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My
Insurer issued a Notice of Closure (NOC). What does it mean?
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I
disagree with the NOC. Now what do I do?
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Should
I appeal my claim closure?
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What
is reconsideration?
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Who
are appellate reviewers?
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How
do I request reconsideration?
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What
happens after I request reconsideration?
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What
is a medical arbiter exam?
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Who
is a medical arbiter?
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Do
I get a hearing in front of the appellate reviewer?
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What
is an Order on Reconsideration?
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Can
an Order on Reconsideration reduce my benefits?
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What
do I do if I disagree with the Order on Reconsideration?
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Where
else can I get help?
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My
insurer issued a Notice of Closure (NOC). What does it mean?
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The insurer decided either: |
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 You are medically
stationary and they have enough information to close your claim and
rate permanent disability, or |
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Your claim meets
the criteria allowing them to close your claim without you being medically
stationary. |
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I
disagree with the NOC. Now what do I do?
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Your
appeal rights are on back of the NOC. They read:
"This Notice of Closure is a legal document that closes your
claim. It tells you periods of time you qualified for temporary
disability (time loss) and how much permanent disability you have,
if any.
Appeal Rights: If you disagree with this Notice of Closure,
you have the right to appeal the closure of your claim by asking
for a "Reconsideration" within 60 days from the mailing
date printed in box 1 on the front of this form. If you do not appeal
within 60 days, you will lose all rights to appeal your claim closure.
A "Request for Reconsideration" form is available from
the Workers' Compensation Division (WCD) in Salem. Call 503-947-7816
or write to the Workers' Compensation Division, Appellate Review
Unit, 350 Winter St. NE, Rm. 27, PO Box 14480, Salem, OR 97309-0405.
The form
is also available on the WCD website.
After completing the form, mail or deliver it to:
Workers’
Compensation Division
Appellate Review Unit
350 Winter St. NE, RM. 27
PO Box 14480
Salem, OR 97309-0405
You
have the right to have an attorney represent you during the appeal
process, although it is not required.”
See form term definitions.
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Should
I appeal my claim closure?
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You
may ask for reconsideration of the claim closure any time within
60 days after the "mailing date" (see box 1 on the NOC)
of the claim closure. The decision to appeal is up to you. You may
contact a lawyer for help making this decision. You may also talk
with the Ombudsman for Injured Workers by calling 503-378-3351 in
Salem, or toll free at 800-927-1271.
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Some
reasons to appeal the closure: |
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You
do not think the insurer should have closed your claim because you
are not medically stationary.
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You
think the insurer should have paid temporary disability benefits for
a period other than those indicated on the closure. |
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You
think the insurer should have granted permanent disability. |
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You
think the insurer should have granted more permanent disability than
is on the NOC. |
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What
is Reconsideration?
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Reconsideration
is a review of information about the claim closure by an appellate
reviewer in WCD.
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Who
are appellate reviewers?
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Appellate
reviewers are specialists who:
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Help
workers understand the reconsideration process, |
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Send
out or help workers fill out the Request for Reconsideration form, |
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Explain
options and answer questions. |
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Help
from an appellate reviewer is free, but they cannot act as an advocate
or provide legal advice. You can contact an appellate reviewer by
calling the WCD/Appellate Review Unit at 503-947-7816 or toll-free
at 800-452-0288. |
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How
do I request reconsideration?:
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If
you decide to ask for reconsideration of your claim closure, you
can do so by:
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Filling
out and mailing in a Request for Reconsideration
(Form
440-2223a) |
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Filling
out the form and submitting it by electronic transmission (facsimile/FAX), |
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Filling
out the form and hand delivering it to the division office in Salem, |
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Calling
the division and asking an appellate reviewer for help filling out
the form over the phone, or |
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Coming
to the Salem office in person and asking an appellate reviewer to
help you fill out the form. |
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What
happens after I request reconsideration?
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When
the Appellate Review Unit receives your request for reconsideration,
they send a letter to you, the insurer, and any attorneys involved.
This letter tells you that the reconsideration process has begun.
On
the 18th working day after the division receives the worker's request,
the appellate reviewer will either issue an Order on Reconsideration
or delay issuing the Order for an additional 60 calendar days. The
division postpones issuing the Order if they need to get more information
or schedule a medical arbiter exam. If the division postpones the
process, you will receive a letter telling you that we are postponing
making a decision so we can request additional information or schedule
a medical arbiter exam.
After
the medical arbiter examines you and sends their report to us, the
appellate reviewer will review all information, including anything
received from you or your insurer. After completing this review,
the appellate reviewer will issue an Order on Reconsideration and
the process will be finished.
