ORS 656.252
Medical report regulation
  • rules
  • duties of attending physician or nurse practitioner
  • disclosure of information
  • notice of changing attending physician or nurse practitioner
  • copies of medical service billings to be furnished to worker


(1)

In order to ensure the prompt and correct reporting and payment of compensation in compensable injuries, the Director of the Department of Consumer and Business Services shall make rules governing audits of medical service bills and reports by attending and consulting physicians and other personnel of all medical information relevant to the determination of a claim to the injured worker’s representative, the worker’s employer, the employer’s insurer and the Department of Consumer and Business Services. Such rules shall include, but not necessarily be limited to:

(a)

Requiring attending physicians and nurse practitioners authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) to make the insurer or self-insured employer a first report of injury within 72 hours after the first service rendered.

(b)

Requiring attending physicians and nurse practitioners authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) to submit follow-up reports within specified time limits or upon the request of an interested party.

(c)

Requiring examining physicians and nurse practitioners authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) to submit their reports, and to whom, within a specified time.

(d)

Such other reporting requirements as the director may deem necessary to insure that payments of compensation be prompt and that all interested parties be given information necessary to the prompt determination of claims.

(e)

Requiring insurers and self-insured employers to audit billings for all medical services, including hospital services.

(2)

The attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) shall do the following:

(a)

Cooperate with the insurer or self-insured employer to expedite diagnostic and treatment procedures and with efforts to return injured workers to appropriate work.

(b)

Advise the insurer or self-insured employer of the anticipated date for release of the injured worker to return to employment, the anticipated date that the worker will be medically stationary, and the next appointment date. Except when the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) has previously indicated that temporary disability will not exceed 14 days, the insurer or self-insured employer may request a medical report every 15 days, and the attending physician or nurse practitioner shall forward such reports.

(c)

Advise the insurer or self-insured employer within five days of the date the injured worker is released to return to work. Under no circumstances shall the physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) notify the insurer or employer of the worker’s release to return to work without notifying the worker at the same time.

(d)

After a claim has been closed, advise the insurer or self-insured employer within five days after the treatment is resumed or the reopening of a claim is recommended. The attending physician under this paragraph need not be the same attending physician who released the worker when the claim was closed.

(3)

In promulgating the rules regarding medical reporting the director may consult and confer with physicians and members of medical associations and societies.

(4)

No person who reports medical information to a person referred to in subsection (1) of this section, in accordance with department rules, shall incur any legal liability for the disclosure of such information.

(5)

Whenever an injured worker changes attending physicians or nurse practitioners authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided), the newly selected attending physician or nurse practitioner shall so notify the responsible insurer or self-insured employer not later than five days after the date of the change or the date of first treatment. Every attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) who refers a worker to a consulting physician promptly shall notify the responsible insurer or self-insured employer of the referral.

(6)

A provider of medical services, including hospital services, that submits a billing to the insurer or self-insured employer shall also submit a copy of the billing to the worker for whom the service was performed after receipt from the injured worker of a written request for such a copy. [1967 c.626 §§2,5; 1979 c.839 §3; 1981 c.535 §6; 1981 c.874 §17; 1987 c.884 §3; 1995 c.332 §26a; 2001 c.865 §14a; 2003 c.811 §§7,8; 2007 c.365 §4]

Source
Last accessed
May. 15, 2020