WA Changes to Claim Administration to Tighten Deadlines
In Washington, the workers’ compensation system is designed to provide prompt medical treatment to affected workers so that the worker can return to work as promptly as possible. As a result, while the employer has the right to investigate claims prior to accepting a claim, the employer is held to…
Accuracy in job descriptions is critical to a successful claim closure in Oregon
In a recent Board decision, the Order on Reconsideration and Opinion & Order denying a penalty was set aside for failure to provide an accurate job description. Dawn Price 77 Van Natta 203 (2025). On review claimant contested the accuracy of the job description’s physical requirements for job at injury…
Oregon Workers’ Compensation: What Happens if Claimant Passes Away?
In Oregon, when a claimant passes away that may not mean immediate claim resolution. Sometimes additional work up of the claim may be necessary before the claim can close. When a claimant dies the date of death is substituted for the medically stationary date, if claimant’s attending physician has not…
Oregon Reminder – Update that IME Appointment Language!
Did the claimant not show up for an Independent Medical Examination (“IME”) appointment despite you sending a timely appointment notice? This can be a really frustrating scenario during the claim, especially if you are relying on the IME to guide a claims processing decision. Before insurers and claim administrators explore…
In Oregon, Medical Dispute Denials Are Now a Valid Basis for a WRME Request
In Cheri L. Goss, 77 Van Natta 159 (2025), the Oregon Workers’ Compensation Board reversed an Administrative Law Judge’s (ALJ) decision to uphold the Workers’ Compensation Division’s denial of a worker requested medical examination (WRME). The worker sought review of an ALJ’s Order. On review, the Board considered whether a…
Shhh… or You’ll Waive It: Confidentiality Pitfalls in Oregon Workplace Investigations
When an internal investigation kicks off in an Oregon workplace, confidentiality becomes the name of the game—but too often, no one knows the actual rules. Employers and attorneys alike make the mistake of thinking confidentiality is automatic or absolute. In reality, the Oregon Rules of Professional Conduct (ORPC) require intentional action…
Oregon Time Loss Refresher
In Oregon, time-loss benefits, also known as temporary disability or lost wages, are paid to workers who are unable to work due to a work-related injury or illness. These benefits compensate for lost income while the worker is under a doctor’s care and authorized to remain off work or modified duty….
WA BIIA 2024 Significant Decisions
Every year the Washington Board of Industrial Insurance Appeals designates several notable decisions each year as significant. A significant decision is one which the Board considers to have an analysis or decision of substantial importance to the Board. For 2024, the Board designated the following decision as significant: In re…
Oregon Court of Appeals Gives Clarity to Complicated Pre-Existing Condition Cases
In an opinion issued on April 2, 2025, the Oregon Court of Appeals clarified the causation standard that applies when a new/omitted medical condition claim involves a standalone pre-existing condition that is exacerbated by a work injury. In Barnes v. Cache Electric, 339 Or App 371 (2025), the Court of…
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…
