Changes coming to retroactive temporary disability authorizations in Oregon
In our prior blog post, here, we discussed the changes coming under House Bill 4138, as it relates to claim closure and overpayment issues. We turn now to the changes to temporary disability issues. These changes go into effect on January 1, 2024.
The first amendment permits the attending physician or authorized nurse practitioner to retroactively authorize payment of temporary disability up to 45 days prior to issuance. ORS 656.262(g)(A). This is a significantly greater length of time than the previous 14 day retroactive authorization period and is intended to address delays in communication between the treating providers, insurers, and claimants.
However, there are three conditions when, if met, the foregoing does not apply. If (1) a denial has been issued or, (2) there is a dispute over the identity of, or treatment by, an attending physician or nurse practitioner or, (3) when notice requirements discussed below have not been given. Here, the retroactive period is unrestricted if a claimant is ultimately successful in challenging the above circumstances. For example, a claimant who overcomes a denial is permitted to seek temporary disability benefits retroactively without limit to the period of valid authorization.
Next, the amendments also prevent the insurer or self-insured employer from ending temporary benefits until written notice has been provided to the worker and their attorney, if represented, and also permits the authorization of benefits 45 days retroactively. ORS 656.262(j).
As noted previously, insurers will have an obligation to issue a notice to the worker and their attorney, that their temporary disability benefits will soon end. The notice is likely appropriate with each temporary disability check, to remind the worker of their obligations to seek treatment every 30 days, unless otherwise authorized by the attending physician. In addition, the worker has more time to contact their attending physician and obtain re-authorization if warranted.
There may be circumstances where these amendments present difficulties in managing administrative claim closures and/or increased risk of processing improprieties. If you need assistance determining your processing obligations or have any questions about these changes, please feel free to contact me at or 503-867-2723.
Posted by Erling Hanna.