Oregon Workers Compensation
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 WCD Reviewing Rules Pertaining to IME’s and WRME’s
The WCD held a meeting to take public comment on the administrative rules related to Independent Medical Exams (IME’s) and Worker Requested Medical Exams (WRME’s). Some of the more lively discussions centered around whether IME providers should be required to produce their report within a certain time frame with claimants’ attorneys arguing medical treatment, time-loss benefits, and permanent impairment can be all be delayed pending these reports. We provided ample testimony that the current rules were adequate to address these concerns. The majority of the rules discussed pertain to the medical providers’ licensing and training. These discussions focused on confirming the WCD’s ability to sanction or remove an IME provider from the approved list of providers is consistent… Continue reading 
Sather Byerly & Holloway, LLP is excited to announce its Workers’ Compensation Online Certification Program for claims examiners, employers, insurance brokers, and medical providers or anyone else interested in learning more about Oregon’s workers’ compensation system. The course includes eight online modules where students will learn about several key issues, such as: • Compensability • Claims Administration • Temporary Disability • Medical Services • Claim Closure • Vocational Benefits • Litigation & Settlement • Board’s Own Motion Jurisdiction • Third-Party Actions • The Workers’ Benefit Fund Students will also be provided with a coursebook, which covers these and many more topics. As an added bonus, each student will be assigned an attorney mentor who they can use as a resource… Continue reading New Average Weekly Wage Calculation Rules
The Workers’ Compensation Division recently issued new rules for calculating average weekly wage. The new rules will apply to claims with dates of injury on or after February 21, 2018. Under the new rule: When a worker is paid irregular wages and there is an increase or decrease in the worker’s pay rate in the previous 52 weeks before the injury/occupational disease, this will not constitute a “new wage earning agreement.” The insurer must calculate the worker’s average weekly hours worked at each pay rate since the last wage earning agreement (not to exceed 52 weeks). The average hours at each pay rate will then be multiplied by the pay rate at the time of injury/occupational disease. Any irregular… Continue reading Worker’s Compensation Division Addresses House Bill 2338 Regarding Benefits to Surviving Children
The Workers’ Compensation Division issued an Addendum to Bulletin No. 377 on December 8, 2017. The Division issued the addendum to address House Bill 2338, which changed the computation of fatal benefits to children of deceased workers or “surviving children.” The addendum does not change the monthly benefit amounts for: Surviving children receiving benefits at 25 percent of the base or average weekly wage (whichever applies) before January 1, 2018; or Surviving children or dependents with no surviving parents who are completing secondary education, a GED, or a program of higher education. The addendum does change all monthly benefits being paid at the 10 percent level before January 1, 2018. Those benefits must be increased to 25 percent for benefits… Continue reading Oregon WCD implements new rejection policy for incomplete or incorrect 801 forms
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 Oregon WCD issues Temporary Rules Clarifying Claim Closure Requirements
In our efforts to keep you apprised of the latest developments regarding the Oregon Supreme Court’s decision in Brown (see Andrew’s blog on the case here.) and how the decision could affect claim processing (see Megan’s blog on the issue here.), we are forwarding the temporary administrative rules issued by the WCD. As expected, the rules confirm that medically stationary status, permanent impairment, and permanent work restrictions must relate to the accepted condition or to a direct medical sequela of the accepted condition. The temporary rules remove the phrase “a condition directly resulting from the work injury.” The WCD also revised Bulletin 239, the claim closure guide provided to medical arbiters. The bulletin provides useful information to ask the attending… Continue reading