In the midst of COVID-19 pandemic, Oregon Court of Appeals issues troubling ruling for processing new/omitted condition claims

The Oregon Court of Appeals issued its decision in Coleman v. SAIF, 304 Or App 122 (2020) on May 13, 2020. Claimant filed a claim for a left knee injury on June 12, 2015. On June 29, 2015, claimant and his attending physician submitted an 827 form for a new/omitted condition claim for medial femoral chondral defect in the left knee. The carrier issued an initial notice of acceptance on August 11, 2015, accepting a left knee strain and contusion; there was no reference to the June 29, 2015 827 form. In a chart note dated October 15, 2015, claimant’s attending physician referenced the June 2015 827 form and indicated it needed to be addressed by the carrier. The carrier… Continue reading

Course of Employment in Washington: What Factors are Considered When an Employee is Injured While Working from Home?

As the State of Washington slowly implements its four-phase recovery plan, many employees continue to work remotely from home in various capacities due to the social distancing requirements brought on by COVID-19. As employees continue to work from home, many employers are faced with new claims involving injuries sustained away from the employer’s premises. These unique claims can make it difficult for employers and third-party administrators to assess what constitutes a compensable injury or occupational disease. In Washington, workers acting in the “course of employment” are covered by the Industrial Insurance Act. Generally speaking, acting in the course of employment means the employee is acting at his or her employer’s direction or furthering the employer’s business. This is broad definition… Continue reading

Oregon Employee Injured While Working from Home? Best Practices to Determine Compensability

With the onset of COVID-19 and statewide stay-at-home orders, a high percentage of today’s workforce is operating from home, or in some variation of remote setup. Even as employees begin to return to a more traditional work setting, it is reasonable to anticipate that the pandemic-related response will have long-term effects on where and how some employers allow their employees to work. So, with the rise in remote workers will likely come a rise in remote workplace injuries. How do you respond? In Oregon the general rule is injuries occurring “in the course of” and “arising out of” employment are compensable. That remains the case for injuries occurring remotely, if the worker is within the course and scope of his… Continue reading

Oregon Health Authority Releases Reopening Guidance for Oregon Employers

On May 7, 2020, the Oregon Health Authority (OHA) released a series of sector-specific guidance as well as general guidance to assist employers in making decisions regarding reopening during the COVID-19 pandemic. Sector-specific guidance is available for Outdoor Recreation Organizations, Personal Services Providers, Retail Stores, Shopping Centers and Malls and Restaurants and Bars. “Phase One” of Governor Brown’s Oregon reopening plan may start as early as May 15 for approved counties with few or no COVID-19 cases. In anticipation of reopening, employers are encouraged to review the guidance and begin making plans consistent with these recommendations. Employers should also refer to the guidance issued by the Centers for Disease Control and Prevention (CDC) when determining the most appropriate actions to… Continue reading

Adjusting to the New Normal – Washington Claims Processing and COVID-19

As the impact of COVID-19 continues to reverberate through Washington, it has created numerous challenges for employers and claims managers who are working hard to process claims properly and as efficiently as possible. Within this ever-evolving situation in mind, this post discusses some of the common issues that have arisen to date and offers suggestions for how to navigate claims processing. Treatment Plans and Time Loss Certification With treating providers cancelling or postponing many non-emergency appointments, it has made it challenging for workers to submit proper time loss certification in a timely manner. To address this issue, Department’s Guidelines suggest workers schedule appointments via video or telephone to document ongoing eligibility for treatment and/or time loss benefits. For claims managers,… Continue reading

L&I Offers Some Guidance on Active Retraining Plans through Office Careers as Moratorium On New Plans Remains in Place

In early March, the Washington Department of Labor of Industries announced a moratorium on approval of new vocational plans that include retraining by Office Careers. The move by L&I followed a three-part investigative series aired by King 5 which was highly critical of the Renton-based school, contending it did not provide adequate training to injured workers to prepare them to re-enter the workforce. The King 5 series spurred an investigation by the Washington Workforce Board, but even before the series aired, L&I had started its own audit of Office Careers. As an unaccredited school approved by L&I to offer vocational retraining, Office Careers has been a frequent target of plaintiff’s attorneys. However, its basic office skills classes, in areas such… Continue reading

Reductions in Hours, Furloughs, and Layoffs During COVID-19

A lot of employers are having hard conversations right now. A part of those conversations inevitably includes employment decisions. Many companies are trying to decide what is best both for their employees and their companies during this uncertain time. The three big options we’ve seen from our clients is a potential reduction in hours due to decreased demand, furloughs, and layoffs. This post will address areas employers should consider when determining the best option for the business and its employees. Employment Agreements Employment agreements are not widely used. However, employers should review any employment agreements entered into with employees to ensure it is not violating any terms of the agreements. Agreement may include notice provisions where employers are required to… Continue reading

Oregon Workers’ Compensation Rule Updates During COVID-19 Crisis

Needless to say, there have been a lot of changes recently, not just in our daily lives, but also in claim processing issues. The WCD has begun discussions to address a variety of issues that have arisen with Workers’ Compensation claims in light of COVID-19. Further, the WCD and WCB have continued forward with new rules. As SBH’s legislative liaison I have included some of the highlights below to help continue to process claims in a timely and proper manner during COVID-19. COVID-19 Potential Proposals I among others are working on identifying potential proposals to address many new issues arising from COVID-19 including: • Effect on claim processing deadlines due to lack of available IME and medical arbiter examiners. •… Continue reading

You still have time to register for SBH’s 2020 Washington Workshop!

It’s not too late to register for SBH’s 10th Annual Washington Workshop–Welcome to the Jungle! This year’s workshop is a live webinar hosted by SBH’s Washington Attorneys and special Guest Speakers, Jan Moss, RN, and Teresa Pacelli, USI Insurance. The webinar starts promptly at 8:30 am this Friday, April 10, 2020. The workshop is approved for 7.0 Washington claims management credits. The workshop is sure to be fun and informative, with topics such as: Blazing a New Trail: How to Handle Claims in a Post Maphet World Appellate Update Washington Workers’ Compensation Jeopardy Tips & Tricks to Closing a Claim Concussions – Discussed with “2020” Clarity How “Reserves” Affect Your Company, Your Claim, The Broker & Our Mutual Client… Continue reading

Washington: COVID 19 and Voluntary Termination/Unemployment Benefits

Workers’ Compensation Is time loss due if a worker performing modified duty takes a voluntary layoff in the context of COVID-19? According to RCW 51.32.090(4), if a worker is performing modified duty and that modified duty “comes to an end”, before his or her recovery is sufficient to permit a return to the job of injury or other available work offered by the employer of injury, time loss should be reinstated. The COVID-19 pandemic has led to many layoffs and company closures. If a worker performing modified duty loses his or her job due to a company shut down or involuntary layoff due to lack of business, the modified duty will have come to an end under RCW 51.32.090(4). Therefore,… Continue reading