Category: Oregon Workers Compensation
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,…
Oregon Workers’ Compensation Division Reviewing Medical Service and Billing Rules Nov. 5th
The WCD is hosting an advisory committee meeting on November 5, 2024. You can find the agenda here including information about how to participate in the meeting. The WCD regularly reviews these rules to make sure medical service billings are appropriately updated, but there are several topics being discussed including:…
Bridging Borders: Oregon’s Workers’ Compensation Reciprocity Explained
Out-of-State Employers When an out-of-state employee travels to Oregon for work and sustains an injury, it may result in an Oregon workers’ compensation claim, depending on key factors. Pursuant to ORS 656.126(2) any out-of-state worker is exempted from the provisions of this chapter while that worker is temporarily within the…
Oregon Workers’ Compensation Board issues decision expanding right to WRME
On September 16, 2024, a WCB Order on Review, Jon C. Landry, 76 Van Natta 462 (2024), expanded on the Court of Appeals ruling in Teitelman v. SAIF to identify what qualifies as a “post-denial IME report” and when an attending physician does concur with the IME report which denial…
Oregon WCB clarifies carrier’s obligation to accept or deny encompassed conditions
A WCB Order on Review, Collin Stringer, 76 Van Natta 462 (2024), distinguished conditions encompassed within previously accepted conditions are not new or omitted conditions. The Board affirmed and supplemented ALJ Naugle’s order to confirm encompassed conditions may be denied where the accepted conditions adequately informed claimant and medical providers…
Oregon Workers’ Compensation Rules change attorney fee caps in settlement and changes to mandatory denial language.
Previously, OAR 438-015-0050(1) and OAR 438-015-0052(1) allowed a workers’ attorney to receive up to 25% of the first $50,000 of DCS and CDA proceeds and only 10% of any additional settlement funds. The Board recently amended these rules to remove the 10% attorney fee limit. The alterations were made with…
Oregon Workers’ Compensation: Does it make sense for an insurer to appeal its own Notice of Closure?
In Oregon, the attending physician plays a crucial role throughout the duration of a workers’ compensation claim. For better or worse, the importance of the attending physician is especially evident when it comes to claim closure. Unless the worker is actively engaged in an authorized training plan, the insurer must…
What type of medical services are compensable after a worker is medically stationary in Oregon?
A common question which arises in Oregon workers’ compensation claims process is what type of medical services will continue to be compensable once a worker has reached a medically stationary status. The Workers’ Compensation Division recently providing some clarification when an insurer will be held liable to compensate a proposed…
Oregon Workers Compensation: Is the deposition of a medical arbiter a thing?
An impartial medical examination is typically scheduled as part of reconsideration proceedings when there is a disagreement about the impairment findings used to close a claim. This examination is known as a medical arbiter examination. A physician or a panel of physicians is assigned by the Appellate Review Unit (“ARU”)…
New Oregon Rule Governing Subsequent Temporary Disability Payments Beginning July 1, 2024
On July 15, 2024, the Oregon Workers’ Compensation Division issued an Industry Notice outlining the rule change for the payment of subsequent temporary disability benefits. The due date for the first payment of temporary disability benefits has not changed. If the attending physician or authorized nurse practitioner has authorized temporary…
Oregon Attorney Fees in Certain Workers’ Compensation Matters Increased as of July 1, 2024
In Oregon Workers’ Compensation, attorney fees for representation of a claimant are controlled by statute. Certain attorney fees associated with penalties for unreasonable claim processing and attorney representation in a responsibility denial have statutory caps. Those statutory caps are adjusted each year based on the increase of the state’s average…
How exclusive is the exclusive remedy in Oregon Workers’ Compensation?
At the core of the Oregon workers’ compensation system is a compromise between workers’ and employers. Employers must provide benefits for work-related injuries even when there was no negligence by the employer which led to the incident. But these work-related injuries cannot serve as the basis of a lawsuit against…
Oregon Court of Appeals Upholds Nava Rule
In Nava v. SAIF, 333 Or App 196 (2024), claimant sought judicial review of the Board’s denial of penalty and attorney fees under ORS 656.262(11)(a) for unreasonable delay in payment of compensation. By way of background, claimant was compensably injured in November 2017 and the claim was accepted for left…
Oregon: Processing Proposed Surgical Authorization Requests Is Not Solely Based on Accepted Conditions
In 2019, the Oregon Supreme Court held that medical services materially related to the work injury are compensable under ORS 656.245 and are not limited to only the accepted conditions. Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019). This decision continues to have a significant impact on claim processing…
OREGON: When post-denial IME reports are submitted as evidence at hearing to bolster denial, Court of Appeals declares denial is based on the post-denial IME report.
On April 17, 2024, the Oregon Court of Appeals issued a ruling in Teitelman v. SAIF that a Worker Requested Medical Examination (WRME) can be based on a post-denial IME that was submitted into evidence by the insurer to bolster a denial. WRMEs are governed by ORS 656.325(1)(e) and OAR…
In Oregon, Delay In Seeking Clarification From Attending Physician Regarding an IME, PCE, and Regular Work Release Can Result in Unreasonable Refusal to Close.
The Oregon Workers’ Compensation Board is holding carriers to a high standard when it comes to securing the evidence needed to rate impairment and work disability. The expectation is the carrier will arrange the closing examination, physical capacity evaluation and then ensure the attending physician provides a clear and unconditional…
Surgery in Oregon? Here’s What to Know
The Oregon Workers’ Compensation Division recently added some new deadlines to be aware of when dealing with surgery requests in the MCO context. You can read more about the changes here. But, dealing with a surgery request can still be complicated with a lot of short deadlines, so here is…
OREGON: “Exclusive Remedy” win for employers/administrators/insurers at Oregon Court of Appeals
On April 10, 2024, the Oregon Court of Appeals issued a ruling reiterating the importance of the exclusive remedy clause under ORS 656.018. The case, Pierce v. Best Western Int., was litigated by Rebecca Watkins of SBH Legal. ORS 656.018 is the “exclusive remedy” clause for workers’ compensation claims in…
Oregon Board finds “going and coming” rule does not apply to worker crossing street to retrieve work clothes from her vehicle
A recent Oregon Workers’ Compensation Board case, In re Cambria Souza, 76 Van Natta 130 (2024), found a workers’ injury compensable where they were hurt crossing a public street to retrieve work clothing from their car. Cambria involved an Oregon restaurant server who parker her car in a public lot…
Navigating the Pitfalls of Oregon Workers’ Compensation. The Ins and Outs of Injury under a Combined Condition.
We are all familiar with the idea of a “compensable injury” in Oregon workers’ compensation law. A compensable injury is any injury sustained while performing work-related duties that results in a disability or the requirement for medical attention. However, this broad concept of an injury may be somewhat limited when…
New Rules Impacting MCO Enrolled Claims in Oregon – Effective April 1, 2024 and October 1, 2024
The Department of Consumer and Business Services Workers’ Compensation Division amended several provisions of the OAR that will directly impact MCO enrolled claims in Oregon. The net effect of the amended OAR is essentially more claim processing, and in the worst-case scenario, potential exposure for increased claim costs, litigation costs,…
Ordered to accept a new/omitted condition in Oregon? Combined condition processing remains a responsive option
On January 9, 2024, the Workers’ Compensation Board ruled in Maria F. Opferman, 76 Van Natta 10 (2024), that the employer’s post-litigation acceptance of a concussion combined with a preexisting condition was valid. Through prior litigation, an administrative law judge (ALJ) ordered the employer to accept a concussion. In lieu…
