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…
Oregon WCB clarifies carrier’s obligation to accept or deny encompassed conditions
A WCB Order on Review, Collin Stringer, 76 Van Natta 462 (2024), distinguished conditions encompassed within previously accepted conditions are not new or omitted conditions. The Board affirmed and supplemented ALJ Naugle’s order to confirm encompassed conditions may be denied where the accepted conditions adequately informed claimant and medical providers…
To Confer or Not to Confer? Understanding Conferral Requirements in Oregon and Washington
Both Oregon and Washington courts emphasize the need for attorneys to confer before filing certain motions, but their specific requirements differ. This post highlights the key distinctions between the Washington State Court Rules and Oregon’s Uniform Trial Court Rules. Oregon: UTCR 5.010 and UTCR 5.100 In Oregon, conferral requirements are…
Oregon Workers’ Compensation Rules change attorney fee caps in settlement and changes to mandatory denial language.
Previously, OAR 438-015-0050(1) and OAR 438-015-0052(1) allowed a workers’ attorney to receive up to 25% of the first $50,000 of DCS and CDA proceeds and only 10% of any additional settlement funds. The Board recently amended these rules to remove the 10% attorney fee limit. The alterations were made with…
Washington Proposed Rule-Making for Third Party Recording: Additional Red Tape in an Already Onerous System?
Since the implementation of new rules allowing claimants to record examinations requested by the Department or Self-Insurer in 2023 employers have encountered increased difficulty in obtaining an independent medical examination (IMEs). Many providers expressed concerns about the unpredictable nature of claimants’ use of the recordings, and are not assuaged by…
Federal Judge Strikes Down FTC’s Ban on Worker Noncompete Agreements: What It Means for Employers
In January 2023, the Federal Trade Commission (FTC) proposed a sweeping federal ban on noncompete agreements in nearly all employment contracts—a move poised to significantly reshape the American labor landscape. Here’s what you need to know about the proposed ban, the recent federal decision, and its implications. Understanding Noncompete Agreements…
Oregon Workers’ Compensation: Does it make sense for an insurer to appeal its own Notice of Closure?
In Oregon, the attending physician plays a crucial role throughout the duration of a workers’ compensation claim. For better or worse, the importance of the attending physician is especially evident when it comes to claim closure. Unless the worker is actively engaged in an authorized training plan, the insurer must…
What type of medical services are compensable after a worker is medically stationary in Oregon?
A common question which arises in Oregon workers’ compensation claims process is what type of medical services will continue to be compensable once a worker has reached a medically stationary status. The Workers’ Compensation Division recently providing some clarification when an insurer will be held liable to compensate a proposed…
Washington Court of Appeals: New Insight on Notice and the Authority of DLI Policies
In the State of Washington, employers are required to give notice of a mandatory IME at least 14 to 60 days prior to the examination, and must provide the worker with the date, time, and location of the exam. But is the worker free to miss the exam without penalty…
Oregon Workers Compensation: Is the deposition of a medical arbiter a thing?
An impartial medical examination is typically scheduled as part of reconsideration proceedings when there is a disagreement about the impairment findings used to close a claim. This examination is known as a medical arbiter examination. A physician or a panel of physicians is assigned by the Appellate Review Unit (“ARU”)…
Washington State Approves Spinal Cord Stimulation for Certain Pain Conditions
On June 14, 2024, there was a final adoption of new guidelines for spinal cord stimulation (SCS). Spinal cord stimulation is a treatment for chronic pain involving the insertion of electrodes into the epidural space near the spinal cord that are connected to an internal or external electrical pulse generator….
New Oregon Rule Governing Subsequent Temporary Disability Payments Beginning July 1, 2024
On July 15, 2024, the Oregon Workers’ Compensation Division issued an Industry Notice outlining the rule change for the payment of subsequent temporary disability benefits. The due date for the first payment of temporary disability benefits has not changed. If the attending physician or authorized nurse practitioner has authorized temporary…
Oregon Attorney Fees in Certain Workers’ Compensation Matters Increased as of July 1, 2024
In Oregon Workers’ Compensation, attorney fees for representation of a claimant are controlled by statute. Certain attorney fees associated with penalties for unreasonable claim processing and attorney representation in a responsibility denial have statutory caps. Those statutory caps are adjusted each year based on the increase of the state’s average…
How exclusive is the exclusive remedy in Oregon Workers’ Compensation?
At the core of the Oregon workers’ compensation system is a compromise between workers’ and employers. Employers must provide benefits for work-related injuries even when there was no negligence by the employer which led to the incident. But these work-related injuries cannot serve as the basis of a lawsuit against…
Washington House Bill 1927 Passed to Adjust Time-Loss Eligibility for Injured Workers
Washington State Governor Jay Inslee signed into law House Bill 1927 which makes it easier for injured workers to qualify for workers’ compensation benefits for the first few days following their injury. This change took effect on June 6, 2024 and impacts all claims with dates of injury or manifestation…
Oregon Court of Appeals Upholds Nava Rule
In Nava v. SAIF, 333 Or App 196 (2024), claimant sought judicial review of the Board’s denial of penalty and attorney fees under ORS 656.262(11)(a) for unreasonable delay in payment of compensation. By way of background, claimant was compensably injured in November 2017 and the claim was accepted for left…
Oregon: Processing Proposed Surgical Authorization Requests Is Not Solely Based on Accepted Conditions
In 2019, the Oregon Supreme Court held that medical services materially related to the work injury are compensable under ORS 656.245 and are not limited to only the accepted conditions. Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019). This decision continues to have a significant impact on claim processing…
Washington Legislature Potentially Provides Extended Benefits to Claimants on Reopen Applications
The Washington Industrial Insurance Act allows claimants to reopen their claims following closure when the conditions proximately related to their industrial injury or occupational disease objectively worsen post-closure pursuant to RCW 51.28.040. To complete a reopening application, the claimant must submit an application completed both by the claimant and by…
OREGON: When post-denial IME reports are submitted as evidence at hearing to bolster denial, Court of Appeals declares denial is based on the post-denial IME report.
On April 17, 2024, the Oregon Court of Appeals issued a ruling in Teitelman v. SAIF that a Worker Requested Medical Examination (WRME) can be based on a post-denial IME that was submitted into evidence by the insurer to bolster a denial. WRMEs are governed by ORS 656.325(1)(e) and OAR…
Normally Reasonable: Transferring Attending Providers in Washington Workers’ Compensation Claim
Claimant’s attending physician plays an important role in assisting claimant’s return to their job of injury. Their attentiveness and skill as a provider often dictate how efficiently a claim is processed. Many claims have one attending provider for the duration, however, there are some instances where claimant seeks treatment from…
In Oregon, Delay In Seeking Clarification From Attending Physician Regarding an IME, PCE, and Regular Work Release Can Result in Unreasonable Refusal to Close.
The Oregon Workers’ Compensation Board is holding carriers to a high standard when it comes to securing the evidence needed to rate impairment and work disability. The expectation is the carrier will arrange the closing examination, physical capacity evaluation and then ensure the attending physician provides a clear and unconditional…