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What
is a medical arbiter exam?
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Appellate
Review Unit staff schedule a medical arbiter exam to settle disputes
over impairment findings. Medical arbiter exams consider condition(s)
the insurer has accepted when it is time to close your claim. The
medical arbiter physician will do a physical examination of you
and prepare a report to answer the appellate reviewer's questions
about your accepted condition(s). The exam focuses on determining
your impairment, so the medical arbiter cannot offer you medical
treatment. For more detailed information about the medical arbiter
process, refer to "What
is a medical arbiter examination?" | ¿Qué
es un examen por un médico árbitro? (Spanish).
If WCD schedules a medical arbiter exam, we will send you a letter
saying when and where the exam will take place. The division can
suspend your disability benefits if you:
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Miss
your exam appointment without a good reason for missing it, and |
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Do not
call Appellate Review Unit staff within 24 hours after the missed
appointment to explain why you missed it. |
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Who
is a medical arbiter?
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A medical
arbiter is a physician who:
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Is a
medical doctor as defined by Oregon statute and in good standing with
the Oregon Medical Board Examiners, |
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Has
undergone training from WCD to provide services as a medical arbiter, |
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Has
not seen you as a patient in this claim, |
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Was
chosen by WCD at random from a list of doctors within the medical
specialty appropriate for your claim, |
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Reviews
your records and performs an examination as needed, and |
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Provides
a report of findings to WCD. |
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Do
I get a hearing in front of the appellate reviewer?
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Reconsideration
is an informal review process, not a hearing. This is your last
chance to provide information about your claim closure. You may:
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Submit
a written statement to tell us your story, explain your condition,
and say why you disagree with the claim closure, |
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Provide
statements from others to support your position, or |
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Talk
to the assigned appellate reviewer for help filing a statement.
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Sample
Statement:
I
was working as a waitress when I was injured. I have returned
to work as a cashier. My hours have been cut back to only 34 hours
per week, and I was working 40 hours when I got hurt. My doctor
told me I would probably need further surgery in the future. I
am still treating with my doctor and had an appointment on (date).
My doctor sent me for more physical therapy. My claim should remain
open because I feel that I still need medical care and I am unable
to return to my regular job. There is an error in the paperwork,
in that I did not graduate from high school and I do not have
a GED.
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What
is an Order on Reconsideration?
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An
Order on Reconsideration is the legal document an appellate reviewer
issues. It includes a brief medical history, the facts considered
in making a decision, and the results of reviewing information about
each issue you raised (for example, temporary disability, impairment
findings, permanent disability).
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Can
an Order on Reconsideration reduce my benefits?
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Yes,
an Order on Reconsideration can reduce benefits. Reconsideration
is a review of those issues raised about a claim closure, so benefits
may increase, decrease, or stay the same.
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What
do I do if I disagree with the Order on Reconsideration?:
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The
worker or the insurer can request a hearing with the Hearings Division
of the Workers' Compensation Board within 30 days of the date the
division issues the Order on Reconsideration. You must send your
request for a hearing in writing to:
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Workers'
Compensation Board
Hearings Division
2601 25th Street SE, Suite 150
Salem, Oregon 97302-1282 |
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Where
else can I get help?:
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Other
things you can read to help you understand the reconsideration process:
Workers’ Compensation
Administrative Rules (OAR 436)—For determining
permanent partial disability
Workers’
Compensation Law Chapter 656 Oregon Revised Statutes—Laws relating to workers’ compensation and safe employment
in Oregon
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What
happens if I’m hurt on the job? (Also
in Spanish) |
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Understanding
Claim Closure and Your Rights (Also in Spanish) |
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Understanding
the Reconsideration Process |
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Oregon
Administrative Rules (OAR) Chapter 436 (Rules for closing workers'
compensation claims, rating permanent disability, and first level
of appeal of claim closures)
Div.
030: Claim Closure and Reconsideration
Div.
035: Standards for Rating Permanent Disability |
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Workers'
Compensation Law (Oregon Revised Statutes, Chapter 656)-Laws relating
to workers' compensation and safe employment in Oregon |
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These
people can talk with you to explain some of your benefits, the claim
closure, and reconsideration. There is no charge for their help.
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Ombudsman
for Injured Workers
503-378-3351 or toll free, 800-927-1271
Benefits & Certifications Unit
503-947-7810
Toll-free: 800-452-0288
Rehabilitation Review (Vocational assistance)
Salem: 503-947-7816
Medford: 541-776-6032
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