656.267 Claims
for new and omitted medical conditions. (1) To initiate omitted medical condition claims
under ORS 656.262 (6)(d) or new medical condition claims under this section,
the worker must clearly request formal written acceptance of a new medical
condition or an omitted medical condition from the insurer or self-insured
employer. A claim for a new medical condition or an omitted condition is not
made by the receipt of medical billings, nor by requests for authorization to
provide medical services for the new or omitted condition, nor by actually providing
such medical services. The insurer or self-insured employer is not required to
accept each and every diagnosis or medical condition with particularity, as
long as the acceptance tendered reasonably apprises the claimant and the
medical providers of the nature of the compensable conditions. Notwithstanding
any other provision of this chapter, the worker may initiate a new medical or
omitted condition claim at any time.
(2)(a) Claims
properly initiated for new medical conditions and omitted medical conditions
related to an initially accepted claim shall be processed pursuant to ORS
656.262.
(b) If an insurer
or self-insured employer denies a claim for a new medical or omitted medical
condition, the claimant may request a hearing on the denial pursuant to ORS
656.283.
(3)
Notwithstanding subsection (2) of this section, claims for new medical or
omitted medical conditions related to an initially accepted claim that have
been determined to be compensable and that were initiated after the rights
under ORS 656.273 expired shall be processed as requests for relief under the
Workers’ Compensation Board’s own motion jurisdiction pursuant to ORS 656.278
(1)(b). [2001 c.865 §10; 2005 c.188 §1]
Notes of Decisions
Cited in
51
cases (
9 in the last 5 years), 2002–2026 · leading case:
Crawford v. SAIF Corp., 250 P.3d 965 (Or. Ct. App. 2011).
Crawford v. SAIF Corp., 250 P.3d 965 (Or. Ct. App. 2011).
· cites it 23× “262(6)(d) provides: “An injured worker who believes that a condition has been incorrectly omitted from a notice of acceptance, or that the notice is otherwise deficient, first must communicate in writing to the insurer or self-insured employer the worker’s objections to the…”
Coleman v. SAIF, 466 P.3d 967 (Or. Ct. App. 2020).
· cites it 72× “In his first assign- ment of error, claimant argues that SAIF was required to respond to his new medical condition claim pursuant to ORS 656.267, even though his related, ini- tial claim had not yet been accepted.”
De Los-Santos v. Si Pac Enter., Inc., 373 P.3d 1274 (Or. Ct. App. 2016).
· cites it 10× “In that order, the board upheld insurer’s denial of claimant’s “new medical or omitted medical condition” claim under ORS 656.267. 1 Finding no error by the board, we affirm.”
Akins v. SAIF Corp., 398 P.3d 463 (Or. Ct. App. 2017).
· cites it 10× “In that order, the board upheld insurer SAIF Corporation’s (1) denial of claimant’s “new and omitted condition” claims, ORS 656.267; and (2) denial of claimant’s “combined condition” claim, ORS 656.”
Brown v. SAIF Corp., 391 P.3d 773 (Or. 2017).
· cites it 2× “262(6)(d) and ORS 656.267. To the extent that Mannix’s comments were directed at those amendments, they make perfect sense: The acceptance of a claim has no “adverse consequences” to the claimant, because, if the acceptance omits conditions that claimant believes should have…”
SAIF v. Williams, 466 P.3d 1052 (Or. Ct. App. 2020).
· cites it 7× “In this appeal, SAIF argues that the board erred by (1) finding medical causation contrary to the law of the case and without substan- tial evidence and substantial reason and (2) applying an incorrect legal standard for determining the compensability of claimant’s new or…”
Nacoste v. Halton Co., 365 P.3d 1098 (Or. Ct. App. 2015).
· cites it 11× “Thus, in employer’s view, claimant may not bring his claim for chondromalacia as an aggravation claim under ORS 656.”
Garcia-Solis v. Farmers Ins. Co. (In re Comp. of Garcia-Solis), 441 P.3d 573 (Or. 2019).
