Deceptive Insurer Medical Questionnaire 2020
Our client got hurt on the job and filed for workers’ compensation. His claim was accepted, and when it came time to close the claim and award him permanent disability benefits, we appealed the award paid by the State Accident Insurance Fund (SAIF). SAIF had sent our client’s doctor a form to report on his condition, and that form provided three boxes – “no limitation,” “some limitation,” and “significant limitation,” as if “significant limitation” were the worst possible alternative. Finding that our client could still do some work, the doctor didn’t want to choose the most extreme alternative, so she checked “some limitation.” As SAIF knew, the law provides for a permanent disability award only for “significant limitation.” The worker’s limitations were certainly “significant;” He could only be on his feet for half a day. TCNF partners Chris Frost and Jim Coon took the case through the Workers’ Compensation Board, up to the Oregon Court of Appeals and got it reversed and sent back to the Workers’ Compensation Board for a new decision. The Court held that SAIF’s form did not accurately convey the relevant question.