OAR 436-060-0147
Worker Requested Medical Examination

(1) Eligibility. The worker is eligible for a worker requested medical examination if:
(a) The worker has made a timely request for a board hearing on a denial of compensability;
(b) The denial is based on one or more independent medical examination reports; and
(c) The attending physician or authorized nurse practitioner does not concur with the report or reports.
(2) Request for exam. The worker must submit a request for the exam to the division. A copy of the request must be sent simultaneously to the insurer.
(a) The request must include:
(A) The name, address, and claim identifying information of the worker;
(B) A list of physicians, including names and addresses, who have previously provided medical services to the worker on the claim, or who have previously provided medical services to the worker related to the claimed conditions;
(C) The date the worker requested a hearing and a copy of the hearing request;
(D) A copy of the insurer’s denial letter; and
(E) Documents that demonstrate that the attending physician or authorized nurse practitioner does not concur with the independent medical examination report or reports, if available.
(b) The director will determine the worker is eligible for an exam if the eligibility criteria in section (1) of this rule are met and:
(A) The worker or insurer provides documents that demonstrate that the attending physician or authorized nurse practitioner does not concur with the independent medical examination report or reports; or
(B) The director has not received documents that demonstrate the attending physician or authorized nurse practitioner does or does not concur with the report or reports, and at least 30 days after the worker’s request for hearing under subsection (1)(a) of this rule have passed.
(3) Required documentation. The insurer must send to the director no later than the 14th day following the insurer’s receipt of the worker’s request, the names and addresses of all physicians or nurse practitioners who have:
(a) Acted as the worker’s attending physician or authorized nurse practitioner;
(b) Provided medical consultations or treatment to the worker;
(c) Examined the worker at an independent medical examination requested by the insurer under ORS 656.325 (Required medical examination); or
(d) Reviewed the worker’s medical records on the claim.
(4) Penalty for failure to provide documentation. Failure to provide the required documentation described in section (3) of this rule in a timely manner may subject the insurer to civil penalties under OAR 436-060-0200 (Assessment of Civil Penalties).
(5) Selection of physicians. If the director determines the worker is eligible for the exam, the director will notify all parties in writing of the physician selected, or will provide the worker or the worker’s attorney a list of appropriate physicians. If the director provides a list of physicians, the following applies:
(a) The worker’s or the worker’s attorney’s response must be in writing, signed, and delivered to the director within 14 days of the mailing date of the list;
(b) The worker or the worker’s attorney may eliminate the name of one physician from the list;
(c) If the worker or the worker’s attorney does not respond as provided in this section, the director will select a physician; and
(d) The director will notify the parties in writing of the physician selected.
(6) Scheduling the exam. The worker or the worker’s attorney must schedule the exam with the selected physician, and notify the insurer and the board of the scheduled exam date within 14 days of the date of the director’s notice in section (5) of this rule. The exam is not required to take place within the 14-day notification period. An unrepresented worker may consult with the Ombudsman for Injured Workers for assistance.
(7) Required medical records. The insurer must send the physician the worker’s complete medical and diagnostic record on the claim and the original questions asked of the independent medical examination physicians no later than 14 days before the date of the scheduled exam. If the diagnostic records are not in the insurer’s possession, the insurer must request that the medical provider send the diagnostic records to the selected physician at least 14 days before the scheduled exam.
(8) Exam questions. The worker, or the worker’s attorney, must communicate questions related to the compensability denial in writing to be answered by the physician at the exam to the physician at least 14 days before the scheduled date of the exam. An unrepresented worker may consult with the Ombudsman for Injured Workers for assistance.
(9) Physician’s response. Upon completion of the exam the physician must address the original independent medical examination questions and the questions from the worker or the worker’s attorney under section (8) of this rule and send the report to the worker’s attorney, if any, or the worker, and the insurer within 14 days.
(10) Payment of physician. The insurer must pay the physician selected under this rule in accordance with OAR 436-009. Medical services to workers must be delivered in accordance with OAR 436-010.
(11) Failure to attend exam. If the worker does not attend the scheduled worker requested medical exam, the insurer must pay the physician for the missed exam under OAR 436-009-0010 (Medical Billing and Payment)(13). The insurer is not required to pay for another exam unless the worker did not attend the missed examination for reasons beyond the worker’s reasonable control.
(12) Reimbursement for services. The insurer must reimburse the worker for all necessary related services under ORS 656.325 (Required medical examination)(1).

Source: Rule 436-060-0147 — Worker Requested Medical Examination, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0147.

436‑060‑0003
Purpose, Applicability, Forms, and Bulletins 436‑060‑0005
Definitions 436‑060‑0008
Administrative Review and Contested Cases 436‑060‑0010
Employer Responsibilities 436‑060‑0011
Insurer Reporting Requirements 436‑060‑0012
Notices and Correspondence Following the Death of a Worker 436‑060‑0015
Required Notice and Information 436‑060‑0017
Release of Claim Documents 436‑060‑0018
Nondisabling and Disabling Claim Reclassification 436‑060‑0019
Determining and Paying the Three Day Waiting Period 436‑060‑0020
Payment of Temporary Total Disability Compensation 436‑060‑0025
Worker’s Weekly Wage Calculation and Rate of Temporary Disability Compensation 436‑060‑0030
Payment of Temporary Partial Disability Compensation 436‑060‑0035
Supplemental Disability for Workers with Multiple Jobs at the Time of Injury 436‑060‑0040
Payment of Permanent Partial Disability Compensation 436‑060‑0045
Payment of Compensation During Worker Incarceration 436‑060‑0055
Payment of Medical Services on Nondisabling Claims 436‑060‑0060
Lump Sum Payment of Permanent Partial Disability Awards 436‑060‑0075
Payment of Death Benefits 436‑060‑0095
Medical Examinations 436‑060‑0105
Suspension of Compensation for Insanitary or Injurious Practices, Refusal of Treatment or Failure to Participate in Rehabilitation 436‑060‑0135
Injured Worker, Worker’s Attorney Responsible to Assist in Investigation 436‑060‑0137
Vocational Evaluations for Permanent Total Disability Benefits 436‑060‑0140
Acceptance or Denial of a Claim 436‑060‑0141
Claims for COVID-19 or Exposure to SARS-CoV-2 436‑060‑0147
Worker Requested Medical Examination 436‑060‑0150
Timely Payment of Compensation 436‑060‑0153
Electronic Payment of Compensation 436‑060‑0155
Penalty to Worker for Untimely Processing 436‑060‑0160
Use of Sight Draft to Pay Compensation Prohibited 436‑060‑0170
Recovery of Overpayment of Benefits 436‑060‑0180
Designation and Responsibility of a Paying Agent 436‑060‑0190
Monetary Adjustments among Parties and Department of Consumer and Business Services 436‑060‑0195
Miscellaneous Monetary Adjustments Among Insurers 436‑060‑0200
Assessment of Civil Penalties 436‑060‑0400
Penalty and Attorney Fee for Untimely Payment of Disputed Claims Settlement 436‑060‑0500
Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury 436‑060‑0510
Reimbursement of Permanent Total Disability Benefits from the Workers’ Benefit Fund
Last Updated

Jun. 8, 2021

Rule 436-060-0147’s source at or​.us