Can a denial in Oregon based on an independent record review trigger entitlement to WRME?
Recently, the Oregon Workers’ Compensation Board confirmed that entitlement to a worker requested medical examination (WRME) is only triggered when the employer’s denial is based on an in-person IME with which an attending physician has not concurred. Michelle L. Knowlden, 75 Van Natta 505 (2023). In Knowlden, the claimant was originally scheduled for an in person IME but the examination was cancelled as a consequence of the COVID-19 pandemic restrictions. The employer secured a records review instead and then issued a denial based on the report. Claimant argued that exceptional circumstances surrounding the pandemic established that a WRME should be granted. The Board did not find any good cause or exceptional circumstances exception to ORS 656.325(1)(e) or OAR 436-0+0-0147(1)(b) which require an in- person IME.
Before arranging an in- person IME to investigate a claim, consider whether a record review will suffice. If there is no dispute regarding diagnosis, a records review is likely sufficient to address causation. However, an in-person evaluation is better suited to address discrepancies in diagnosis, issues concerning symptom magnification, and to secure a more complete medical history concerning nature of injury/exposure and prior treatment.
If you have questions about WRMEs or other claim issues, you can contact me at or (503) 595-2136.
Posted by Steve Verotsky.
