You may have noticed, the Oregon Workers’ Compensation Division has revised the standard Form-801 “Report of Job Injury or Illness.” This form is the normal starting place for many claims and used throughout the claims administration process.
The new revisions include acknowledgements by both the worker and employer regarding the worker’s right to select their medical provider. Specifically, by signing the 801:
The worker is agreeing “I understand I have a right to see a health care provider of my choice subject to certain restrictions under ORS 656.260 and ORS 656.325.”
The employer is agreeing “I understand I may not restrict the worker’s choice of or access to a health care provider. If I do, it could result in civil penalties under ORS 656.260.”
The changes to the form are intended to address concerns that employers are directing the medical care of their employees. Violations of directing a worker’s care can result in sanctions up to $2,000 for each violation. ORS 656.260(21)(a).
ORS 656.245(2)(a) provides that the worker may choose the attending physician and the worker can subsequently change physicians twice without approval by the WCD. ORS 656.260(21)(a)(A) provides that only a certified managed organization (MCO) can restrict the choice of a health care provider or medical service provider by a worker. An insurer or someone acting on behalf of the insurer cannot manage the care of non-MCO enrolled workers by limiting the choice of providers or by requiring medical providers to abide by specific treatment standards, guidelines, or protocols. OAR 436-015-0007.
What does this mean?
Employers are still required to provide the 801 form upon request by a worker, or upon notice/knowledge of an accident or illness that may be compensable;
Employers and insurers are encouraged to start using the new form immediately, but the WCD is allowing parties until April 1, 2017 to update their reporting systems;
Employers should review their incident report procedures to make sure internal policies do not restrict the worker’s ability to choose a medical provider or wait for approval before seeking necessary treatment;
Employers should train managers, supervisors, team leads, and employees regarding the worker’s ability to choose the medical provider;
If there is a company policy to provide transportation for an injured worker, that policy as well as the person providing the transportation should make clear the worker has the right to choose their provider.
There may still be limited reasons where a specific medical facility or provider is needed. The closest provider might be needed in emergency or urgent situations. Specialty providers might be needed for unique injuries or occupational diseases. Take caution to explain the worker retains the right to choose their own provider.