Category: Oregon Workers Compensation
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…
The Oregon Legislature has been busy this year!
You have probably heard about House Bill 3471 which changed the way defense counsel and adjusters settle workers’ compensation claims, specifically with regard to employment releases. But the legislature has been working on other changes in the law that specifically affect workers’ compensation. House Bill 3412 is one of those…
Investigations and Compensability Standards
Industrial Injury? Occupational Disease? Combined Condition? Under what theory of compensability should you investigate an initial claim for compensation? All of them! Under Oregon Administrative Rule 436-060-0140, the insurer is obligated to conduct a “reasonable” investigation upon receipt of a worker’s claim for compensation. This may include a recorded statement…
What evidence is necessary to support a ceases denial in Oregon?
ORS 656.262(6)(c) authorizes an administrator to deny an accepted combined condition if the compensable injury ceases to be the major contributing cause of the combined condition. In such situations, the administrator has the burden to show the compensable injury is no longer the major contributing cause of the workers’ disability…
Acute Stomach Pain and the Sheepherder–Oregon Court of Appeals issues decision on course and scope
The Oregon Court of Appeals issued a non-precedential memorandum opinion on an interesting case recently involving a worker who experienced an acute medical condition, a burst appendix, but in a remote geographical area. This decision addresses the fact, regardless of the category of risk, claimant must still establish a causal…
New Law Restricting “No-Rehire Provisions” In Oregon Workers’ Compensation Settlement’s Takes Effect
On July 27, 2023 Oregon Governor Tina Kotek signed HB 3471 into law. The bill places restrictions on when a “no-rehire” provision can be included in a workers’ compensation settlement: HB 3471 restricts “no-rehire provision” HB 3471 prohibits employers from requiring a “no-rehire provision” as a part of workers’ compensation…
Denying an Oregon Claim Based on an IME? Read This!
At this point, you can probably issue a claim denial in your sleep. You know the denial must state the factual and legal reasons for the denial (OAR 436-060-0140(8)(a)) and must contain, in prominent or bold-face type, notice regarding the worker’s rights to an appeal (OAR 438-005-0055). You also know…
Oregon Annual Adjustment to Maximum Attorney Fees Effective July 1, 2023
It’s that time of year again, the Oregon Workers’ Compensation Board published the annual adjustment to attorney fees awarded under ORS 656.262(11)(a); ORS 656.262(14)(a); and ORS 656.308(2)(d). This year–there’s a twist: there was no increase to the maximum attorney fees. Per ORS 656.262(11)(a) and ORS 656.308(2), maximum attorney fees under…
Oregon Legislative Roundup
There was slightly more drama to the 2023 Oregon legislative session than in a typical year, but the session came to a close on June 25, 2023 after the legislature finalized a slate of bills. The workers’ compensation system will be impacted in particular by three new pieces of legislation….
Oregon Court of Appeals Rejects Claimant Argument to Expand Meaning of “Compensable Injury” for Purposes of Assigning Permanent Impairment
On June 7, 2023, the Oregon Court of Appeals issued its Opinion on Gramada v. SAIF, refusing to expand the meaning of the term “compensable injury” for the purposes of assigning permanent impairment. Gramada stems from an appeal of an Order on Reconsideration which affirmed the Notice of Closure on…
