ORS 656.325
Required medical examination

  • worker-requested examination
  • qualified physicians
  • claimant’s duty to reduce disability
  • suspension or reduction of benefits
  • cessation or reduction of temporary total disability benefits
  • rules
  • penalties

(1)

Intentionally left blank —Ed.

(a)

Any worker entitled to receive compensation under this chapter is required, if requested by the Director of the Department of Consumer and Business Services, the insurer or self-insured employer, to submit to a medical examination at a time reasonably convenient for the worker as may be provided by the rules of the director. No more than three independent medical examinations may be requested except after notification to and authorization by the director. If the worker refuses to submit to any such examination, or obstructs the same, the rights of the worker to compensation shall be suspended with the consent of the director until the examination has taken place, and no compensation shall be payable during or for account of such period. The provisions of this paragraph are subject to the limitations on medical examinations provided in ORS 656.268 (Claim closure).

(b)

When a worker is requested by the director, the insurer or self-insured employer to attend an independent medical examination, the examination must be conducted by a physician selected from a list of qualified physicians established by the director under ORS 656.328 (List of authorized providers and standards of professional conduct for providers of independent medical examinations).

(c)

The director shall adopt rules applicable to independent medical examinations conducted pursuant to paragraph (a) of this subsection that:

(A)

Provide a worker the opportunity to request review by the director of the reasonableness of the location selected for an independent medical examination. Upon receipt of the request for review, the director shall conduct an expedited review of the location selected for the independent medical examination and issue an order on the reasonableness of the location of the examination. The director shall determine if there is substantial evidence for the objection to the location for the independent medical examination based on a conclusion that the required travel is medically contraindicated or other good cause establishing that the required travel is unreasonable. The determinations of the director about the location of independent medical examinations are not subject to review.

(B)

Impose a monetary penalty against a worker who fails to attend an independent medical examination without prior notification or without justification for not attending the examination. A penalty imposed under this subparagraph may be imposed only on a worker who is not receiving temporary disability benefits under ORS 656.210 (Temporary total disability) or 656.212 (Temporary partial disability). An insurer or self-insured employer may offset any future compensation payable to the worker to recover any penalty imposed under this subparagraph from a claim with the same insurer or self-insured employer. When a penalty is recovered from temporary disability or permanent total disability benefits, the amount recovered from each payment may not exceed 25 percent of the benefit payment without prior authorization from the worker.

(C)

Impose a sanction against a medical service provider that unreasonably fails to provide in a timely manner diagnostic records required for an independent medical examination.

(d)

Notwithstanding ORS 656.262 (Processing of claims and payment of compensation) (6), if the director determines that the location selected for an independent medical examination is unreasonable, the insurer or self-insured employer shall accept or deny the claim within 90 days after the employer has notice or knowledge of the claim.

(e)

If the worker has made a timely request for a hearing on a denial of compensability as required by ORS 656.319 (Time within which hearing must be requested) (1)(a) that is based on one or more reports of examinations conducted pursuant to paragraph (a) of this subsection and the worker’s attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) does not concur with the report or reports, the worker may request an examination to be conducted by a physician selected by the director from the list described in ORS 656.328 (List of authorized providers and standards of professional conduct for providers of independent medical examinations). The cost of the examination and the examination report shall be paid by the insurer or self-insured employer.

(f)

The insurer or self-insured employer shall pay the costs of the medical examination and related services which are reasonably necessary to allow the worker to submit to any examination requested under this section. As used in this paragraph, “related services” includes, but is not limited to, child care, travel, meals, lodging and an amount equivalent to the worker’s net lost wages for the period during which the worker is absent if the worker does not receive benefits pursuant to ORS 656.210 (Temporary total disability) (4) during the period of absence. A claim for “related services” described in this paragraph shall be made in the manner prescribed by the director.

(g)

A worker who objects to the location of an independent medical examination must request review by the director under paragraph (c)(A) of this subsection within six business days of the date the notice of the independent medical examination was mailed.

(2)

For any period of time during which any worker commits insanitary or injurious practices which tend to either imperil or retard recovery of the worker, or refuses to submit to such medical or surgical treatment as is reasonably essential to promote recovery, or fails to participate in a program of physical rehabilitation, the right of the worker to compensation shall be suspended with the consent of the director and no payment shall be made for such period. The period during which such worker would otherwise be entitled to compensation may be reduced with the consent of the director to such an extent as the disability has been increased by such refusal.