· cites it 5× “267(1), nor whether they may be disqualified as a "new" or "omitted" condition because claimant may have failed to comply with the formal requirements of ORS 656.267. Claimant asserts that "compensable injury" cannot mean "accepted condition," because the concept of "accepted…”
Rose v. Saif Corp., 116 P.3d 913 (Or. Ct. App. 2005).
· cites it 11× “Employer responds that claimant is ignoring ORS 656.267 and the “reasonably apprises” standard that was the basis for the board’s decision.”
Young v. Hermiston Good Samaritan, 194 P.3d 857 (Or. Ct. App. 2008).
· cites it 5× “According to employer, under ORS 656.267(1), to begin the processing of a new or omitted medical condition *103 claim, “the worker must clearly request formal written acceptance of a new medical condition or an omitted medical condition from the insurer or the self-insured…”
SAIF Corp. v. Williams, 381 P.3d 955 (Or. Ct. App. 2016).
· cites it 4× “Petitioners, SAIF Corporation and Baker County-School District #61, seek reversal of an order of the Workers’ Compensation Board that concluded that claimant had established the compensability of a “new medical or omitted medical condition” under ORS 656.267 for a thoracic spine…”
SAIF Corp. v. Martinez, 182 P.3d 873 (Or. Ct. App. 2008).
· cites it 3× “262(7)(a); ORS 656.267(1), or otherwise. We review for substantial evidence and errors of law, ORS 656.”
— Or. Rev. Stat. § 656.267(1) — 27 cases
Coleman v. SAIF, 466 P.3d 967 (Or. Ct. App. 2020).
“In his first assign- ment of error, claimant argues that SAIF was required to respond to his new medical condition claim pursuant to ORS 656.267, even though his related, ini- tial claim had not yet been accepted.”
Young v. Hermiston Good Samaritan, 194 P.3d 857 (Or. Ct. App. 2008).
“According to employer, under ORS 656.267(1), to begin the processing of a new or omitted medical condition *103 claim, “the worker must clearly request formal written acceptance of a new medical condition or an omitted medical condition from the insurer or the self-insured…”
Garcia-Solis v. Farmers Ins. Co. (In re Comp. of Garcia-Solis), 441 P.3d 573 (Or. 2019).
“267(1), nor whether they may be disqualified as a "new" or "omitted" condition because claimant may have failed to comply with the formal requirements of ORS 656.267. Claimant asserts that "compensable injury" cannot mean "accepted condition," because the concept of "accepted…”
SAIF Corp. v. Martinez, 182 P.3d 873 (Or. Ct. App. 2008).
“262(7)(a); ORS 656.267(1), or otherwise. We review for substantial evidence and errors of law, ORS 656.”
Brown v. SAIF Corp., 391 P.3d 773 (Or. 2017).
“262(6)(d) and ORS 656.267. To the extent that Mannix’s comments were directed at those amendments, they make perfect sense: The acceptance of a claim has no “adverse consequences” to the claimant, because, if the acceptance omits conditions that claimant believes should have…”
— Or. Rev. Stat. § 656.267(2) — 2 cases
Rose v. Saif Corp., 116 P.3d 913 (Or. Ct. App. 2005).
“Employer responds that claimant is ignoring ORS 656.267 and the “reasonably apprises” standard that was the basis for the board’s decision.”
— Or. Rev. Stat. § 656.267(2)(a) — 3 cases
Coleman v. SAIF, 466 P.3d 967 (Or. Ct. App. 2020).
“In his first assign- ment of error, claimant argues that SAIF was required to respond to his new medical condition claim pursuant to ORS 656.267, even though his related, ini- tial claim had not yet been accepted.”
Nacoste v. Halton Co., 365 P.3d 1098 (Or. Ct. App. 2015).
“Thus, in employer’s view, claimant may not bring his claim for chondromalacia as an aggravation claim under ORS 656.”
— Or. Rev. Stat. § 656.267(3) — 2 cases
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