ORS 656.327
Review of medical treatment of worker

  • findings
  • review
  • costs

(1)

Intentionally left blank —Ed.

(a)

If an injured worker, an insurer or self-insured employer or the Director of the Department of Consumer and Business Services believes that the medical treatment, not subject to ORS 656.260 (Certification procedure for managed health care provider), that the injured worker has received, is receiving, will receive or is proposed to receive is excessive, inappropriate, ineffectual or in violation of rules regarding the performance of medical services, the injured worker, insurer or self-insured employer must request administrative review of the treatment by the director prior to requesting a hearing on the issue and so notify the parties.

(b)

Unless the director issues an order finding that no bona fide medical services dispute exists, the director shall review the matter as provided in this section. Appeal of an order finding that no bona fide medical services dispute exists shall be made directly to the Workers’ Compensation Board within 30 days after issuance of the order. The board shall set aside or remand the order only if the board finds that the order is not supported by substantial evidence in the record. Substantial evidence exists to support a finding in the order when the record, reviewed as a whole, would permit a reasonable person to make that finding. The decision of the board is not subject to review by any other court or administrative agency.

(c)

The insurer or self-insured employer shall not deny the claim for medical services nor shall the worker request a hearing on any issue under this section until the director issues an order under subsection (2) of this section.

(2)

The director shall review medical information and records regarding the treatment. The director may cause an appropriate medical service provider to perform reasonable and appropriate tests, other than invasive tests, upon the worker and may examine the worker. Notwithstanding ORS 656.325 (Required medical examination) (1), the worker may refuse a test without sanction. Review of the medical treatment shall be completed and the director shall issue an order within 60 days of the request for review. The director shall create a documentary record sufficient for purposes of judicial review. If the worker, insurer, self-insured employer or medical service provider is dissatisfied with that order, the dissatisfied party may request review under ORS 656.704 (Actions and orders regarding matters concerning claim and matters other than matters concerning claim). The administrative order may be modified at hearing only if it is not supported by substantial evidence in the record or if it reflects an error of law. No new medical evidence or issues shall be admitted. The worker is not obligated to pay for medical treatment determined not to be compensable under this subsection.

(3)

Upon request of either party, the director may delegate to a physician or a panel of physicians the review of medical treatment under this section. At least one member of any such panel shall be a practitioner of the healing art of the medical service provider whose treatment is being reviewed. No member of any such panel shall be a physician whose treatment is the subject of review. The panel shall be chosen in such manner as the director may prescribe, in consultation with the committee referred to in ORS 656.790 (Workers’ Compensation Management-Labor Advisory Committee). The physician or panel shall submit findings to the director within the time limits as prescribed by the director.

(4)

The physician or the panel of physicians and the medical arbiter or panel of medical arbiters appointed pursuant to ORS 656.268 (Claim closure) acting pursuant to the authority of the director are agents of the Department of Consumer and Business Services and are subject to the provisions of ORS 30.260 (Definitions for ORS 30.260 to 30.300) to 30.300 (ORS 30.260 to 30.300 exclusive). The findings of the physician or panel of physicians, the medical arbiter or panel of medical arbiters, all of the records and all communications to or before a panel or arbiter are privileged and are not discoverable or admissible in any proceeding other than those proceedings under this chapter. No member of a panel or a medical arbiter shall be examined or subject to administrative or civil liability regarding participation in or the findings of the panel or medical arbiter or any matter before the panel or medical arbiter other than in proceedings under this chapter.

(5)

The costs of review of medical treatment by the physician or panel of physicians pursuant to this section and costs incurred by the worker in attending any examination required under this section, including child care, transportation, lodging and meals, shall be paid by the insurer or self-insured employer. [1987 c.884 §29; 1990 c.2 §26; 1995 c.332 §41; 2005 c.26 §12]

Source: Section 656.327 — Review of medical treatment of worker; findings; review; costs, https://www.­oregonlegislature.­gov/bills_laws/ors/ors656.­html.

Notes of Decisions

Director has exclusive power to review appropriateness of ongoing or proposed medical treatment. Liberty Northwest Ins. Corp. v. Yon, 137 Or App 413, 904 P2d 645 (1995)

Contested case hearing is not prerequisite to appellate review of director’s decision. Quaker State Oil Co. v. Taskinen, 147 Or App 245, 935 P2d 1229 (1997), Sup Ct review denied

Requirement for contested case hearing before Director of Department of Consumer and Business Services pursuant to [former] ORS 183.310 to 183.550 is modified by other restrictions on hearing, therefore full contested case hearing is not required. O’Neil v. National Union Fire, 152 Or App 497, 954 P2d 847 (1998), Sup Ct review denied

Director of Department of Consumer and Business Services may limit time available for employer to request administrative review of proposed treatment. Roseburg Forest Products v. Humbert, 212 Or App 285, 158 P3d 21 (2007), Sup Ct review denied

Law Review Citations

32 WLR 217 (1996)

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

Current through early 2024

§ 656.327’s source at oregon​.gov