ORS 656.267
Claims for new and omitted medical conditions


(1)

To initiate omitted medical condition claims under ORS 656.262 (Processing of claims and payment of compensation) (6)(d) or new medical condition claims under this section, the worker must clearly request formal written acceptance of a new medical condition or an omitted medical condition from the insurer or self-insured employer. A claim for a new medical condition or an omitted condition is not made by the receipt of medical billings, nor by requests for authorization to provide medical services for the new or omitted condition, nor by actually providing such medical services. The insurer or self-insured employer is not required to accept each and every diagnosis or medical condition with particularity, as long as the acceptance tendered reasonably apprises the claimant and the medical providers of the nature of the compensable conditions. Notwithstanding any other provision of this chapter, the worker may initiate a new medical or omitted condition claim at any time.

(2)

(a) Claims properly initiated for new medical conditions and omitted medical conditions related to an initially accepted claim shall be processed pursuant to ORS 656.262 (Processing of claims and payment of compensation).

(b)

If an insurer or self-insured employer denies a claim for a new medical or omitted medical condition, the claimant may request a hearing on the denial pursuant to ORS 656.283 (Hearing rights and procedure).

(3)

Notwithstanding subsection (2) of this section, claims for new medical or omitted medical conditions related to an initially accepted claim that have been determined to be compensable and that were initiated after the rights under ORS 656.273 (Aggravation for worsened conditions) expired shall be processed as requests for relief under the Workers’ Compensation Board’s own motion jurisdiction pursuant to ORS 656.278 (Board has continuing authority to alter earlier action on claim) (1)(b). [2001 c.865 §10; 2005 c.188 §1]

Notes of Decisions

Under Former Similar Statute (Ors 656.262)

Clause permitting worker to file new claim at any time prevents application of claim preclusion doctrine to claim, but does not prevent application of issue preclusion doctrine. Evangelical Lutheran Good Samaritan Society v. Bonham, 176 Or App 490, 32 P3d 899 (2001), Sup Ct review denied

In General

New medical condition claim for worsened condition is subject to time limitations for aggravation rights under claim for original injury. Davis v. SAIF, 185 Or App 500, 60 P3d 578 (2002)

Where worker files claim for new medical condition, provision that insurer need not accept each and every diagnosis or medical condition with particularity if acceptance reasonably apprises claimant of nature of compensable conditions refers to acceptance of new medical condition claim, not acceptance previously issued by insurer. Rose v. SAIF, 200 Or App 654, 116 P3d 913 (2005)

Where claimant suffered compensable knee injury and, after claim closed, developed separate condition in same knee that doctors stated was consequential condition, and claimant brought aggravation claim for consequential condition, claim was properly denied because aggravation claim must be based on worsening of underlying condition instead of on consequential condition. Nacoste v. Halton Co., 275 Or App 600, 365 P3d 1098 (2015)

§§ 656.001 to 656.794

Law Review Citations

55 OLR 432-445 (1976); 16 WLR 519 (1979); 22 WLR 559 (1986)

Chapter 656

Notes of Decisions

Party having affirmative of any issue must prove it by preponderance of evidence unless legislature fixes some different quantum of proof. Hutcheson v. Weyerhaeuser Co., 288 Or 51, 602 P2d 268 (1979)

Amendments to existing statutes and enactment of additional statutes by 1995 legislation generally apply to pending cases and to orders still appealable on June 7, 1995, effective date. Volk v. America West Airlines, 135 Or App 565, 899 P2d 746 (1995), Sup Ct review denied

Amendments to existing statutes and enactment of additional statutes by 1995 legislation do not extend or shorten procedural time limitations with regard to actions taken prior to June 7, 1995, effective date. Motel 6 v. McMasters, 135 Or App 583, 899 P2d 1212 (1995)

Atty. Gen. Opinions

Benefit unavailability for inmates engaged in prison work programs, (1996) Vol 48, p 134

Law Review Citations

24 WLR 321, 341 (1988); 32 WLR 217 (1996)


Source
Last accessed
May. 15, 2020