Oregon Workers Compensation
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 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