Oregon Workers Compensation
Annual Adjustment of Attorney Fees in Workers’ Compensation Claims in Oregon
The Oregon Workers’ Compensation Board recently issued a revised Bulletin No. 1 addressing the maximum attorney fee under several statutes. The attorney fees affected by the revised bulletin are provided in ORS 656.262(11)(a) (unreasonable delay or refusal to pay compensation or accept or deny), ORS 656.262(14)(a) (claimant attorney participation in claimant’s statement or deposition), and ORS 656.308(2)(d) (responsibility denial). The maximum attorney fee amount is adjusted annually on July 1 by the same percentage increase, if any, as made to the state’s average weekly wage (SAWW) under ORS 656.211. The reasonable hourly rate for an attorney’s time spent during a claimant’s interview or deposition pursuant to ORS 656.262(14)(a) is also adjusted by the same percentage on July 1. Effective July… Continue reading 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 to complete 24 hours of training within a three-year cycle. These CEUs include at least 6 hours on ORS chapter 656 and OAR chapter 436, at least one hour on interactions with IME providers, and additional training related to medical case management, communication skills, and claims processing skills. Thankfully, the administrative rules provide a 12-month grace period to renew certification. During the grace period, an examiner is still “certified” under… Continue reading In the midst of COVID-19 pandemic, Oregon Court of Appeals issues troubling ruling for processing new/omitted condition claims
The Oregon Court of Appeals issued its decision in Coleman v. SAIF, 304 Or App 122 (2020) on May 13, 2020. Claimant filed a claim for a left knee injury on June 12, 2015. On June 29, 2015, claimant and his attending physician submitted an 827 form for a new/omitted condition claim for medial femoral chondral defect in the left knee. The carrier issued an initial notice of acceptance on August 11, 2015, accepting a left knee strain and contusion; there was no reference to the June 29, 2015 827 form. In a chart note dated October 15, 2015, claimant’s attending physician referenced the June 2015 827 form and indicated it needed to be addressed by the carrier. The carrier… Continue reading Oregon Employee Injured While Working from Home? Best Practices to Determine Compensability
With the onset of COVID-19 and statewide stay-at-home orders, a high percentage of today’s workforce is operating from home, or in some variation of remote setup. Even as employees begin to return to a more traditional work setting, it is reasonable to anticipate that the pandemic-related response will have long-term effects on where and how some employers allow their employees to work. So, with the rise in remote workers will likely come a rise in remote workplace injuries. How do you respond? In Oregon the general rule is injuries occurring “in the course of” and “arising out of” employment are compensable. That remains the case for injuries occurring remotely, if the worker is within the course and scope of his… Continue reading Oregon Workers’ Compensation Rule Updates During COVID-19 Crisis
Needless to say, there have been a lot of changes recently, not just in our daily lives, but also in claim processing issues. The WCD has begun discussions to address a variety of issues that have arisen with Workers’ Compensation claims in light of COVID-19. Further, the WCD and WCB have continued forward with new rules. As SBH’s legislative liaison I have included some of the highlights below to help continue to process claims in a timely and proper manner during COVID-19. COVID-19 Potential Proposals I among others are working on identifying potential proposals to address many new issues arising from COVID-19 including: • Effect on claim processing deadlines due to lack of available IME and medical arbiter examiners. •… Continue reading Oregon – COVID-19 Incident Reports, Workers’ Comp, Wage and Leave Issues
As Oregon employers continue to face unique issues in the wake of the COVID-19 coronavirus, SBH has assembled this list of commonly asked questions addressing workplace rights and responsibilities for incident reports, workers’ compensation claims, and other employment-related concerns. When should an OSHA Injury and Illness Incident report be filed? OSHA has deemed COVID-19 a recordable illness when an employee of a covered employer is infected on the job. https://www.osha.gov/SLTC/covid-19/standards.html Employers should file an incident report if either: An employee has tested positive for COVID-19; or The employee was exposed at work to an individual who tested positive for COVID-19. Further, employers must report the death or in-patient hospitalization of any worker due to an on-the-job injury by calling… Continue reading Oregon Supreme Court rules that medical services for conditions caused in material part by the work injury incident, not just accepted conditions, are compensable
In a much-awaited decision, the Oregon Supreme Court recently ruled in Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019) that medical services for conditions caused in material part by the work injury incident, not just accepted conditions, are compensable under ORS 656.245(1)(a). In relevant part, ORS 656.245(1)(a) states that “For every compensable injury, the insurer or the self-insured employer shall cause to be provided medical services for conditions caused in material part by the injury for such period as the nature of the injury or the process of the recovery requires.” This case involves a 2009 work injury, in which a food server sustained bodily injuries. Over the next two years, the insurer accepted numerous musculoskeletal conditions. In 2012,… Continue reading WCD Issues New Rules Related to Medical Services
The WCD has written new rules related to medial services that will go into effect April 1, 2019. While there are a number of changes, here are a couple of the most significant: MCO’s Requires MCO when less than 3 providers in a provider category in a geographical service area, to provide list of at least 3 physicians willing to treat claimant in given area. If the MCO does not provide the list or have anyone available, the worker is allowed to treat outside the MCO. Allows worker to continue treating with current provider for 14 days (formerly 7 days) after being enrolled in the MCO before having to establish with MCO provider. Elective Surgery Removes statement that chart… Continue reading Workers Compensation Board Reviewing Attorney Fees
The WCB is statutorily required to review claimant attorney fees every other year and it just held a public meeting to discuss the issue. Several concepts were put forward by the claimant’s attorneys including: Creating an optional bifurcated proceeding to address attorney fees after the judge has ruled on the merits of the case; Using a set multiplier to compensate attorneys for the contingent nature of their work; Increasing the fees for recorded statements to $400/hour (now at $275) and/or allowing attorney’s to be paid for the time preparing for the worker’s statement/deposition, and; Using defense fees/hours as a factor for the judge to consider in awarding a fee to claimant’s attorney. You can find the proposals and written testimony… Continue reading WCD Rulemaking Meeting – Medical Billing/Services
The WCD held another public advisory meeting, this time to discuss the medical billing and medical services administrative rules. Probably the most important and interesting topic was whether the WCD should look into rules to regulate and/or promote telemedicine in Oregon. The discussion was generally positive. Allowing workers to speak with a doctor via video on the work site was described as a good screening tool to determine whether the worker needed to seek emergency, urgent, or any follow up care. Telemedicine would also increase the availability of medical providers to many workers in rural areas. If you have any experience with telemedicine and workers’ compensation claims, the WCD would like your input. Our meeting agenda also covered a variety… Continue reading