because it did not dispute the existence of her condition; rather, the denial stated that the claimed condition was not compensably related to her accepted claim. With respect to a new or omitted medical condition claim, a denial of compensability encompasses a denial of the existence of a condition. Claimant has the burden to prove that the claimed...
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