SAIF Corp. v. Jensen

Summary

The Oregon Court of Appeals held that the statutory 30-day or 12-visit limitation for chiropractic treatment applied regardless of whether the workers’ compensation claim had been accepted or denied. The court also held that SAIF was not equitably estopped from denying payment because the provider had not materially changed position in reliance on SAIF’s communications and SAIF had no statutory duty to provide notice of the limitation.

Holdings

1. The statutory limitation applies regardless of whether the claim had been accepted or denied when the medical services were provided. A chiropractor who is not a member of a managed care organization may qualify as an attending physician only for 30 days from the date of first treatment or 12 visits, whichever occurs first.
2. SAIF was not equitably estopped from denying payment for Jensen's services because Jensen did not materially change his position in reliance on SAIF's letters, and SAIF had no duty to notify Jensen of the statutory attending-physician requirements.

Questions Presented

1. Whether ORS 656.245(2)(b)(A)'s 30-day or 12-visit limitation on compensable treatment by a chiropractor who is not qualified as an attending physician applies when the workers' compensation claim is denied.
2. Whether SAIF was equitably estopped from denying payment for chiropractic services provided before SAIF notified Jensen that he did not qualify as an attending physician.

Disposition

reversed