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    Jim Van Ness   
503-947-7753   


Claim closure dispute resolution

 

Requests for reconsideration

According to Oregon law, there is a process that an injured worker can follow if he or she disagrees with the terms of claim closure. The worker can ask the director to review specific issues on the closure. The name of this review process is reconsideration.

A worker must make his or her request for reconsideration within 60 days of the mailing date of the closure. A reviewer in the Appellate Review Unit of the Resolution Section does the review.

Issues the worker can dispute include:

  • When the worker's condition was medically stationary
  • Whether the claim was closed incorrectly or before it should have been
  • How long temporary disability benefits were authorized
  • Whether permanent disability was awarded and, if it was, the amount of that award
  • Eligibility for death benefits

An insurer or self-insured employer may also request reconsideration of the closure. However, they must make their request within seven days of the mailing date of the closure. The insurer or self-insured employer can only disagree with the impairment findings used as the basis for a permanent disability award.

Because reconsideration is the last chance to add new information to the official claim closure record, both parties in the dispute must provide all their documents during the reconsideration process.

The worker or insurer or self-insured employer may:

  • Correct information in the record
  • Submit additional materials, including evidence that should have been submitted-but was not-by the attending physician at the time the claim was closed

The injured worker may also submit written statements:

  • Explaining his or her condition at the time the claim was closed
  • Giving the reasons for his or her disagreement with the claim closure
  • From other people who support his or her position

The department must either complete the reconsideration process by the 18th working day after the reconsideration proceeding begins or postpone issuing an order for an additional 60 days if it needs more information or a medical arbiter examination.

An appellate reviewer will study all information received from the injured worker and the insurer. After reviewing the information (including any report from a medical arbiter), the reviewer will issue an Order on Reconsideration.


Reference: ORS 656.268, OAR 436-030-0165

 

Medical arbiter examination

When there is a dispute over impairment findings for an injured worker's accepted condition at the time the insurer closes the claim, the department may need to have the worker examined by a medical arbiter.

The medical arbiter:

  • Must be a medical doctor as defined by Oregon law
  • Must be in good standing with the Oregon Board of Medical Examiners
  • Is chosen at random from the department's list of qualified doctors
  • Has not seen or treated the worker during the time the claim was open
  • Reviews the medical records and examines the worker's accepted condition
  • Provides the appellate reviewer with a written report describing the objective findings of impairment

Reference: ORS 656.268, OAR 436-030-0165

 
For more information contact:
Appellate Review Unit: 503-947-7816

If you have questions about this webpage, please contact Jim Van Ness, 503-947-7753.