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HB
2218 Regulatory streamlining |
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HB
2244 Permanent partial disability sunset repeal |
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HB 2247
Nurse practitioner sunset repeal
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HB
2250 Assigned risk plan |
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HB
2756 Expanded workers' compensation treatment authority |
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HB
2783 Insurance cancellation notice |
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HB
2943 Independent Medical Examination standards |
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HB
3362 Home Care Commission election of coverage |
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SB
253 ALJ approval of settlements |
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SB
404 Worker expense reimbursements and attorney liens |
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SB
504 Emergency room physicians |
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SB
559 Eliminate guaranty contracts |
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SB
563 Managed care organization treatment standards |
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SB
688 Taxicab owner-operator coverage |
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SB
762 Non-disabling claim medical deductible adjustment |
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SB
835 MLAC death benefit study |
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HB
2218 - Regulatory streamlining
HB 2218 is a regulatory streamlining bill, addressing a number of issues. |
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Current
law requires the Department of Consumer and Business Services to adopt a temporary rule
to determine a worker's permanent disability when it is not addressed by the disability
rating standards. The temporary rule applies only to the specific claim, expires in 180
days, and sets no precedent for future claims. This bill eliminates the requirement to
adopt a rule and instead allows the determination of impairment to be awarded in an order
on reconsideration, which can be appealed to the Workers' Compensation Board. |
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Workers
are entitled to three choices of attending physician during the life of their claim,
and may request the department authorize additional changes. Current law requires the
department seek, if requested, the advice of a physician when approving a change in attending
physician. The department has not had any such requests in recent memory nor do these
decisions require medical expertise. HB 2218 eliminates this outdated requirement to
consult a physician if requested. |
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Insurers
are required to pay a permanent partial disability award of $6,000 or less in a lump
sum. If the award is more than $6,000, the worker may request a lump sum payment, but
insurers may deny the worker's request. If the insurer denies the request for the lump
sum payment, current law requires the department to review the insurer's decision, whether
or not the parties want to appeal the matter. HB 2218 clarifies the statutes by consolidating
into one section of the law the reasons for which an insurer can deny a lump sum award
and removes the required review. If the worker disagrees with the insurer's decision,
the worker can request a penalty for unreasonable delay in payment under ORS 656.262(11). |
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The
statutes governing managed care organizations allow the department to revoke or suspend
an organization's certification, but not to impose lesser sanctions to address less severe
performance issues. This bill gives the department the authority to issue civil penalties
against managed care organizations that fail to comply with laws or rules. |
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| HB
2244 - Permanent partial disability sunset repeal |
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The
Department of Consumer and Business Services studied the impact of the permanent partial
disability benefit changes made by SB 757 in 2003 and HB 2408 in 2005, which were scheduled
to sunset on Jan. 1, 2008. The study showed that the law changes have redistributed permanent
partial disability benefits from workers who are able to return to work more quickly
toward workers with more challenging injuries and work disability. The department's study
also showed that the law changes were cost-neutral within the overall system. This is
consistent with the policy goals intended by the Workers' Compensation Management-Labor
Advisory Committee (MLAC) when it supported the statutory changes in 2003 and 2005. HB
2244 removes the sunset and makes the permanent partial disability laws permanent. The
bill also requires MLAC to review permanent partial disability benefit amounts on a biennial
basis and make recommendations to ensure the original policy goals continue to be met
over time. |
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| HB
2247 - Nurse practitioner sunset repeal |
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In
2003, HB 3669 expanded the role of nurse practitioners in the workers' compensation system
by allowing them to provide compensable medical services to injured workers for up to
90 days, authorize time loss for up to 60 days, release the worker to work, and manage
the worker's return to work in that time period. Workers were also allowed to "bring"
their nurse practitioners into a managed care organization under specific circumstances.
