Category: Oregon Workers Compensation
What can the Oregon Workers’ Compensation Board consider before applying the First Responders Presumption under ORS 656.802(7)(b)?
Certain first responders are entitled to a presumption of compensability when a preponderance of medical evidence from a psychiatrist or psychologist establishes the worker has more likely than not satisfied the DSM-5 diagnostic criteria for post-traumatic stress disorder (“PTSD”) or acute stress disorder. ORS 656.802(7)(b). Applicable roles include full time…
Oregon WCD Formal Rulemaking – Medical Treatment
The WCD met in November to discuss some issues regarding medical billing, treatment, and MCO procedures. The WCD is moving forward with formal rulemaking on some of these topics. A meeting is set for February 18, 2026, and it will be the last opportunity to provide input on these proposed…
Was that Oregon Claim Closure Unreasonable?
The Court of Appeals issued an important decision which addressed in part an employer’s reliance upon an attending physician’s repeated determinations of medically stationary status when issuing a notice of closure. An insurer must close an Oregon Workers’ Compensation claim when a worker is medically stationary. OAR 436-030-0020(1). Proper notice…
Oregon IME Appointment Notices: Strict Compliance with Administrative Rules: The All-or-Nothing Game
While standardized boilerplate templates for documents such as IME appointment notices can be an efficient tool in an employer’s or insurer’s claims-handling arsenal, case law continues to underscore a critical point: efficiency cannot come at the expense of strict regulatory compliance. Oregon’s workers’ compensation system leaves little margin for error…
Got Paystubs? You May Need More When Navigating Time Loss and AWW Disputes in Oregon
You have done it! You have finally mastered calculating the worker’s average weekly wage calculation for both regular and irregular pay. Time loss payments are issuing, claim processing is moving along, and then, you see the dreaded piece of mail: a request for hearing generically marking the issue as “temporary…
Nothing Average About It: Oregon Average Weekly Wage Calculations
In Oregon workers’ compensation, calculation of an injured worker’s average weekly wage is often litigated and often misunderstood. The first step in calculating an average weekly wage is the most important—establishing whether the worker was earning regular or irregular wages at the time of injury. Regular and irregular wages have…
In Oregon, Hearing Requests from Former Opposing Counsel May Haunt You!
Generally, if a claimant does not timely file a hearing request, they will lose their right to compensation unless they can show good cause. The Supreme Court of Oregon has long held that an attorney’s failure to file a hearing request does not constitute good cause. Sekermestrovich v. SAIF, 280…
Navigating Responses to Requests for Lump-Sum Payments of Permanent Disability Awards in Oregon
Updated to reflect changes coming January 1, 2026. You’ve done it – the claim has closed. This is a difficult feat in and of itself. A permanent partial disability (PPD) has been accurately determined and will be awarded in installments. You are ready to begin installments (or you have already…
Oregon WCD Rulemaking Meetings Set for November 18-19, 2025
The WCD scheduled a public advisory meeting for November 18, 2025, 1:00 – 4:00 PM to address potential changes to medical treatment, billing, and MCO rules. You can find the agenda here. Some of the proposed changes stem from MLAC’s subcommittee on medical treatment issues and issues related to finding…
Oregon Supreme Court Affirms Broad WRME Entitlement
A common tool of administrators and employers in obtaining information necessary to process a workers’ compensation claim is an independent medical examination (IME), whereby a physician without any prior tie to the worker provides a medical opinion. In Oregon, if certain conditions are met, injured workers are entitled to a…
Oregon Workers’ Compensation Division is Considering Changes to Claim Processing Rules
The WCD held a public advisory meeting on September 11, 2025, to discuss potential changes to various provisions in OAR 436-060. The meeting addressed some rule-making processes stemming from recent legislative changes on lump sum payments, but also included several other issues. The public comment period remains open until September…
Oregon Rulemaking and Work Groups
A few weeks ago, I discussed the recent legislative changes from the 2025 session. There are now a few different rulemaking and advisory groups developing the administrative framework for those statutory changes. You can see a schedule of the WCD’s meetings here. The Oregon Workers’ Compensation Division will be forming…
2025 Oregon Legislative Sessions Comes to an End
The Oregon legislature adjourned as few weeks ago. While the session had some rather contentious issues to deal with as usual, there were a few workers’ compensation issues that had support through MLAC and passed through the legislature. HB 2800 (PEOs) Changes the term “worker leasing company” to “professional employer…
Overpayment In Oregon? You better explain it!