(3)

A worker who has received an award for permanent total or permanent partial disability should be encouraged to make a reasonable effort to reduce the disability; and the award shall be subject to periodic examination and adjustment in conformity with ORS 656.268 (Claim closure).

(4)

When the employer of an injured worker, or the employer’s insurer determines that the injured worker has failed to follow medical advice from the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) or has failed to participate in or complete physical restoration or vocational rehabilitation programs prescribed for the worker pursuant to this chapter, the employer or insurer may petition the director for reduction of any benefits awarded the worker. Notwithstanding any other provision of this chapter, if the director finds that the worker has failed to accept treatment as provided in this subsection, the director may reduce any benefits awarded the worker by such amount as the director considers appropriate.

(5)

Intentionally left blank —Ed.

(a)

Except as provided by ORS 656.268 (Claim closure) (4)(c) and (11), an insurer or self-insured employer shall cease making payments pursuant to ORS 656.210 (Temporary total disability) and shall commence making payment of such amounts as are due pursuant to ORS 656.212 (Temporary partial disability) when an injured worker refuses wage earning employment prior to claim determination and the worker’s attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided), after being notified by the employer of the specific duties to be performed by the injured worker, agrees that the injured worker is capable of performing the employment offered.

(b)

If the worker has been terminated for violation of work rules or other disciplinary reasons, the insurer or self-insured employer shall cease payments pursuant to ORS 656.210 (Temporary total disability) and commence payments pursuant to ORS 656.212 (Temporary partial disability) when the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) approves employment in a modified job that would have been offered to the worker if the worker had remained employed, provided that the employer has a written policy of offering modified work to injured workers.

(c)

If the worker is a person present in the United States in violation of federal immigration laws, the insurer or self-insured employer shall cease payments pursuant to ORS 656.210 (Temporary total disability) and commence payments pursuant to ORS 656.212 (Temporary partial disability) when the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) approves employment in a modified job whether or not such a job is available.

(6)

Any party may request a hearing on any dispute under this section pursuant to ORS 656.283 (Hearing rights and procedure). [Formerly 656.280; 1977 c.804 §12; 1977 c.868 §4; 1979 c.839 §29; 1981 c.535 §10; 1981 c.723 §4; 1981 c.854 §23; 1983 c.816 §8; 1985 c.770 §7; 1987 c.884 §43; 1989 c.598 §1; 1990 c.2 §25; 1995 c.332 §40; 2001 c.865 §13; 2003 c.657 §§11,12; 2003 c.811 §§13,14; 2005 c.675 §§1,2; 2007 c.274 §6; 2007 c.365 §7; 2011 c.99 §4]

Source: Section 656.325 — Required medical examination; worker-requested examination; qualified physicians; claimant’s duty to reduce disability; suspension or reduction of benefits; cessation or reduction of temporary total disability benefits; rules; penalties, https://www.­oregonlegislature.­gov/bills_laws/ors/ors656.­html.

Notes of Decisions

Since licensed clinical psychologist is not doctor or physician, claimant had no duty to submit to psychological examination to determine whether or not his disease was occupational and compensable. Frey v. Willamette Ind., Inc., 13 Or App 449, 509 P2d 861 (1973), Sup Ct review denied

Where, on original claim, court held that employee’s refusal to undergo myelogram and possible resulting surgery was reasonable, employee’s refusal to submit to myelography did not bar recovery for aggravation of initial injury. Waldroup v. J. C. Penney Company, 30 Or App 443, 567 P2d 576 (1977)

Refusal to submit to medical treatment is not absolute bar to recovery, but is factor considered in determining what treatment is “reasonably essential” Waldroup v. J. C. Penney Company, 30 Or App 443, 567 P2d 576 (1977)

Where appeal period has run, insurer may seek redetermination of award where there is available medical or other evidence that injured worker’s condition has improved. Bentley v. SAIF, 38 Or App 473, 590 P2d 746 (1979)

Injured party has duty to mitigate damages and therefore downrating of claimant’s disability to reflect failure to lose excess weight was proper. Nelson v. EBI Companies, 64 Or App 16, 666 P2d 1360 (1983), aff’d 296 Or 246, 674 P2d 596 (1984)

