June 29, 2022
by Anna McFaul

Who is the attending provider? New Oregon Court of Appeals case provides some insight.

In Oregon, when a worker is treating with multiple providers it can be difficult to identify the attending provider is for purposes of claim closure. The rules dictate that an attending provider is primarily responsible for the care and treatment of the compensable injury, authorizing temporary disability, and prescribing and monitoring ancillary and specialty care. ORS 656.005(12)(b); OAR 436-010-0210(1). ORS 656.245(2)(a) allows a worker to choose the initial attending provider and thereafter to change attending providers two times without director approval. A claim may be closed when the worker is medically stationary and the insurer has “sufficient information” to determine any disability. ORS 656.268(1). Only the attending provider may provide “sufficient information” including stationary status, permanent impairment and release to regular or modified work determinations for the purposes of claim closure. ORS 656.245(2)(b)(C); ORS 656.268(1)(a).

A recent Court of Appeals case clarified the extent to which the worker’s choice governs who is the attending provider, regardless of which provider has most recently seen the worker or referred the worker for further care. In Precision Castparts Corp-PCC Structurals v. Cramer, 320 Or APP 324 (2022), the Court considered who the attending provider was for purposes of providing “sufficient information” for closure. The worker in that case sustained a work injury and was enrolled in an MCO. Claimant completed a form identifying Dr. Anderson as her attending physician. Dr. Anderson ordered imaging, referred claimant for physical therapy, and endorsed work restrictions. Claimant decided she no longer wanted to treat with Dr. Anderson and for six months treated with primary care physician Dr. Constein. Dr. Constein recommended more physical therapy but this could not be authorized as Dr. Constein was not within the MCO. Dr. Constein indicated he was no longer willing to continue treating claimant so she returned to Dr. Anderson for one visit to obtain a physical therapy referral. Dr. Anderson referred claimant to physical therapy and a physiatry consultation. Claimant followed through with Dr. Anderson’s recommendations. Dr. Anderson thereafter responded to the insurer that claimant was stationary without permanent impairment or work restrictions. The worker reported to the insurer and MCO that she did not want Dr. Anderson as her attending physician. A Notice of Closure issued without permanent partial disability award based on Dr. Anderson’s opinions.

The Court determined that in addition to who provided treatment and referrals, claimant’s choice of attending provider impacted who was “primarily responsible” for her care and treatment. Because the worker did not want Dr. Anderson as her attending physician, and she had only returned to Dr. Anderson for a referral, the Court found closure could not be based on Dr. Anderson’s opinions as he was not the attending physician. This interesting decision indicates the importance of the workers’ preference of attending physician when determining who is the attending provider. Properly determining who the attending physician is can be a difficult task. If you need help with claim closure or have questions, please contact me directly at 503-412-3101 or .

Posted by Anna McFaul.