Workers' Compensation

ORS 656.704
Actions and orders regarding matters concerning claim and matters other than matters concerning claim

  • authority of director and board
  • administrative and judicial review
  • rules


(1)

Actions and orders of the Director of the Department of Consumer and Business Services regarding matters concerning a claim under this chapter, and administrative and judicial review of those matters, are subject to the procedural provisions of this chapter and such procedural rules as the Workers’ Compensation Board may prescribe.

(2)

(a) A party dissatisfied with an action or order regarding a matter other than a matter concerning a claim under this chapter may request a hearing on the matter in writing to the director. The director shall refer the request for hearing to the Workers’ Compensation Board for a hearing before an Administrative Law Judge. Review of an order issued by the Administrative Law Judge shall be by the director and the director shall issue a final order that is subject to judicial review as provided by ORS 183.480 (Judicial review of agency orders) to 183.497 (Awarding costs and attorney fees when finding for petitioner).

(b)

The director shall prescribe the classes of orders issued under this subsection by Administrative Law Judges and other personnel that are final, appealable orders and those orders that are preliminary orders subject to revision by the director.

(3)

(a) For the purpose of determining the respective authority of the director and the board to conduct hearings, investigations and other proceedings under this chapter, and for determining the procedure for the conduct and review thereof, matters concerning a claim under this chapter are those matters in which a worker’s right to receive compensation, or the amount thereof, are directly in issue. However, subject to paragraph (b) of this subsection, such matters do not include any disputes arising under ORS 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), 656.260 (Certification procedure for managed health care provider) or 656.327 (Review of medical treatment of worker), any other provisions directly relating to the provision of medical services to workers or any disputes arising under ORS 656.340 (Vocational assistance procedure) except as those provisions may otherwise provide.

(b)

The respective authority of the board and the director to resolve medical service disputes shall be determined according to the following principles:

(A)

Any dispute that requires a determination of the compensability of the medical condition for which medical services are proposed is a matter concerning a claim.

(B)

Any dispute that requires a determination of whether medical services are excessive, inappropriate, ineffectual or in violation of the rules regarding the performance of medical services, or a determination of whether medical services for an accepted condition qualify as compensable medical services among those listed in ORS 656.245 (Medical services to be provided) (1)(c), is not a matter concerning a claim.

(C)

Any dispute that requires a determination of whether a sufficient causal relationship exists between medical services and an accepted claim to establish compensability is a matter concerning a claim.

(c)

Notwithstanding ORS 656.283 (Hearing rights and procedure) (3), if parties to a hearing scheduled before an Administrative Law Judge are involved in a dispute regarding both matters concerning a claim and matters not concerning a claim, the Administrative Law Judge may defer any action on the matter concerning a claim until the director has completed an administrative review of the matters other than those concerning a claim. The director shall mail a copy of the administrative order to the parties and to the Administrative Law Judge. A party may request a hearing on the order of the director. At the request of a party or by the own motion of the Administrative Law Judge, the hearings on the separate matters may be consolidated. The Administrative Law Judge shall issue an order for those matters concerning a claim and a separate order for matters other than those concerning a claim.

(4)

Hearings under ORS 656.740 (Review of proposed order declaring noncomplying employer or nonsubjectivity determination) shall be conducted by an Administrative Law Judge from the board’s Hearings Division.

(5)

If a request for hearing or administrative review is filed with either the director or the board and it is determined that the request should have been filed with the other, the dispute shall be transferred. Filing a request will be timely filed if the original filing was completed within the prescribed time. [1965 c.285 §54b; 1977 c.804 §23; 1979 c.839 §16; 1981 c.874 §11; 1985 c.770 §8; 1987 c.373 §38a; 1990 c.2 §37; 1995 c.332 §50; 1999 c.849 §§121a,121c,121e; 1999 c.876 §4; 1999 c.926 §2; 2003 c.75 §48; 2005 c.26 §15; 2009 c.35 §5]

Notes of Decisions

Board has no jurisdiction over dispute between carriers not affecting claimant's right to compensation. Renolds-Croft v. Bill Morrison Co., 55 Or App 487, 638 P2d 495 (1982)

Board had jurisdiction to consider carriers' requests that Board order repayment of or offset for monies erroneously sent to claimant. SAIF v. Zorich, 94 Or App 661, 766 P2d 1053 (1989)

Referee has subject matter jurisdiction over case even if request for hearing is subject to denial as untimely. SAIF v. Roles, 111 Or App 597, 826 P2d 1039 (1992), Sup Ct review denied

Workers' Compensation Board conclusion that naturopathic physician acted beyond scope of license was within board's authority for purposes of determining whether treatment compensable. Stiehl v. Timber Products, 115 Or App 651, 839 P2d 755 (1992)

Determination whether employer or worker is subject to Act is not reviewable by board because worker's right to receive compensation is not directly in issue. Lankford v. Copeland, 141 Or App 138, 917 P2d 55 (1996)

Dispute over medical services related to compensable claim is to be decided by Director of Department of Consumer and Business Services, regardless of when or how dispute first arose. Roseburg Forest Products v. Langley, 156 Or App 454, 965 P2d 477 (1998)

Where issue changes from one within jurisdiction of Workers' Compensation Board to one outside jurisdiction of board, transferal of case to Director of Department of Consumer and Business Services is not available and case must be dismissed. SAIF v. Shipley, 326 Or 557, 955 P2d 244 (1998)

Where employer challenges both causal relationship between medical services and accepted claim and medical appropriateness of services, both issues must be resolved favorably to claimant for services to be compensable. AIG Claim Services, Inc. v. Cole, 205 Or App 170, 133 P3d 357 (2006), Sup Ct review denied

On reconsideration of notice of closure, Director of Department of Consumer and Business Services may determine amount of disability compensation to which claimant is entitled. Martin v. SAIF, 247 Or App 377, 270 P3d 296 (2011)

Director of Department of Consumer and Business Services is not authorized to determine whether factual dispute exists concerning causal relationship between claimant's medical services and accepted injury and may not deny transfer of issue to Workers' Compensation Board based on determination. Daugherty v. SAIF, 258 Or App 512, 310 P3d 713 (2013)

§§ 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
Jun. 26, 2021