Claimant may not be denied benefits for reasonable refusal of treatment essential to promote recovery. Reef v. Willamette Industries, 65 Or App 366, 671 P2d 1197 (1983), Sup Ct review denied

Because temporary benefits are compensation for loss of wages, worker suffering aggravation after retirement does not qualify. Cutright v. Weyerhaeuser, 299 Or 290, 702 P2d 403 (1985)

Where claimant suffers aggravation while in workforce, claimant is entitled to temporary total disability benefits until medically stationary and released for work even though claimant voluntarily withdraws from workforce prior to closure of claim. Weyerhaeuser Co. v. Kepford, 100 Or App 410, 786 P2d 745 (1990), Sup Ct review denied

Insurer may seek board review of director’s order re-examining award of permanent total disability. Lehman v. SAIF, 107 Or App 207, 811 P2d 924 (1991)

Injury incurred during compelled medical examination requested by employer is analyzed as independent work-related injury, not consequence of original compensable injury. Robinson v. Nabisco, Inc., 331 Or 178, 11 P3d 1286 (2000)

Worker “entitled to receive compensation” includes worker whose claim has been denied and who is pursuing challenge to denial. Darling v. Johnson Controls Battery Group, Inc., 188 Or App 190, 70 P3d 894 (2003), Sup Ct review denied

Whether employer has written policy of offering modified work to injured workers is determined as of time physician approves modified job that would have been offered to worker, not time of worker injury. Morales v. SAIF, 196 Or App 693, 103 P3d 654 (2004), aff’d 339 Or 574, 124 P3d 1233 (2005)

Requirement that employer cease payment of temporary total disability benefits under specified circumstances applies to both initial and aggravation claims. Morales v. SAIF, 196 Or App 693, 103 P3d 654 (2004), aff’d 339 Or 574, 124 P3d 1233 (2005)

Suspension sanction for claimant failure to cooperate with insurer medical examination prevents using failure as basis for denying claim under ORS 656.262. Lewis v. CIGNA Insurance Co., 339 Or 342, 121 P3d 1128 (2005)

Where worker is terminated following return to modified employment, requirement to pay temporary total disability benefits until attending physician approves modified employment does not apply. SAIF v. Vivanco, 216 Or App 210, 173 P3d 160 (2007)

Attorney General Opinions

Workers’ Compensation Board’s authority to order payment of claimant’s attorney fees, (1978) Vol 38, p 2069