The law changes were scheduled to sunset on Jan. 2, 2008, to allow an opportunity for
review. The department and MLAC conducted a study to determine the system impact of the
law change, which illustrated some expansion in a worker's ability to continue treatment
with a provider with whom they have an established relationship, without a significant
cost impact to the system. HB 2247 repeals the sunset and makes nurse practitioners'
expanded authority permanent. |
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| HB
2250 - Assigned risk plan |
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The
workers' compensation assigned risk plan provides workers' compensation coverage to employers
who cannot obtain it in the voluntary market. The plan provides discounts to make workers'
compensation insurance affordable for new and small employers, and also covers employers
in high-risk fields or with poor loss experience. HB 2250 implements one of the recommendations
arising out of a department study of the assigned risk plan, by allowing for a surcharge
to plan members, if necessary, to help pay the costs of assigned risk pool losses when
the losses exceed premiums. Otherwise, employers who buy insurance in the voluntary market
must pay these costs. |
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| HB
2756 - Expanded workers' compensation treatment authority |
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Following
the veto of HB 2588 in 2003, which would have allowed chiropractors to serve as attending
physicians for injured workers on a pilot basis, the Governor asked the department and
MLAC to study the role of chiropractors and other care providers in the workers' compensation
system. Based on the study and MLAC's recommendations, HB 2756 allows chiropractic physicians,
podiatrists, naturopaths, and physician assistants to act as attending physicians for
60 days or 18 visits, whichever comes first. In addition, the four provider groups can
authorize time loss for 30 days and manage the worker's return to work during that period.
The bill does not give the four provider groups authority to determine a worker's permanent
impairment at claim closure, and it requires all four-provider types to certify they
have reviewed informational materials developed by the director of the department. |
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| HB
2783 - Insurance cancellation notice |
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Under
current law, insurers are required to give 30 days advance notice to employers when they
terminate the employer's workers' compensation insurance coverage, to alert the employer
that it may need to find new workers' compensation insurance coverage. HB 2783 extends
the advance notice requirement to the employer from 30 days to 45 days. This time frame
is consistent with the notice requirements for other types of commercial liability insurance
and will allow the employer more time to obtain new coverage. HB 2783 also shortens the
notice required to the employer to 10 days in the event of non-payment of premium, similar
to the time frame used in at least 30 other states. |
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| HB
2943 - Independent Medical Examination standards |
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SB
311 (2005) required workers' compensation independent medical examination providers to
be authorized by the department. Under SB 311, the department may remove providers from
the authorized list if they violate their regulatory board's code of conduct for independent
medical examinations or, if a regulatory board does not have a code of conduct, if they
violate guidelines published by the American Board of Independent Medical Examiners (ABIME).
HB 2943 removes the statutory reference to the ABIME guidelines and requires instead
that the department adopt rules that outline the standard of conduct for providers that
do not have conduct guidelines from their regulatory board. The rules may be consistent
with the code of conduct adopted by the Independent Medical Examination Association. |
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| HB
3362 - Home Care Commission election of coverage |
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Home
care workers are hired by elderly or disabled persons who receive funds from the Department
of Human Services to pay the wages of the home care workers. Under current law, these
home care workers are not considered subject workers. This bill requires the Home Care
Commission to elect coverage on behalf of all Department of Human Services' clients who
employ home care workers, making the home care workers "subject workers" if
they are paid by the state on behalf of the client. Currently, insurers may stop paying
temporary total disability benefits if a worker who has been released to modified work
refuses an offer of modified employment with their employer at injury. HB 3362 allows
termination of temporary total disability benefits when a home care worker refuses modified
employment offered by any Department of Human Services client who employs home care workers,
not just the original employer client, with some exceptions for work location and the
worker's physical capacity. Because home care workers typically work for only one client,
home care workers that are released to modified employment will have more return-to-work
options with other Department of Human Services clients, not just with their original
employer. |
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| SB
253 - ALJ approval of settlements |
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Currently,
the authority to review, approve, and disapprove a workers' compensation Claim Disposition
Agreement (CDA) rests exclusively with the Workers' Compensation Board. Some CDAs arise
from mediations conducted by an Administrative Law Judge (ALJ) involving the worker,
the insurer/self-insured employer, and their attorneys. In addition to the board, SB
253 also allows the ALJ who mediates a workers' compensation CDA to approve the agreement. |
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| SB
404 - Worker expense reimbursements and attorney liens |
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SB
404 allows for payment of reasonable costs for records, expert opinions, and witness
fees associated with appealing a workers' compensation claim if the claimant prevails.
The bill caps reimbursement for reasonable costs at $1,500 unless the claimant demonstrates
extraordinary circumstances justifying payment of a greater amount. The bill also allows
an attorney who represents an injured worker a lien for recovery of fees out of additional
awarded compensation or the proceeds of a claim settlement if the worker signs an attorney
fee agreement for representation and the attorney was instrumental in obtaining the outcome
of the claim. |
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| SB
504 - Emergency room physicians |
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Attending
physicians in the workers' compensation system are primarily responsible for the treatment
of a worker's compensable on-the-job injury. As part of this authority, an attending
physician manages a worker's access to time-loss benefits, manages the worker's return
to work, and determines the worker's permanent disability. When workers seek treatment
through a hospital emergency room, the workers may only see the physician for that visit.
