Source: https://www.oregonlaws.org/ors/656.268
Timestamp: 2019-01-21 14:25:31
Document Index: 713136232

Matched Legal Cases: ['§31', '§3', '§2', '§5', '§1', '§4', '§7', '§19', '§13', '§1', '§8', '§10', '§16', '§1', '§30', '§1', '§1', '§1', '§3', '§1', '§63', '§12', '§1', '§7', '§11', '§1', '§3', '§1', '§11', '§4', '§4', '§6', '§2', '§1', '§1', '§1']

ORS 656.268 - Claim closure - 2017 Oregon Revised Statutes
2017 ORS Vol. 14 Chapter 656 Section 656.268
2017 ORS 656.268¹
• termination of temporary total disability benefits
• reconsideration of closure
• medical arbiter to make findings of impairment for reconsideration
• credit or offset for fraudulently obtained or overpaid benefits
(1) One purpose of this chapter is to restore the injured worker as soon as possible and as near as possible to a condition of self support and maintenance as an able-bodied worker. The insurer or self-insured employer shall close the worker’s claim, as prescribed by the Director of the Department of Consumer and Business Services, and determine the extent of the worker’s permanent disability, provided the worker is not enrolled and actively engaged in training according to rules adopted by the director pursuant to ORS 656.340 (Vocational assistance procedure) and 656.726 (Duties and powers to carry out workers’ compensation and occupational safety laws), when:
(a) The worker has become medically stationary and there is sufficient information to determine permanent disability;
(b) The accepted injury is no longer the major contributing cause of the worker’s combined or consequential condition or conditions pursuant to ORS 656.005 (Definitions) (7). When the claim is closed because the accepted injury is no longer the major contributing cause of the worker’s combined or consequential condition or conditions, and there is sufficient information to determine permanent disability, the likely permanent disability that would have been due to the current accepted condition shall be estimated;
(c) Without the approval of the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided), the worker fails to seek medical treatment for a period of 30 days or the worker fails to attend a closing examination, unless the worker affirmatively establishes that such failure is attributable to reasons beyond the worker’s control; or
(d) An insurer or self-insured employer finds that a worker who has been receiving permanent total disability benefits has materially improved and is capable of regularly performing work at a gainful and suitable occupation.
(2) If the worker is enrolled and actively engaged in training according to rules adopted pursuant to ORS 656.340 (Vocational assistance procedure) and 656.726 (Duties and powers to carry out workers’ compensation and occupational safety laws), the temporary disability compensation shall be proportionately reduced by any sums earned during the training.
(3) A copy of all medical reports and reports of vocational rehabilitation agencies or counselors shall be furnished to the worker, if requested by the worker.
(4) Temporary total disability benefits shall continue until whichever of the following events first occurs:
(a) The worker returns to regular or modified employment;
(b) The attending physician or nurse practitioner who has authorized temporary disability benefits for the worker under ORS 656.245 (Medical services to be provided) advises the worker and documents in writing that the worker is released to return to regular employment;
(c) The attending physician or nurse practitioner who has authorized temporary disability benefits for the worker under ORS 656.245 (Medical services to be provided) advises the worker and documents in writing that the worker is released to return to modified employment, such employment is offered in writing to the worker and the worker fails to begin such employment. However, an offer of modified employment may be refused by the worker without the termination of temporary total disability benefits if the offer:
(A) Requires a commute that is beyond the physical capacity of the worker according to the worker’s attending physician or the nurse practitioner who may authorize temporary disability under ORS 656.245 (Medical services to be provided);
(B) Is at a work site more than 50 miles one way from where the worker was injured unless the site is less than 50 miles from the worker’s residence or the intent of the parties at the time of hire or as established by the pattern of employment prior to the injury was that the employer had multiple or mobile work sites and the worker could be assigned to any such site;
(C) Is not with the employer at injury;
(D) Is not at a work site of the employer at injury;
(E) Is not consistent with the existing written shift change policy or is not consistent with common practice of the employer at injury or aggravation; or
(F) Is not consistent with an existing shift change provision of an applicable collective bargaining agreement;
(d) Any other event that causes temporary disability benefits to be lawfully suspended, withheld or terminated under ORS 656.262 (Processing of claims and payment of compensation) (4) or other provisions of this chapter; or
(e) Notwithstanding paragraph (c)(C), (D), (E) and (F) of this subsection, the attending physician or nurse practitioner who has authorized temporary disability benefits under ORS 656.245 (Medical services to be provided) for a home care worker who has been made a subject worker pursuant to ORS 656.039 (Election of coverage for workers not subject to law) advises the home care worker and documents in writing that the home care worker is released to return to modified employment, appropriate modified employment is offered in writing by the Home Care Commission or a designee of the commission to the home care worker for any client of the Department of Human Services who employs a home care worker and the home care worker fails to begin the employment.
