ORS 656.289
Orders of Administrative Law Judge; review; disposition of claim when compensability disputed; approval of director required for reimbursement of certain expenditures


(1)

Upon the conclusion of any hearing, or prior thereto with concurrence of the parties, the Administrative Law Judge shall promptly and not later than 30 days after the hearing determine the matter and make an order in accordance with the Administrative Law Judge’s determination.

(2)

A copy of the order shall be sent forthwith by mail to the Director of the Department of Consumer and Business Services and to all parties in interest.

(3)

The order is final unless, within 30 days after the date on which a copy of the order is mailed to the parties, one of the parties requests a review by the Workers’ Compensation Board under ORS 656.295 (Board review of Administrative Law Judge orders). When one party requests a review by the board, the other party or parties shall have the remainder of the 30-day period and in no case less than 10 days in which to request board review in the same manner. The 10-day requirement may carry the period of time allowed for requests for board reviews beyond the 30th day. The order shall contain a statement explaining the rights of the parties under this subsection and ORS 656.295 (Board review of Administrative Law Judge orders).

(4)

(a) Notwithstanding ORS 656.236 (Compromise and release of claim matters except for medical benefits), in any case where there is a bona fide dispute over compensability of a claim, the parties may, with the approval of an Administrative Law Judge, the board or the court, by agreement make such disposition of the claim as is considered reasonable.

(b)

Insurers or self-insured employers who are parties to an approved disputed claim settlement under this subsection shall not be joined as parties in subsequent proceedings under this chapter to determine responsibility for payment for claim conditions for which settlement has been made.

(c)

Notwithstanding ORS 656.005 (Definitions) (21), as used in this subsection, “party” does not include a noncomplying employer, except where a noncomplying employer has submitted a disputed claim settlement with a claimant for approval before the claim has been referred to an assigned claims agent by the director. Upon approval of the disputed claim settlement, the Administrative Law Judge, the board or the court shall mail to the director a copy of the disputed claim settlement.

(5)

Any claim in which the parties enter into a disposition under subsection (4) of this section shall not be eligible for reimbursement of expenditures from the Workers’ Benefit Fund without the prior approval of the director. [1965 c.285 §35; 1969 c.212 §1; 1977 c.804 §9; 1983 c.809 §3; 1990 c.2 §21; 1995 c.332 §35; 1995 c.641 §19]

Notes of Decisions

Where court found bona fide dispute over compensability and approved settlement agreement between employee and employer, no “compensable claim” existed for which employee could later bring claim for aggravation of previous injury. Seeber v. Marlette Homes, 30 Or App 233, 566 P2d 926 (1977)

Thirty-day time period for appeal from referee’s order begins to run from date of original order and not from date of order correcting irrelevancy in original order. Chisholm v. SAIF, 277 Or 51, 559 P2d 511 (1977)

Whether settlement amount is proportionate to injury and cost incurred is irrelevant where bona fide dispute exists as to compensability. Greenwade v. SAIF, 41 Or App 697, 598 P2d 1265 (1979), Sup Ct review denied

Settlement entered into by one insurer and claimant on issue of responsibility after issuance of order under ORS 656.307 was invalid where there was dispute as to which insurer was responsible for claimant’s injury or condition. J.C. Compton Co. v. DeGraff, 52 Or App 317, 628 P2d 437 (1981), Sup Ct review denied, modified 52 Or App 1023, 630 P2d 395 (1981)

Subsequent injury to same body part does not create bona fide dispute as to claimant’s entitlement to future medical benefits for accepted original injury. EBI Companies v. Freschette, 71 Or App 526, 692 P2d 723 (1984), Sup Ct review denied

Referee cannot extend 30-day appeal period for order determining issues directly affecting claimant’s right to compensation where referee did not intend to reconsider any issue in such order. Farmers Ins. Group v. SAIF, 301 Or 612, 724 P2d 799 (1986)

Where disputed claims settlement agreement between claimant and his insurer provided, in part, that insurer would hold claimant harmless from outstanding medical bills for disputed psychiatric condition, claimant’s unilateral understanding that bill would be paid in full was not part of contract. EBI Companies v. Moore, 90 Or App 99, 750 P2d 1194 (1988)

Provision of health insurance contract requiring loan receipt agreement that insured worker would reimburse health insurance carrier directly for payments made for covered medical expenses was contrary to legislative policy that disputes between health insurance providers and workers’ compensation insurance carriers be settled by arbitration. Pacific Hospital Assn. v. Marchbanks, 91 Or App 459, 756 P2d 648 (1988)

Thirty-day deadline for issuance of order is not limitation on referee’s authority to withdraw or abate decision before time for appeal to Workers’ Compensation Board expires. Lyday v. Liberty Northwest Ins. Corp., 115 Or App 668, 839 P2d 756 (1992)

Where referee signed abatement order within 30-day period but did not mail it until time period had expired, date of abatement order was when it was mailed. Geer v. SAIF, 121 Or App 647, 855 P2d 1145 (1993)

Stipulated settlement agreement approved by administrative law judge is determination by administrative law judge regarding merits of claim and therefore allows for award of attorney fees if compensation was not disallowed or reduced. Deaton v. Hunt-Elder, 145 Or App 110, 928 P2d 992 (1996)

Disputed claim settlement may only dispose of claims that have been formally denied prior to date of settlement. Trevisan v. SAIF, 146 Or App 358, 932 P2d 1202 (1997)

Agreement that provides for claim to remain in denied status must be in form of disputed claim settlement, not stipulation. Simmons v. Lane Mass Transit District, 171 Or App 268, 15 P3d 568 (2000)

Law Review Citations

32 WLR 217 (1996)

§§ 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
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May. 15, 2020