Combined Condition Compensability Ping Pong in Oregon
Combined condition processing can present a complicated challenge for employers and insurers. Once compensability has been challenged at the hearing level, and on review, employers and workers must engage in a game of burden shifting ping pong to establish or rebut compensability. Fortunately, the Board recently issued an opinion in…
Timeliness in Washington: Friend or Foe? Washington Courts say “Friend” . . . if you preserve your right
Employers are wise to keep track of deadlines—both their own and those of injured workers. In Washington workers’ compensation cases where a worker does not file a claim in the allotted time, the employer may avoid liability. For injury claims, workers must file their claims within one year of the…
Oregon Assessed Attorney Fees – The Vicious Circle
The Oregon’s Workers Compensation Board (“WCB”) recently issued an Order on Remand, awarding $68,300 for services litigating reasonableness of an initial attorney fee award. Karista D. Peabody v. SAIF, 77 Van Natta 67, 72 (2025). This ruling aligned with the remand from the Court of Appeals. Peabody v. SAIF Corp.,…
Washington Hearing Loss Claims – Refresh Your Knowledge!
In Washington, hearing loss claims timeframes for filing are governed under RCW 51.28.055. If there is reported hearing loss resulting from a sudden single event, this is considered conductive hearing loss, which is distinguished from an occupational disease claim. For an injury of this nature and to be considered timely,…
Oregon Vocational Assistance – Authorization to Work in the US is No Longer a Requirement for Eligibility
An injured worker must meet certain conditions to be eligible for vocational assistance, typically the costliest aspect of a workers’ compensation claim. OAR 436-120-0145(2) lays out the specific requirements for a worker to be eligible for vocational retraining. In reviewing that rule you may notice a significant change to the…
Oregon WCB Confirms, No Compensable Claim: No Rule Violation, No Unreasonable Delay
In a recent legal decision, Rosita E. Peery, 77 Van Natta 15 (January 10, 2025), the Oregon Workers’ Compensation Board affirmed an Administrative Law Judge’s (ALJ) ruling, upholding the denial of a worker’s injury and occupational disease claim for a right shoulder condition. The case also addressed whether the worker…
Oregon WCB Confirms Initial Notice of Acceptance Does Not Set a “Theory of the Case”
What is the difference between an injury, a claim, and an accepted condition? The answer, frustratingly, is “it depends.” But the Oregon Workers’ Compensation Board recently issued a decision which at least provides some clarity as to whether one condition accepted in a claim dictates the types of other conditions…
In Washington, Can a Worker Successfully Pursue an Occupational Disease Condition under an Open Industrial Injury Claim?
When a claim has been accepted, and compensation has been paid, the self-insurer is required to send the Department the SIF-2, the claim allowance request form, the SIF-5, and an explanation and documentation used to determine the date of manifestation for occupational disease claims. At that point, the Department will…
New Medical Services Rules Proposed by the OR WCD
On February 19, 2025, the WCD is holding a hearing to propose amendments to several medical services rules in OAR 436-009, 436-010, and 436-015. Many of the amendments are to address billing code issues and remove outdated notice language. However, there are several notable proposals: OAR 436-009-0010 would be amended…
Washington Department of Labor & Industries Listening Sessions Signal Changes to Claim Process
On January 7 and 23, 2025 the Department held two listening sessions open to attendance by members of the self-insured community regarding The Claims Process Project. These listening sessions were aimed at increasing efficiency and consistency of adjudication and improving accuracy, timeliness, and quality of claim management by all parties…
Oregon OSHA – Increased Penalties for 2025
In 2023, with the passage of Senate Bill 592, the Oregon Legislature dramatically augmented the range of civil penalties on employers who violate Oregon Safe Employment laws. Previously, Oregon law imposed only the minimum civil penalties prescribed under the federal OSHA. Over the past two years, the penalties have continued to…
Washington L&I Self-Insurance Reminders About Employer Claim Closures
Happy 2025 from SBH Legal! Let’s start the year off with a refresh on self-insured employer closures in Washington. Self-insured employers have the authority to close claims if: (1) there have been no Department Orders resolving a dispute, (2) the claimant has returned to work for the same employer or…
Washington’s Department of Labor & Industries Announces Mystery Listening Sessions
Listening sessions scheduled by the Department of Labor & Industries are nothing new. It is common practice for the Department to ask for feedback from those directly or indirectly impacted by its rulemaking process and procedures. A recent notable series of listening sessions occurred when the Department was developing, drafting,…
Oregon Workers’ Compensation End of Year Wrap Up: Let’s End on a High Note!
