Reminder – Significant changes to Oregon claim closure requirements and temporary disability notices
The start of the year brought several updates to the administrative rules governing claim closure, reconsideration, claim administration, and vocational assistance to injured workers. Carriers should be mindful of the changes discussed below as they have been in effect as of January 1, 2024.
Changes to the rules governing Claim Closure
The new rules governing claims administration and closure require insurers or self-insured employers to deliver a written notice of a worker’s medically stationary status within seven days following the receipt of information the worker is medically stationary. Accordingly, it is recommended to monitor for and act upon letters from physicians regarding medically stationary status to avoid unnecessary delays and litigation related to claim closure. Additionally, this is a good prompt to review the matter to identify whether there is sufficient information to close the claim and if not, start to work with the attending physician to obtain information to rate impairment and close the claim.
Changes to the rules governing Temporary Disability
Carriers are now required to notify workers when their temporary disability will end and the reason temporary disability is no longer due and payable. OAR 436-060-0015(7). This new rule carriers to mail or deliver to the worker and their attorney, a notice which indicates temporary disability benefits will be stopped and explains the reason the benefits are no longer due and payable. Insurers and self-insured employers are also required to provide such a notice when an attending physician or authorized nurse practitioner is unable to confirm a worker’s inability to work. See OAR 436-060-0020(4)(b).
In addition to the above, attending physicians may not retroactively approve temporary disability up to 45 days. Originally, attending physicians were permitted to retroactively authorize temporary disability benefits for only the previous fourteen (14) days prior to issuance. However, under the current statute, authorized providers may backdate the authorization of temporary disability benefits up to forty-five (45) days prior to issuance. See ORS 656.262(2)(g)(A).
These updates to the Oregon Administrative rules governing claim closure and temporary disability bring notable changes to claim administration and closure process. It is paramount that insurers and self-insured employers are up to date regarding the updates to these rules or they will risk being exposed to possible penalties and fees.
If you have any questions regarding the updates to Oregon’s Administrative rules governing Workers’ Compensation, please do not hesitate to contact me at either or 503-867-2726.
Posted by TJ Bhullar.
