OAR 438-012-0037
Payment of Medical Benefits

Except as otherwise provided in OAR 438-012-0020 (Insurer to Process Own Motion Claim: Notice and Contents of Claim; Worsened Condition Claim; “Post-aggravation Rights” New Medical Condition or Omitted Medical Condition Claim; Pre-1966 Injury Claim)(7), for every condition resulting from a compensable injury occurring before January 1, 1966, the Own Motion insurer may pay for reasonable and necessary medical services when:

(1)

Undertaken for curative purposes;

(2)

Provided to a claimant who has been determined to have permanent total disability;

(3)

Provided in the form of prescription medications;

(4)

Necessary to administer prescription medication or to monitor administration of prescription medication;

(5)

Provided in the form of prosthetic devices, braces and supports;

(6)

Necessary to maintain and monitor the status, replacement or repair of a prosthetic device, brace or support;

(7)

Necessary to diagnose the claimant’s condition;

(8)

Necessary to enable the claimant to continue current employment;

(9)

Provided in the form of life-preserving modalities similar to insulin therapy, dialysis and transfusions; or

(10)

The Board determines that special circumstances justify the provision of further medical services.

Source: Rule 438-012-0037 — Payment of Medical Benefits, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=438-012-0037.

Last Updated

Jun. 8, 2021

Rule 438-012-0037’s source at or​.us