New Claim Closure and Overpayment Rules in Oregon Starting January 1, 2024
As we have touched on before, there will be some major changes next year to how we process claims, particularly when it comes to claim closure and overpayment issues. These changes have already been made, but will not apply to claims until January 1, 2024.
First, when determining claimant’s medically stationary status, the attending physician is prevented from using a medically stationary date more than 60 days before the determination. ORS 656.268(1)(a). Additionally, if the attending physician determines claimant was medically stationary more than 60 days prior, the workers’ medically stationary date will be the 60th day prior to the medically stationary determination. OAR 436-030-0035(9).
Second, once a worker is medically stationary, the insurer/self-insured employer must mail or deliver written notice to the worker (and worker’s attorney) within 7 days following the receipt of information confirming medically stationary status. ORS 656.268(1)(a); OAR 436-030-0015(14). The purpose of the change is to put the worker on notice claim closure will be coming and ongoing temporary disability payments may be subject to overpayments.
Third, upon closure the insurer/self-insured employer can only recover up to 50% of any overpayment against the PPD awarded at closure. ORS 656.268(16)(a); OAR 436-060-0170(1). The remaining overpayment remains in effect and can be asserted against future benefits on the claim. The change also does not affect the priority of other liens against closure benefits. ORS 656.234(3)(d). For example, if there is a child support order, up to half of the PPD proceeds will go to paying the child support arrears and then up to half of the remaining PPD can go to the overpayment.
Fourth, insurers/self-insured employers may not declare an overpayment of any compensation paid more than two years prior to the date of declaration. ORS 656.268(16)(b). This change was intended for our ability to assert an overpayment matches claimant’s two-year limitation on requesting a hearing on claim processing issues. While some of the specifics for each case are unclear, we recommend running audits as appropriate on your claims now and after the new change goes into effect, running regular audits.
HB 4138 also includes some changes to temporary disability issues, which we will address in later blogs. However, if you have any questions about these changes, please feel free to contact me at or 503-595-2130.
Posted by Kevin Anderson.