We welcomed 2024 with a slew of changes to the Oregon Revised Statutes and Oregon Administrative rules on Workers’ Compensation that impact and change how we process claims. As the year evolved, additional requirements came into effect. We at SBH Legal want all of our clients to be successful in…
Navigating claim compensability for injuries outside the State of Washington
Under the Industrial Insurance Act, workers for Washington employers are entitled to benefits for injuries sustained in the course of employment. Under Washington’s extraterritorial statute, this remains true even if the injury occurs outside the territorial limits of the state. Washington courts have recently placed limitations on the extraterritorial statute….
Important Changes to Oregon IME Appointment Notices in Effect as of October 1, 2024
Have you updated the bold language and formatting in your Oregon IME appointment notice template? In case you missed it, the Oregon Workers’ Compensation Division updated the language and formatting that must be used when issuing an IME appointment notice to an injured worker. These changes went into effect on…
Washington L&I Expands Coverage for Acupuncture Treatment
The Washington Department of Labor & Industries recently adopted a new policy approving acupuncture as a covered treatment for chronic migraine when accepted under a workers compensation claim. Previously, acupuncture was a covered benefit only for treatment of accepted lumbar conditions. The Department adopted its lumbar coverage policy for acupuncture…
New denial appeal and hearing rights language requirements in Oregon Workers’ Compensation
As a reminder, the Oregon Workers’ Compensation Board recently revised Oregon Administrative Rule (OAR) 438-005-0055 to reflect changes to the required denial and hearing rights language that must issue with any denial. As always, all notices of denial must specify the factual and legal reasons for the denial and, effective…
What constitutes a valid light duty job offer in Washington?
If an injured worker is not able to perform their job of injury, but is able to perform some type of work, offering a light duty job is often a good option. For a light duty job offer to be “valid” pursuant to RCW 51.32.090(b): A job description or job…
Stress of Navigating Oregon Workers’ Compensation: Possible Ground for Mental Health Condition?
Filing an Oregon Workers’ Compensation claim includes a range of administrative processes, from injury reports to claim closure, encompassing medical treatment, independent medical evaluations, entitlement issues, and several other factors critical to successfully processing a claim. Can this process alone be a valid basis for a compensable mental health condition,…
Oregon Workers’ Compensation Division Reviewing Medical Service and Billing Rules Nov. 5th
The WCD is hosting an advisory committee meeting on November 5, 2024. You can find the agenda here including information about how to participate in the meeting. The WCD regularly reviews these rules to make sure medical service billings are appropriately updated, but there are several topics being discussed including:…
Bridging Borders: Oregon’s Workers’ Compensation Reciprocity Explained
Out-of-State Employers When an out-of-state employee travels to Oregon for work and sustains an injury, it may result in an Oregon workers’ compensation claim, depending on key factors. Pursuant to ORS 656.126(2) any out-of-state worker is exempted from the provisions of this chapter while that worker is temporarily within the…
In Washington, willful or not, misrepresentation puts you on the spot
Everyone can agree, when you take something that you are not entitled to, there are consequences that follow. In Washington worker’s compensation claims it is no different. The Washington Administrative Code speaks to when an injured worker willfully, intentionally, and/or deliberately takes or accepts benefits that they are not entitled…
Oregon Workers’ Compensation Board issues decision expanding right to WRME
On September 16, 2024, a WCB Order on Review, Jon C. Landry, 76 Van Natta 462 (2024), expanded on the Court of Appeals ruling in Teitelman v. SAIF to identify what qualifies as a “post-denial IME report” and when an attending physician does concur with the IME report which denial…
The Oregonian Names SBH Legal A Winner Of The Oregon And Southwestern Washington Top Workplaces, Second Year In A Row!
SBH Legal has been awarded a Top Workplaces 2024 honor by The Oregonian for the second consecutive year. Check out the full list: The Oregonian. This award is based solely on employee feedback gathered through a third-party survey. The confidential survey uniquely measures 15 culture drivers that are critical to the…
