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Parties
must request administrative review by the director within 90 days
for billing or treatment disputes.
For billing disputes (such as the insurer’s reduction of a
medical bill or failure to pay within 45 days), use Form
2842 with attachment 2842a.
Medical treatment disputes may be initiated by any party using Form
2842. The insurer can request WCD administrative review to contend
treatment is excessive, inappropriate or unnecessary, or in violation
of a medical services rules. The health care provider can request
administrative review by WCD if the insurer does not approve palliative
care, curative care, elective surgery, etc.
Mediation and alternative dispute resolution processes are also
available to resolve disputes between parties.
For claims enrolled in a Managed Care Organization (MCO), billing
or treatment disputes must go to the MCO for dispute resolution
before the worker may request administrative review of the matter
by the Workers’ Compensation Division. Requests for review
through the MCO dispute resolution process must be made to the MCO
within 30 days of the mailing date of the initial MCO decision.
Requests for review of the final decision of the MCO must be made
to the Workers' Compensation Division's Medical Section Resolution
Team within 60 days of the mailing date of the MCO decison.
Medical
Resolution Team
Workers'
Compensation Division
350
Winter St NE
PO Box
14480
Salem,
OR 97309-0405
For additional information on requests for administrative review
by WCD for medical issues, refer to Bulletin
293.
If the insurer denies the compensability of the condition,
it will issue a denial, which the worker can appeal to the Workers’
Compensation Board.
Workers'
Compensation Board
2601
25th St SE, Suite 150
Salem, OR
97302-1282
Questions? Contact wcd.medicalquestions@state.or.us
or call 503-934-6049.
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