In a June 27, 2017 Industry Notice, the Oregon WCD announced it will reject incomplete or incorrect insurer/employer created 801 and 1502 forms. Insurers and self-insured employers are required to process and file claims and reports with the WCD in compliance with ORS 656 and OAR chapter 436. OAR 436-060-0011 requires insurers/self-insured employers file a 1502 form within 14 days of (1) the initial decision to accept or deny the claim; (2) the date of any reopening of the claim; (3) the date of change in the acceptance or classification of the claim; (4) the date of a litigation order or the insurer’s decision that changes the acceptance or classification of the claim or causes the claim to be… Continue reading
Hopefully you are reading this blog post from the safety of your computer and not while driving. If you are using your cell phone to read this while on your morning commute, you could be violating a newly passed Washington Law. Governor Jay Inslee signed a measure that will prohibit Washington drivers from holding an electronic device while driving. Current law in Washington only prohibits texting or holding a phone to the ear while driving. The expanded law prohibits drivers from holding an electronic device while driving, including while in traffic or waiting for a traffic light. This means, no checking Facebook, no reading or sending emails, or using apps. Drivers are allowed to minimally use a finger to activate,… Continue reading
The Oregon Supreme Court’s recent decision in Brown v. SAIF, 361 Or 241 (2017) calls into doubt the applicability of the Workers’ Compensation Division rules involving claim closure. Specifically, the WCD amended closure rules in 2015 to require an impairment rating based on the compensable injury rather than the accepted conditions. Brown held that a compensable injury refers only to the accepted conditions. (For more information on the recent decision see Andrew Evenson’s post here.) The WCD issued an industry notice on April 3, 2017 to address the case. The WCD is reviewing the rules and will be holding its first meeting to discuss rule changes in light of the recent decision on April 20, 2017. The WCD stated they… Continue reading
In 2016, the Workers’ Compensation Division drafted changes to OAR 436-060. These changes went into effect on January 1, 2017. Below, I have outlined several changes that claim’s administrators should be aware of. Please note that the below list and recommendations is not a complete list of changes to Division 060. I encourage you to review the new rules. OAR 436-060-0010(6): The worker may choose a medical service provider, attending physician or authorized nurse practitioner under ORS 656.245, 656.260, OAR 436-010 and 436-015. Except as provided under ORS 656.260 and OAR 436-015, if an employer restricts the worker’s choice of medical service provider the director may impose a civil penalty of up to $2,000. What this means for you: This… Continue reading
Earlier this year, the Oregon Workers’ Compensation Division proposed extensive changes to division rules. The rule changes go into effect on January 1, 2017. The following OAR 436 divisions include changes: – 050, Employer/Insurer Coverage Responsibility – 060, Claims Administration – 105, Employer‐at‐Injury Program – 110, Preferred Worker Program – 120, Vocational Assistance to injured Workers A complete copy of the rules and changes can be found here. Over the next couple of weeks, SBH will provide details on how the rule changes will impact claims administration. In the meantime, if you have any questions about the rule changes please contact me at firstname.lastname@example.org.
Please join me at the DMEC Roundtable on December 14, 2016. Mike Moses from Kaiser Permanente and I will be speaking on ADAAA and Family Leave. Please register by December 9. More information and registration is available here.
Claimant only required to show idiopathic factors were less likely to have caused unexplained injury
The Oregon Court of Appeals established new case-law on claimant’s burden of proof in “unexplained fall” claims. If an injury is unexplained, as a matter of law, it is presumed to arise out of employment. Whether an injury is unexplained, is a question of fact. An injury is only deemed truly unexplained if the claimant eliminates idiopathic factors as causative. In Sheldon v. U.S. Bank, claimant fell in the lobby of her employer’s building. U.S. Bank denied the claim and argued her fall was caused by her diabetes and obesity. The Workers’ Compensation Board agreed and determined because there was medical evidence demonstrating diabetes and obesity can contribute to balance problems her fall was not truly unexplained.… Continue reading
The Oregon Workers’ Compensation Board passed revised attorney fee rules on October 13, 2016. The most significant changes involve increased attorney fees for disputed claims settlements and claims disposition agreements. The Board increased attorney fees on Disputed Claim Settlements and Claims Disposition Agreements. Previously attorneys were awarded 25% of the first $17,500 of the settlement process plus 10% of any amount of proceeds in excess. The Board revised the rules to allow 25% of the first $50,000 of the settlement proceeds plus 10% of any amount of proceeds in excess of $50,000. The Board also increased the amount of attorney fees received in PPD and PTD cases. Previously awards were limited to 25% of increased compensation not to exceed… Continue reading
On October 26, 2006, SAIF issued a denial of claimant’s injury claim. The denial was mailed via certified mail and a person who identified himself as claimant signed for the denial. In June 2015, claimant requested hearing on the denial. Claimant testified that the address the denial was sent to was his address but denied signing for it. Claimant argued the statutory timeline for requesting the hearing did not start until he was made aware of the denial in June 2015. The Board first held the relevant time period for starting the statutory timeline is the date the denial is mailed, not the date claimant became aware of the denial. The Board next held, per ORS 656.319(1), there… Continue reading
The Department of Labor issued an interim final rule increasing penalties assessed by the Office of Workers’ Compensation Programs under the LHWCA. The new rules increase penalties for: Failure to file first report of injury or filing a false statement or misrepresentation in first report increased from maximum of $11,000 to $22,587 Failure to report termination of payments increase from $110 to $275 Discrimination against employees who claim compensation increase from the current minimum of $1,100 to a minimum of $2,259 and increase from the current maximum of $5,500 to a maximum of $$1,293 A copy of the interim final rules can be found here. An interim final rule goes into effect as soon as it is published but… Continue reading