Category: Oregon Workers Compensation
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…
Oregon Injured Worker Not Cooperating? There’s a Denial for that.
Insurers or self-insured employers are required to conduct a reasonable investigation based on all available information” in order to decide whether to accept or deny a claim. See OAR 436-060-0140(1). Additionally, workers also have an obligation to cooperate with and assist the insurer’s or self-insured employer’s investigation into their claim….
Reminder – Significant changes to Oregon claim closure requirements and temporary disability notices
The start of the year brought several updates to the administrative rules governing claim closure, reconsideration, claim administration, and vocational assistance to injured workers. Carriers should be mindful of the changes discussed below as they have been in effect as of January 1, 2024. Changes to the rules governing Claim…
Extinguishing the Firefighter Presumption in Oregon Workers’ Compensation
The introduction of H.B. 2915 to the Oregon Legislature, signed into law in the same year, expanded workers’ compensation protection to Portland firefighters who had previously been exempted under Oregon law due to the city’s independent disability and retirement system. This inclusion further gave rise to the need to understand…
Oregon WCD Proposing New Medical Treatment and Billing Rules
The Oregon Workers’ Compensation Division had a public comment meeting in November 2023 to discuss issues related to the medical fee schedule, medical services, and MCO. The agenda and minutes are included here. From that meeting, the WCD is moving forward with proposed rules. The full proposal is here, but…
Ensuring Temporary Disability Benefits Issue Timely in Oregon
Whether an insurer timely paid temporary disability benefits in Oregon is one of the most heavily litigated issues in workers’ compensation. Late-payments create exposure for a penalty up to 25 percent of the late-paid amount, as well as an assessed attorney fee. Ensuring temporary disability benefits issue timely can save…
Flare-Ups, Aggravation, and Combined Conditions: When is Arthritis Compensable in Oregon workers’ compensation?
If a worker with longstanding cervical arthritis injures her neck while lifting a box at work, can the arthritis itself be a compensable condition under her workers’ compensation claim? In Oregon workers’ compensation law, arthritis is specifically listed as a pre-existing condition. Pre-existing conditions can be compensable only under certain…
Oregon Administrative Claim Closure Requires Strict Compliance with the Rule
Administrative closure can be a useful tool for processing an Oregon Workers’ Compensation claim to closure where a worker is inconsistent or non-compliant with treatment requirements. In some circumstances, the law requires the use of administrative claim closure, and failure to close the claim accordingly can create a penalty issue…
Beware of Fees on Fees in Oregon Workers’ Compensation Cases
In the case of Taylor v. SAIF, 329 Or App 135 (2023) (Taylor II), the Court of Appeals overturned the decision of the Workers’ Compensation Board, which had initially ruled that the claimant’s attorney should not receive a reasonable fee for time spent exclusively contesting the Board’s attorney fee award….
Can a denial in Oregon based on an independent record review trigger entitlement to WRME?
Recently, the Oregon Workers’ Compensation Board confirmed that entitlement to a worker requested medical examination (WRME) is only triggered when the employer’s denial is based on an in-person IME with which an attending physician has not concurred. Michelle L. Knowlden, 75 Van Natta 505 (2023). In Knowlden, the claimant was…
Reminder – Oregon Legislative Changes Starting January 1, 2024
As we approach the end of the year, it is important to remember that there are some big changes coming to Oregon workers’ compensation claim processing and employment issues. Here are some of the larger changes, which have been passed by the legislature, but do not take effect until January…
