The Good Cause Standard: Some Clarification
Martin L. Alvey P.C. was able to achieve a positive result for our client Corey Otterson when the Workers’ Compensation Board issued an important decision concerning what constitutes “good cause” for failure to give notice of an injury within 90 days.
Corey is an auto-mechanic who had an accident on the job while lifting a tire to complete a tire rotation. When he sought medical treatment four days later, he was told that he was only suffering from abdominal pain and should take aspirin until the pain subsided. No further treatment was recommended. Corey went back to work, but couldn’t shake the pain in his groin for months.
9 months later, Corey went back to the doctor’s office with the same pain. This time an ultrasound was taken and the doctors discovered that Corey was suffering from a hernia and needed surgery.
Corey filed a workers’ compensation claim immediately after he discovered that he had a hernia. Unfortunately for Corey, SAIF denied his claim because he did not file an incident report within 90 days of his original injury.
When Corey received his denial letter he came to Martin L. Alvey P.C. for help. We filed a request for hearing contesting the denial. Our argument was that Corey had “good cause” for not filing his claim within 90 days of the incident.
Failure to give notice within the 90-day time frame bars a claim unless the notice is given within one year of the accident and the worker establishes that he or she had “good cause” for failure to give notice within the 90-day period. ORS 656.265(4)(c). The problem with what constitutes “good cause” is that there are surprisingly few appellate and Workers’ Compensation Board decisions specifically explaining the good cause standard.
At his hearing, Corey was able to explain his accident and the reason he did not initially file a claim. Corey did a great job recounting exactly what happened. On October 7, 2009 the administrative law judge issued an Opinion and Order setting aside SAIF’s denial.
SAIF appealed the decision to the Workers’ Compensation Board. The Board affirmed the ALJ’s order on January 25, 2011. The Board’s opinion is not only favorable, but also helped establish what constitutes good cause in a workers’ compensation case.
The Board held that Corey’s hernia injury claim was not barred as untimely filed because his lack of knowledge that he had incurred a significant injury established good cause for his failure to provide notice of the accident within the statutory 90 day period. The Board went on to conclude that the work injury was a material contributing cause of his need for treatment/disability and, as such, found his claim compensable..
Our firm is very pleased that we were able to help Corey and that the Board’s decision will help future claimant’s in a similar position.
To read the Board’s entire Order on Review: WCB Case No 09-06419
Also, the Board’s Order was summarized in the Workers’ Compensation Board’s News and Case Notes for January 2011: