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 the goal of compensating workers’ attorneys for their work on complex claims; to encourage settlement; and to attract and retain high quality attorneys for injured workers. This change is effective September 3, 2024, and applies to any CDA or DCS filed with the Board on or after September 3, 2024. Please feel free to contact SBH with your settlement questions.
Oregon changes mandatory denial language
OAR 438-005-0055 details the appeal rights language to be included when issuing a denial of a workers’ compensation claim. The Board has adopted amendments to the mandatory denial language with the goal of simplifying and increasing readability of the denial language. The amendment is effective November 1, 2024 and applies to all denials issued on or after November 1, 2024. Below is the new mandatory denial language. Please contact SBH with your claim processing and closing questions and we would be happy to assist you.
OAR 438-005-0055 Notice of Claim Denial and Hearing Rights
(1) Except for a denial issued under ORS 656.262(15), in addition to the requirements of 656.262 and OAR 436-001-0060 (Bulletin No. 379), the notice of denial shall specify the factual and legal reasons for denial; and shall contain a notice, in prominent or bold-face type, as follows:
IF YOU DISAGREE with this DENIAL, you must file an APPEAL WITHIN 60 DAYS after the mailing date of the DENIAL by doing one of the following:
(1) MAILING a letter to the Workers’ Compensation Board, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280;
(3) Sending a FAX to: 503-373-1600; or
(4) PHYSICAL DELIVERY of a letter to a Workers’ Compensation Board Office in Salem, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280, or Portland, 16760 SW Upper Boones Ferry Road, Suite 220, Portland, OR 97224-7696.
Your letter, email, or fax, should include: (1) you want a hearing; (2) your address; (3) the date of the denial; (4) the claim number; and (5) the date of your injury or exposure, if you know the date. If the Workers’ Compensation Board receives your appeal more than 60 days after the mailing date of this denial, you may have to prove you filed the appeal within 60 days.
IF YOU DO NOT APPEAL WITHIN 60 DAYS of the mailing date of this denial, YOU WILL LOSE ANY RIGHT you may have to compensation. The only exception is if you can show good cause for delay beyond the 60 days. After 180 days, all of your rights will be lost.
By law, your appeal cannot affect your employment.
You may request an examination by a physician selected by the Workers’ Compensation Division at no cost to you if: (1) you timely request a hearing on a denial of compensability; (2) the denial is based on one or more medical reports of insurer or self-insured employer requested medical examinations; and (3) your attending physician does not agree with or did not comment on the report(s).
You may be REPRESENTED BY AN ATTORNEY of your choice at NO COST TO YOU for attorney fees.
If you have questions you may contact:
(1) The Ombuds Office for Oregon Workers toll free at 1-800-927-1271, https://www.oregon.gov/dcbs/OOW.
(2) The Workers’ Compensation Board toll free at 877-311-8061, https://www.oregon.gov/wcb.
(3) The Workers’ Compensation Division toll free at 1-800-452-0288, https://wcd.oregon.gov.
(2) If an insurer or self-insured employer intends to deny a claim under ORS 656.262(15) because of a worker’s failure to cooperate in the investigation of the claim, in addition to the requirements of ORS 656.262, the notice of denial shall specify the factual and legal reasons for denial, and shall contain a notice, in prominent or bold-face type, as follows:
IF YOU DISAGREE with this DENIAL, you must file an APPEAL WITHIN 60 DAYS after the mailing date of the DENIAL by doing one of the following:
(1) MAILING a letter to the Workers’ Compensation Board, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280;
(3) Sending a FAX to: 503-373-1600; or
(4) PHYSICAL DELIVERY of a letter to a Workers’ Compensation Board Office in Salem, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280, or Portland, 16760 SW Upper Boones Ferry Road, Suite 220, Portland, OR 97224-7696.
Your letter, email, or fax should include: (1) that you want an EXPEDITED hearing; (2) your address; (3) the date of the denial; (4) the claim number; and (5) the date of your injury or exposure, if you know the date.
If the Workers’ Compensation Board receives your appeal more than 60 days after the mailing date of this denial, you may have to prove you filed the appeal within 60 days.
IF YOU DO NOT APPEAL WITHIN 60 DAYS of the mailing date of this denial, YOU WILL LOSE ANY RIGHT you may have to compensation. The only exception is if you can show good cause for delay beyond the 60 days. After 180 days, all of your rights will be lost.
You will receive an EXPEDITED hearing within 30 days.
By law, your appeal cannot affect your employment.
You may be REPRESENTED BY AN ATTORNEY of your choice at NO COST TO YOU for attorney fees.
If you have questions you may contact:
(1) The Ombuds Office for Oregon Workers toll free at 1-800-927-1271, https://www.oregon.gov/dcbs/OOW.
(2) The Workers’ Compensation Board toll free at 877-311-8061, https://www.oregon.gov/wcb.
(3) The Workers’ Compensation Division toll free at 1-800-452-0288, https://wcd.oregon.gov.
If you have any questions about these changes, please contact me at or 503-412-3101.
Posted by Anna McFaul.
