Author: Evan Novotny
Oregon: Processing Proposed Surgical Authorization Requests Is Not Solely Based on Accepted Conditions
In 2019, the Oregon Supreme Court held that medical services materially related to the work injury are compensable under ORS 656.245 and are not limited to only the accepted conditions. Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019). This decision continues to have a significant impact on claim processing…
Oregon Administrative Claim Closure Requires Strict Compliance with the Rule
Administrative closure can be a useful tool for processing an Oregon Workers’ Compensation claim to closure where a worker is inconsistent or non-compliant with treatment requirements. In some circumstances, the law requires the use of administrative claim closure, and failure to close the claim accordingly can create a penalty issue…
Oregon Court of Appeals Rejects Claimant Argument to Expand Meaning of “Compensable Injury” for Purposes of Assigning Permanent Impairment
On June 7, 2023, the Oregon Court of Appeals issued its Opinion on Gramada v. SAIF, refusing to expand the meaning of the term “compensable injury” for the purposes of assigning permanent impairment. Gramada stems from an appeal of an Order on Reconsideration which affirmed the Notice of Closure on…
Permanent Rule Changes Coming to Oregon Workers’ Compensation!
There are new and significant rule changes to Oregon Workers Compensation. These will affect the way workers’ compensation benefits are paid and calculated. Additionally, notable and significant revisions from HB 4138 (regarding overpayments) will not be in effect until January 1, 2024. Apportionment of PPD in light of Johnson v….
Increased WRMEs in Oregon?
A worker requested medical exam (WRME) is the equivalent of an insurer arranged independent medical exam–but as the title implies, requested specifically by the worker. Under ORS 656.325(1)(e), there are three main criteria when a worker can request a WRME: The insurer has issued a compensability denial, on which the…
Oregon Court of Appeals issues another decision scrutinizing combined condition defenses
We often discuss combined condition acceptances and denials as useful claim processing tools, particularly in closing a claim which may otherwise be difficult to close, but also for apportioning impairment at claim closure and defending against compensability if a claimant has a preexisting condition. ORS 656.005(7)(a)(B) states that “if an…
Combined Conditions in Oregon Workers’ Compensation: Not always a Simple Open and Shut Case
Combined condition acceptances and denials can be a useful claim processing tool in Oregon for several reasons. They can be used as a defense against compensability. They can also be used to close a claim and allow for apportionment of permanent impairment at claim closure. A combined condition exists when…
Oregon WCD Issues Revised Temporary Rule on Claims for COVID-19 or Exposure to COVID-19
The Workers’ Compensation Division has issued OAR 436-060-0141, a temporary rule addressing claims for COVID-19 and claims for exposure to COVID-19. The rule will remain in effect for 180 days while the Department works on a permanent rule. The rule covers claims for COVID-19 as well as presumptive cases where…
Claims Examiner Certification Renewal in Oregon and COVID-19
Three months into the pandemic, we have all seen changes in both our daily lives and in our professional lives. One of these changes has been the cancellation of several conferences and seminars which provide the continuing education units (CEUs) required for recertification. Under OAR 436-055-0070, claims examiners are required…
Oregon’s Distracted Driving Law Goes into Effect October 1
As of October 1, 2017 any use of mobile devices will be prohibited while driving in Oregon. Like the law in Washington, which went into effect this summer, the new Oregon law prohibits drivers from holding or touching their mobile devices or using any function of the phone while driving…
