All Contested Case Subject
Evidence
In General
In an appeal of an MCO's disapproval of a surgery request, the MCO's provider manual was found to be confidential "data" under ORS 656.260(6), therefore a motion to compel its production was denied. Williams, Gayle J.,
15 CCHR 84 (2010).
The proposed exhibit, a massage therapy license, is not "medical evidence" as contained in OAR 436-001-0225(2), and therefore it is not barred by the ban on new medical evidence by that rule. Burchett, Dennis K.*,
14 CCHR 111 (2009).
The ALJ admitted two exhibits into evidence because in the context of OAR 436-001-0225(3) new evidence is simply that which is not submitted to WCD at the time it conducted its review of the vocational dispute, and new evidence is admissible in vocational rehabilitation disputes before WCB. Barton, Mark,
14 CCHR 76 (2009).
The physician's chart note, and his response to claimant's counsel's inquiry are admitted even though they were not admitted at WCD's vocational review process since there is no evidentiary limitation that an adjudicator should exclude evidence from the record merely because it existed at the time of WCD's review but was not submitted to WCD. Barton, Mark,
14 CCHR 76 (2009).
The ALJ's finding of historical fact was modified because of a lack of documented evidence. Engles, Nicholas A.,
9 CCHR 311 (2004).
Medical opinions in a vocational assistance case are divided and must be evaluated; the opinion of the worker's attending physician is not persuasive. Brooke, Teresa*,
8 CCHR 33 (2003).
Admissibility
Evidence that was not presented during the administrative review cannot be admitted at the hearing in a medical services dispute. Foster, Agnes K.,
16 CCHR 354 (2011).
New evidence is not admissible at a hearing on a medical services dispute. OAR 436-001-0225(2). Landis, Guy A.*,
16 CCHR 307 (2011).
Under OAR 436-001-0225(2)and ORS 656.327(2), new medical evidence is not admissible at a hearing in a medical services dispute. Pamela J. Panek,
16 CCHR 269 (2011).
Medical evidence that was not provided for the administrative review is not admissible at the hearing because new medical evidence and issues may not be raised at the hearing under OAR 436-001-0225(2). Bores, Edward E.,
16 CCHR 214 (2011).
An exhibit that could have been, but was not, offered during the administrative review, and that was related to an argument not made during the administrative review, was not admissible at the hearing. Bores, Edward E.*,
16 CCHR 14 (2011).
Under OAR 436-001-0225, evidence of the existence of a treatment plan was not admissible at hearing because this was new medical evidence that was not admissible in a hearing on a medical services dispute. Beck, Michelle M.,
15 CCHR 224 (2010).
The ALJ erred in admitting new evidence outside of the WCD record in a substantial evidence review. Texeria, Bill E.,
15 CCHR 138 (2010).
Motion to compel production of MCO provider manual/contract denied because the manual is confidential data under 656.260(6); the contract is not medical evidence and is generally admissible, but the entire contract is not relevant, and the relevant portion is in the record. Williams, Gayle J.,
15 CCHR 147 (2010).
Under OAR 436-001-0225(1), new evidence was found inadmissible, because the rule was silent as to whether or not new evidence was admissible, when the standard of review is de novo. Back In Action Physical Therapy*,
15 CCHR 52 (2010).
If claimant has submitted an exhibit to MRU before its decision, the exhibit should be included in the evidentiary record. Smith, Howard D,
13 CCHR 15 (2008).
The ALJ declined to admit evidence attached to a motion to remand because it did not in a meaningful way address the issues in the order and was not a part of the evidentiary record considered by MRU. Smith, Howard D*,
12 CCHR 133 (2007).
Excluded exhibits are part of the record, but are not admitted into evidence. Hlobeczy, Robin M,
12 CCHR 138 (2007).
New evidence can be admitted before an ALJ at the time of hearing on a vocational eligibility issue and it is not required that the evidence could not have been discovered and produced during RRU's review. Caswell, Dianna L*,
12 CCHR 121 (2007).
At the hearing before an ALJ in a managed care dispute within the director's jurisdiction, new medical evidence or issues may not be admitted or considered. Hlobeczy, Robin M*,
12 CCHR 79 (2007).
When new medical evidence becomes available after MRU's order which may affect the outcome of the case, remand is appropriate for MRU to determine whether the new evidence will be considered. Crook, James C,
12 CCHR 45 (2007).
In vocational services disputes, new evidence may be admitted and considered under OAR 436-001-0225(3). Branum Jr., Ray,
12 CCHR 67 (2007).
When the substantial-evidence/error of law standard of review applies, only the documentary record created by the director's designee (WCD in this case) will be used, therefore evidence not a part of the record is beyond the scope of review and not admissible. Dougarian, Thomas,
12 CCHR 60 (2007).
OAR 436-001-0225(3) allows new evidence to be admitted and considered in vocational disputes. Dorcy, Tommy H*,
11 CCHR 310 (2006).
On appeal, additional evidence must be submitted to the ALJ and other parties 28 days before the hearing or within 7 days of receipt of the division's document index, whichever is later. Under OAR 436-001-0240, an ALJ does not have discretion to ignore the timeliness of submitted evidence. Rodriguez-Duarte, Samuel*,
11 CCHR 242 (2006).
On appeal, the ALJ has the responsibility to ensure that the record is fully developed and sufficient for judicial review, in doing so the ALJ may admit and consider new evidence. Rodriguez-Duarte, Samuel*,
11 CCHR 242 (2006).
New evidence is not allowed in a managed care dispute hearing. Marshall, Leroy M,
11 CCHR 119 (2006).
An ALJ has authority to accept and admit evidence unless it is new medical evidence, which is inadmissible. Robuck, Richard E,
11 CCHR 50 (2006).
A motion to remand to consider new evidence is denied because the record is closed after MRU review. Bieghler, David,
11 CCHR 24 (2006).
Admissible evidence is evidence that relates to the claim addressed in the Administrative Order and is not involving a new issue. Boutard, Lecrecia N.,
10 CCHR 398 (2005).
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