656.001
Short title
656.003
Application of definitions to construction of chapter
656.005
Definitions
656.006
Effect on employers’ liability law
656.008
Extension of laws relating to workers’ compensation to federal lands and projects within state
656.010
Treatment by spiritual means
656.012
Findings and policy
656.017
Employer required to pay compensation and perform other duties
656.018
Effect of providing coverage
656.019
Civil negligence action for claim denied on basis of failure to meet major contributing cause standard
656.020
Damage actions by workers against noncomplying employers
656.021
Coverage exception for laborers under contracts with construction and landscape contractor licensees
656.023
Who are subject employers
656.025
Individuals engaged in commuter ridesharing not subject workers
656.027
Who are subject workers
656.029
Obligation of person awarding contract to provide coverage for workers under contract
656.031
Coverage for municipal volunteer personnel
656.033
Coverage for participants in work experience or school directed professional training programs
656.035
Status of workers in separate occupations of employer
656.037
Exemption from coverage for persons engaged in certain real estate activities
656.039
Election of coverage for workers not subject to law
656.041
City or county may elect to provide coverage for adults in custody
656.043
Governmental agency paying wages responsible for providing coverage
656.044
State Accident Insurance Fund Corporation may insure liability under Longshoremen’s and Harbor Workers’ Compensation Act
656.046
Coverage of persons in college work experience and professional education programs
656.052
Prohibition against employment without coverage
656.054
Claim of injured worker of noncomplying employer
656.056
Subject employers must post notice of manner of compliance
656.070
Definitions for ORS 656.027, 656.070 and 656.075
656.075
Exemption from coverage for newspaper carriers
656.126
Coverage while temporarily in or out of state
656.128
Sole proprietors, limited liability company members, partners, independent contractors may elect coverage by insurer
656.132
Coverage of minors
656.135
Coverage of deaf school work experience trainees
656.138
Coverage of apprentices, trainees participating in related instruction classes
656.140
Coverage of persons operating equipment for hire
656.154
Injury due to negligence or wrong of a person not in the same employ as injured worker
656.156
Intentional injuries
656.160
Effect of incarceration on receipt of compensation
656.170
Validity of provisions of certain collective bargaining agreements
656.172
Applicability of and criteria for establishing program under ORS 656.170
656.174
Rules
656.202
Compensation payable to subject worker in accordance with law in effect at time of injury
656.204
Death
656.206
Permanent total disability
656.208
Death during permanent total disability
656.209
Offsetting permanent total disability benefits against Social Security benefits
656.210
Temporary total disability
656.211
“Average weekly wage” defined
656.212
Temporary partial disability
656.214
Permanent partial disability
656.216
Permanent partial disability
656.218
Continuance of permanent partial disability payments to survivors
656.222
Compensation for additional accident
656.225
Compensability of certain preexisting conditions
656.226
Cohabitants and children entitled to compensation
656.228
Payments directly to beneficiary or custodian
656.230
Lump sum award payments
656.232
Payments to aliens residing outside of United States
656.234
Compensation not assignable nor to pass by operation of law
656.236
Compromise and release of claim matters except for medical benefits
656.240
Deduction of benefits from sick leave payments paid to employees
656.245
Medical services to be provided
656.247
Payment for medical services prior to claim acceptance or denial
656.248
Medical service fee schedules
656.250
Limitation on compensability of physical therapist services
656.252
Medical report regulation
656.254
Medical report forms
656.256
Considerations for rules regarding certain rural hospitals
656.258
Vocational assistance service payments
656.260
Certification procedure for managed health care provider
656.262
Processing of claims and payment of compensation
656.263
To whom notices sent under ORS 656.262, 656.265, 656.268 to 656.289, 656.295 to 656.325 and 656.382 to 656.388
656.264
Compensable injury, denied claim and other reports
656.265
Notice of accident from worker
656.266
Burden of proving compensability and nature and extent of disability
656.267
Claims for new and omitted medical conditions
656.268
Claim closure
656.273
Aggravation for worsened conditions
656.277
Request for reclassification of nondisabling claim
656.278
Board has continuing authority to alter earlier action on claim
656.283
Hearing rights and procedure
656.285
Protection of witnesses at hearings
656.287
Use of vocational reports in determining loss of earning capacity at hearing
656.289
Orders of Administrative Law Judge
656.291
Expedited Claim Service
656.295
Board review of Administrative Law Judge orders
656.298
Judicial review of board orders
656.304
When acceptance of compensation precludes hearing
656.307
Determination of issues regarding responsibility for compensation payment
656.308
Responsibility for payment of claims
656.310
Presumption concerning notice of injury and self-inflicted injuries
656.313
Stay of compensation pending request for hearing or review
656.319
Time within which hearing must be requested
656.325
Required medical examination
656.327
Review of medical treatment of worker
656.328
List of authorized providers and standards of professional conduct for providers of independent medical examinations
656.331
Contact, medical examination of worker represented by attorney prohibited without written notice
656.340
Vocational assistance procedure
656.360
Confidentiality of worker medical and vocational claim records
656.362
Liability for disclosure of worker medical and vocational claim records