Claims adjusters sometimes have difficulty later contacting the emergency room doctor
to clarify return-to-work options, temporary disability authorization, and treatment
issues, and to obtain a closing examination. SB 504 excludes an emergency room physician
from the definition of an attending physician when the physician refers the worker to
a primary care physician for follow-up care. If the worker needs time off work, the bill
allows the emergency room physician to authorize time-loss benefits for a maximum of
14 days. Thereafter, the worker would need to see another qualified attending physician
to manage his or her care and authorize time-loss benefits. In some instances, a physician
may treat patients in an emergency room but also maintain an independent practice. If
so, the emergency room physician could act as the worker's attending physician if the
doctor otherwise qualifies to be an attending physician and provides the follow-up care
to the injured worker. |
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| SB
559 - Eliminate guaranty contracts |
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The
Legislature created the guaranty contract in 1965 as the way employers and insurers provide
proof of workers' compensation coverage to the department. When an employer obtains workers'
compensation coverage by purchasing an insurance policy from an insurer, the insurer
is required to file a duplicative guaranty contract with the department. The guaranty
contract is an agreement between the insurer and the state, where the insurer assumes
the employer's liability for payment of compensation to injured workers. SB 559 removes
the requirement for a guaranty contract filing and instead requires the insurer to provide
insurance policy information to the department as the proof of workers' compensation
coverage. The bill makes the focus of coverage, reporting, and regulatory actions related
to workers' compensation insurance similar to what occurs with the insurance policy in
other lines of insurance and as reported in most other states. The bill will streamline
reporting requirements for insurers and eliminate an unnecessary, duplicate filing with
the department. |
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| SB
563 - Managed care organization treatment standards |
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The
bill removes the requirement for the department to review and approve all individual
treatment standards adopted by managed care organizations. Under the rules that implemented
SB 670 (2005), managed care organizations were required to submit all individual treatment
standards for review. SB 563 requires the department to approve managed care organizations'
processes for developing, reviewing, and adopting the treatment standards. The change
will maintain regulatory oversight over managed care organizations, ensuring workers
receive appropriate treatment for work-related injuries, while allowing managed care
organizations the flexibility to more quickly update treatment standards. |
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| SB
688 - Taxicab owner-operator coverage |
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Owner-operators
of taxicabs are currently excluded from coverage under workers' compensation law. Some
situations involving employment contracts and leasehold interests can create confusion
as to whether the worker (driver) is subject, independent, or operating under the direction
and control of another. This distinction determines whether the insurer should collect
premium for a worker. Recent cases have established that some taxicab operators are subject
because the shift-lease arrangements seldom require the lessee to handle the full maintenance
of the vehicle. SB 688 clarifies the exemption applies to a person who operates and has
an ownership or leasehold interest in a passenger motor vehicle that is operated as a
taxicab. The bill also exempts workers who provide passenger vehicle transportation for
non-emergency medical transportation. |
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| SB
762 - Non-disabling claim medical deductible adjustment |
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Beginning
in 1987, employers were allowed to pay a portion of medical costs on their non-disabling
workers' compensation claims so that minor injuries would not adversely affect an employer's
experience rating. The insurer first pays for the medical services and then the employer
has the option of reimbursing the insurer up to the threshold amount. The limit was originally
set at $500 for non-disabling claims. Because increases in medical costs had reduced
the impact of the original limit, the 2005 Legislature increased the threshold amount
to $1,500 per non-disabling claim. This bill will require the department to establish
a threshold each year based on the change in the medical services consumer price index.
The department will evaluate the change in the index and adjust the threshold amount,
rounding to the nearest $100. The department will publish, by bulletin, the updated threshold
amount prior to the Jan. 1 effective date so insurers have sufficient time to plan for
the change and program their computer systems. |
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| SB
835 - MLAC death benefit study |
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Workers'
compensation law establishes specific benefit amounts for the survivors of workers who
die as a result of an on-the-job injury. Monthly benefits are provided for the spouse
of a deceased worker, dependent children, and other dependents. Fatal benefits are also
provided to survivors of permanently and totally disabled workers upon their death, regardless
of the cause of death. Statute provides a burial benefit up to 10 times the Oregon average
weekly wage. SB 835 requires MLAC to conduct an interim study of the adequacy of death
benefits in the workers' compensation system. The evaluation will include a review of
the method of calculating benefits, burial amounts, categories of beneficiaries, and
feasibility of providing lump sum benefit payments. A written report to the 75th Oregon
Legislative Assembly is required by Jan. 31, 2009. |
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