OR Court Determines Tests for Condition Not Accepted by Employer Are Not Compensable

The Oregon Court of Appeals determined that an employer was not responsible for diagnostic tests for a condition that was not part of an employee’s compensable workplace injury.

Elvia Garcia-Solid was struck by a tent pole at work when the wind kicked up. She had a large laceration on her scalp and was in the hospital for about a month. She received workers’ compensation for a concussion, a closed head injury, chronic headache syndrome, facial scarring and a right supraorbital nerve injury.

Her doctor referred her to a psychologist as she was exhibiting symptoms potentially linked to post-traumatic stress disorder (PTSD) as a result of her work related injury. For example she was afraid of going outside when it was windy. She sought an appointment with a psychologist to talk about these symptoms and possible PTSD. The employer denied the claim and did not authorize the consultation because PTSD is not an acceptable compensable condition.

She sought a hearing with an administrative law judge who upheld the employer’s denial even though they thought the psychology referral was linked to a workplace injury. The Workers’ Compensation Board affirmed these findings, reasoning that diagnostic services are only compensable if they are related to an already accepted injury/condition, or are necessary to determine the cause or extent of that accepted injury. Since PTSD was not an accepted condition, the meeting with the counselor would not be considered compensable either.

The Court of Appeals upheld the decision of the Workers’ Compensation Board. Justice James Egan dissented, saying that the Supreme Court still has not made it clear about who pays for diagnostic tests, and that the Appeals Court had relied too much on related, but misplaced, cases when making their decision. His opinion is that workers should have access to diagnostic tests that are related to injuries and access should not be based on whether they are related to accepted conditions.

Read the case and the dissenting opinion here.

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