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All Contested Case Subject
Request for Hearing
Practice and Procedure-Dismissal
Under OAR 43-006-0071(2), the unjustified failure by a party that requested a hearing to attend the hearing is deemed a waiver of the right to hearing and the request for hearing shall be dismissed. Granville, Alton R.,
17 CCHR 19 (2012).
It was proper to dismiss a hearing request where a claimant who requested a hearing failed to appear for the hearing and only offered as justification that there had been an unforseen mixup and accident. Granville, Alton R.,
17 CCHR 19 (2012).
Where the insurer had denied payment for medical fees on the grounds of causation and the WCB had dismissed a hearing request on causation issues the claimant's request for a hearing on medical fee payment issues was dismissed because claim preclusion barred litigating those issues. Patterson, Kevin D.,
16 CCHR 281 (2011).
Request for review was improperly dismissed as untimely where insurer did not give claimant written notice of 90 day limit to request review, and there was no evidence claimant had actual knowledge of dispute. Weitzman, David*,
15 CCHR 295 (2010).
Request for review was improperly dismissed as untimely where insurer did not give claimant written notice of 90 day limit to request review, and there was no evidence claimant had actual knowledge of dispute. Weitzman, David*,
15 CCHR 227 (2010).
Motion to dismiss MCO's request for hearing denied; MCO entitled as any other party to request a hearing after administrative review. Williams, Gayle J.,
15 CCHR 147 (2010).
It was not error to dismiss claimant's request for hearing on the denial of eligibility for vocational services where claimant knowingly waived his right to receive vocational assistance in a claim disposition agreement. Turnbow, Matthew O.,
15 CCHR 93 (2010).
An MCO was entitled to request a hearing regarding its disapproval of a surgery request under OAR 436-010-0008(13), so a motion to dismiss the MCO's request for hearing on the basis that the MCO was not a "party" was denied. Williams, Gayle J.,
15 CCHR 84 (2010).
The case was properly dismissed for lack of justiciable controversy, where WCD could not issue a binding decision regarding claimant's possible liability for medical services. Gonzalez, Juvenal,
15 CCHR 39 (2010).
Under OAR 438-006-0071, the ALJ dismissed the request for a hearing, where the party requesting the hearing failed to appear. Hightower, Patricia D.,
15 CCHR 16 (2010).
Under OAR 438-006-0071, the ALJ dismissed the request for a hearing, where the party requesting the hearing failed to appear. Thompson, Troy A.,
15 CCHR 17 (2010).
The failure of the director to mail a copy of an administrative order on reconsideration to the attorney of a party did not render the order void because the order was mailed to the parties; the order became final when no party filed a request for hearing, thus dismissal was appropriate for a request appealing the administrative order. Fonseca-Domingues Antonio,
14 CCHR 193 (2009).
Dismissal is not required in a request for hearing when prejudice is not shown, where a lay person conforms to the minimal requirements of ORS 656.704(2)(a), clearly identifying the case at issue and following the appeal procedure outline therein; even though an attorney would be required to comply with the "applicable" specified information requirements of OAR 436-001-0019(2). Warren, Debra J.,
14 CCHR 166 (2009).
The dismissal of claimant's request for administrative review is affirmed because the dispute about an alleged refusal to provide a work hardening program is essentially moot; insurer has implemented the treatment as claimant's attending physician and the claims examiner agreed. Graham, Denise,
14 CCHR 83 (2009).
OAR 438-006-0071(1) & (2) provides that when the movant does not appear at the hearing the ALJ shall dismiss the request for hearing as abandoned unless extraordinary circumstances exist, and no such circumstances existed when the movant neither appeared nor motioned for a postponement or a continuance in advance of the hearing. Hanlon, Veronica T,
12 CCHR 273 (2007).
Dismissal is appropriate when the party requesting a hearing fails to appear. Harris. Danny C,
12 CCHR 242 (2007).
Dismissal for lack of jurisdiction was appropriate because claimant entered a DCS, which was a final determination that the medical services were noncompensable. Ard, Alisha M*,
12 CCHR 228 (2007).
Dismissal is appropriate when the evidence supports that the medical services were not submitted to the insurer for payment, therefore there was no dispute ripe for review. Smith, Howard D*,
12 CCHR 219 (2007).
Dismissal is appropriate when substantial evidence supports the conclusion that certain providers did not submit bills to insurer and the other bills were paid in a timely manner. Smith, Howard D*,
12 CCHR 215 (2007).
Dismissal is appropriate when substantial evidence supports the conclusion that the insurer responded with the payment dates for each specific prescription listed in the request for review. Smith, Howard D*,
12 CCHR 224 (2007).
Claimant filed an appeal for the original order and not the amended order, but the ALJ found that claimant's properly filed appeal was sufficient to challenge the amended order due to the complicated and confusing nature of the orders and the fact that the amended order was essentially identical to the timely appealed order. Tran, Tin T*,
12 CCHR 118 (2007).
Practice and Procedure-Filing
Claimant's request for hearing was not untimely where insurer did not provide notice of 90 day time limit and claimant's intent to pursue reimbursement under ORS 656.247 did not demonstrate claimant had actual knowledge of existence of a dispute. Weitzman, David*,
15 CCHR 295 (2010).
Claimant's request for hearing was not untimely where insurer did not provide notice of 90 day time limit and claimant's intent to pursue reimbursement under ORS 656.247 did not demonstrate claimant had actual knowledge of existence of a dispute. Weitzman, David*,
15 CCHR 227 (2010).
When the MCO's dispute resolution decision was not successfully mailed to all the parties because it was returned as undeliverable, the decision can be republished and given new appeal rights. Harsha, Greg A,
12 CCHR 281 (2007).
The worker had good cause for his failure to timely request a hearing from the department's order when the department failed to mail correspondence to the worker's correct attorney and the department had been notified of the change by letter. Kraft, Ronald,
12 CCHR 277 (2007).
The test for determining whether good cause exists has been equated to the standard of "mistake, inadvertence, surprise or excusable neglect" recognized under ORCP 71B(1) and former ORS 18.160, but the lack of due diligence does not constitute good cause. Kraft, Ronald,
12 CCHR 277 (2007).
Pursuant to OAR 436-009-0008(2)(a) and (b) and 436-010-0008(6), medical services disputes must be submitted to MRU within 90 days from the date of the explanation of benefits. Jimenez, Tammie D,
12 CCHR 169 (2007).
When a request for hearing is not timely, claimant has the burden of proving good cause. Lack of diligence did not constitute good cause when claimant's attorney was charged with the responsibility for filling the request for hearing and even though he had good cause for the last 7 days of the filing period, he did not have good cause for the first 23 days. Meola, Jason M,
12 CCHR 95 (2007).
Waiting for a piece of evidence does not establish a "good cause" that allows claimant to file an untimely request for a hearing; a request for a hearing does not depend upon obtaining a certain piece of evidence. Gode, Charles R,
11 CCHR 135 (2006).
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