656.382
Penalties and attorney fees payable by insurer or employer in processing claim
656.383
Attorney fees in cases prior to decision or after request for hearing
656.385
Attorney fees in cases regarding certain medical service or vocational rehabilitation matters
656.386
Recovery of attorney fees, expenses and costs in appeal on denied claim
656.388
Approval of attorney fees required
656.390
Frivolous appeals, hearing requests or motions
656.403
Obligations of self-insured employer
656.407
Qualifications of insured employers
656.419
Workers’ compensation insurance contracts
656.423
Cancellation of coverage by employer
656.427
Termination of workers’ compensation insurance contract or surety bond liability by insurer
656.430
Certification of self-insured employer
656.434
Certification effective until canceled or revoked
656.440
Notice of certificate revocation
656.441
Advancement of funds from Workers’ Benefit Fund for compensation due workers insured by certain decertified self-insured employer groups
656.443
Procedure upon default by employer or self-insured employer group
656.445
Advancement of funds from Workers’ Benefit Fund for compensation due workers insured by insurer in default
656.447
Sanctions against insurer for failure to comply with contracts, orders or rules
656.455
Self-insured employers to process claims and make records available at authorized locations
656.502
“Fiscal year” defined
656.504
Rates, charges, fees and reports by employers insured by State Accident Insurance Fund Corporation
656.505
Estimate of payroll when employer fails to file payroll report
656.506
Assessments for programs
656.508
Authority to fix premium rates for employers
656.526
Distribution of dividends from surplus in Industrial Accident Fund
656.536
Premium charges for coverage of reforestation cooperative workers based on prevailing wage
656.552
Deposit of cash, bond or letter of credit to secure payment of employer’s premiums
656.554
Injunction against employer failing to comply with deposit requirements
656.556
Liability of person letting a contract for amounts due from contractor
656.560
Default in payment of premiums, fees, assessments or deposit
656.562
Moneys due Industrial Accident Fund as preferred claims
656.564
Lien for amounts due from employer on real property, improvements and equipment on or with which labor is performed by workers of employer
656.566
Lien on property of employer for amounts due
656.576
“Paying agency” defined
656.578
Workers’ election whether to sue third person or noncomplying employer for damages
656.580
Payment of compensation notwithstanding cause of action for damages
656.583
Paying agency may compel election and prompt action
656.587
Paying agency must join in any compromise
656.591
Election not to bring action operates as assignment of cause of action
656.593
Procedure when worker or beneficiary elects to bring action
656.595
Precedence of cause of action
656.596
Damage recovery as offset against compensation
656.602
Disbursement procedures
656.605
Workers’ Benefit Fund
656.612
Assessments for department activities
656.614
Self-Insured Employer Adjustment Reserve
656.622
Reemployment Assistance Program
656.625
Reopened Claims Program
656.628
Workers with Disabilities Program
656.630
Oregon Institute of Occupational Health Sciences funding
656.632
Industrial Accident Fund
656.634
Trust fund status of Industrial Accident Fund
656.635
Reserve accounts in Industrial Accident Fund
656.636
Reserves in Industrial Accident Fund for awards for permanent disability or death
656.640
Creation of reserves
656.642
Emergency Fund
656.644
Petty cash funds
656.702
Disclosure of records of corporation, department and insurers
656.704
Actions and orders regarding matters concerning claim and matters other than matters concerning claim
656.708
Hearings Division
656.709
Ombudsman for injured workers
656.712
Workers’ Compensation Board
656.714
Removal of board member
656.716
Board members not to engage in political or business activity that interferes with duties as board member
656.718
Chairperson
656.720
Prosecution and defense of actions by Attorney General and district attorneys
656.722
Authority to employ subordinates
656.724
Administrative Law Judges
656.725
Duties and status of Administrative Law Judges
656.726
Duties and powers to carry out workers’ compensation and occupational safety laws
656.727
Rules for administration of benefit offset
656.730
Assigned risk plan
656.732
Power to compel obedience to subpoenas and punish for misconduct
656.735
Civil penalty for noncomplying employers
656.740
Review of proposed order declaring noncomplying employer or nonsubjectivity determination
656.745
Civil penalty for inducing failure to report claims
656.751
State Accident Insurance Fund Corporation created
656.752
State Accident Insurance Fund Corporation
656.753
State Accident Insurance Fund Corporation exempt from certain financial administration laws
656.754
Manager
656.758
Inspection of books, records and payrolls
656.772
Annual audit of State Accident Insurance Fund Corporation by Secretary of State
656.774
Annual report by State Accident Insurance Fund Corporation to Secretary of State
656.776
Notice to Secretary of State regarding action on audit report
656.780
Certification and training of claims examiners
656.790
Workers’ Compensation Management-Labor Advisory Committee
656.794
Advisory committee on medical care
656.795
Informational materials for nurse practitioners
656.797
Certification by nurse practitioner of review of required materials
656.798
Duty of insurer, self-insured employer and self-insured employer group to provide information to director
656.799
Informational materials for other health care professionals
656.802
Occupational disease
656.804
Occupational disease as an injury under Workers’ Compensation Law
656.807
Time for filing of claims for occupational disease
656.850
License
656.855
Licensing system for worker leasing companies
656.990
Penalties
Green check means up to date. Up to date