As you probably know, employers and insurers in Oregon are entitled to recover overpayments by withholding a certain percentage of future benefits that may be due to the worker on any claim. ORS 656.268(14). You may know that overpayments have to be asserted and documented in writing. OAR 436-060-0170. But…
Oregon Workers’ Compensation: What Happens if Claimant Passes Away?
In Oregon, when a claimant passes away that may not mean immediate claim resolution. Sometimes additional work up of the claim may be necessary before the claim can close. When a claimant dies the date of death is substituted for the medically stationary date, if claimant’s attending physician has not…
Oregon Reminder – Update that IME Appointment Language!
Did the claimant not show up for an Independent Medical Examination (“IME”) appointment despite you sending a timely appointment notice? This can be a really frustrating scenario during the claim, especially if you are relying on the IME to guide a claims processing decision. Before insurers and claim administrators explore…
Oregon Assessed Attorney Fees – The Vicious Circle
The Oregon’s Workers Compensation Board (“WCB”) recently issued an Order on Remand, awarding $68,300 for services litigating reasonableness of an initial attorney fee award. Karista D. Peabody v. SAIF, 77 Van Natta 67, 72 (2025). This ruling aligned with the remand from the Court of Appeals. Peabody v. SAIF Corp.,…
Oregon Vocational Assistance – Authorization to Work in the US is No Longer a Requirement for Eligibility
An injured worker must meet certain conditions to be eligible for vocational assistance, typically the costliest aspect of a workers’ compensation claim. OAR 436-120-0145(2) lays out the specific requirements for a worker to be eligible for vocational retraining. In reviewing that rule you may notice a significant change to the…
Oregon WCB Confirms, No Compensable Claim: No Rule Violation, No Unreasonable Delay
In a recent legal decision, Rosita E. Peery, 77 Van Natta 15 (January 10, 2025), the Oregon Workers’ Compensation Board affirmed an Administrative Law Judge’s (ALJ) ruling, upholding the denial of a worker’s injury and occupational disease claim for a right shoulder condition. The case also addressed whether the worker…
Oregon WCB Confirms Initial Notice of Acceptance Does Not Set a “Theory of the Case”
What is the difference between an injury, a claim, and an accepted condition? The answer, frustratingly, is “it depends.” But the Oregon Workers’ Compensation Board recently issued a decision which at least provides some clarity as to whether one condition accepted in a claim dictates the types of other conditions…
New Medical Services Rules Proposed by the OR WCD
On February 19, 2025, the WCD is holding a hearing to propose amendments to several medical services rules in OAR 436-009, 436-010, and 436-015. Many of the amendments are to address billing code issues and remove outdated notice language. However, there are several notable proposals: OAR 436-009-0010 would be amended…
Oregon Workers’ Compensation End of Year Wrap Up: Let’s End on a High Note!
We welcomed 2024 with a slew of changes to the Oregon Revised Statutes and Oregon Administrative rules on Workers’ Compensation that impact and change how we process claims. As the year evolved, additional requirements came into effect. We at SBH Legal want all of our clients to be successful in…
Important Changes to Oregon IME Appointment Notices in Effect as of October 1, 2024
Have you updated the bold language and formatting in your Oregon IME appointment notice template? In case you missed it, the Oregon Workers’ Compensation Division updated the language and formatting that must be used when issuing an IME appointment notice to an injured worker. These changes went into effect on…
New denial appeal and hearing rights language requirements in Oregon Workers’ Compensation
As a reminder, the Oregon Workers’ Compensation Board recently revised Oregon Administrative Rule (OAR) 438-005-0055 to reflect changes to the required denial and hearing rights language that must issue with any denial. As always, all notices of denial must specify the factual and legal reasons for the denial and, effective…
Stress of Navigating Oregon Workers’ Compensation: Possible Ground for Mental Health Condition?
Filing an Oregon Workers’ Compensation claim includes a range of administrative processes, from injury reports to claim closure, encompassing medical treatment, independent medical evaluations, entitlement issues, and several other factors critical to successfully processing a claim. Can this process alone be a valid basis for a compensable mental health condition,…