(5)(a) Findings by the insurer or self-insured employer regarding the extent of the worker’s disability in closure of the claim shall be pursuant to the standards prescribed by the director.
(b) The insurer or self-insured employer shall issue a notice of closure of the claim to the worker, to the worker’s attorney if the worker is represented, and to the director. If the worker is deceased at the time the notice of closure is issued, the insurer or self-insured employer shall mail the worker’s copy of the notice of closure, addressed to the estate of the worker, to the worker’s last known address and may mail copies of the notice of closure to any known or potential beneficiaries to the estate of the deceased worker.
(c) The notice of closure must inform:
(A) The parties, in boldfaced type, of the proper manner in which to proceed if they are dissatisfied with the terms of the notice of closure;
(B) The worker of:
(i) The amount of any further compensation, including permanent disability compensation to be awarded;
(ii) The duration of temporary total or temporary partial disability compensation;
(iii) The right of the worker or beneficiaries of the worker who were mailed a copy of the notice of closure under paragraph (b) of this subsection to request reconsideration by the director under this section within 60 days of the date of the notice of closure;
(iv) The right of beneficiaries who were not mailed a copy of the notice of closure under paragraph (b) of this subsection to request reconsideration by the director under this section within one year of the date the notice of closure was mailed to the estate of the worker under paragraph (b) of this subsection;
(v) The right of the insurer or self-insured employer to request reconsideration by the director under this section within seven days of the date of the notice of closure;
(vi) The aggravation rights; and
(vii) Any other information as the director may require; and
(C) Any beneficiaries of death benefits to which they may be entitled pursuant to ORS 656.204 (Death) and 656.208 (Death during permanent total disability).
(d) If the insurer or self-insured employer has not issued a notice of closure, the worker may request closure. Within 10 days of receipt of a written request from the worker, the insurer or self-insured employer shall issue a notice of closure if the requirements of this section have been met or a notice of refusal to close if the requirements of this section have not been met. A notice of refusal to close shall advise the worker of:
(A) The decision not to close;
(B) The right of the worker to request a hearing pursuant to ORS 656.283 (Hearing rights and procedure) within 60 days of the date of the notice of refusal to close;
(C) The right to be represented by an attorney; and
(D) Any other information as the director may require.
(e) If a worker, a worker’s beneficiary, an insurer or a self-insured employer objects to the notice of closure, the objecting party first must request reconsideration by the director under this section. A worker’s request for reconsideration must be made within 60 days of the date of the notice of closure. If the worker is deceased at the time the notice of closure is issued, a request for reconsideration by a beneficiary of the worker who was mailed a copy of the notice of closure under paragraph (b) of this subsection must be made within 60 days of the date of the notice of closure. A request for reconsideration by a beneficiary to the estate of a deceased worker who was not mailed a copy of the notice of closure under paragraph (b) of this subsection must be made within one year of the date the notice of closure was mailed to the estate of the worker under paragraph (b) of this subsection. A request for reconsideration by an insurer or self-insured employer may be based only on disagreement with the findings used to rate impairment and must be made within seven days of the date of the notice of closure.
(f) If an insurer or self-insured employer has closed a claim or refused to close a claim pursuant to this section, if the correctness of that notice of closure or refusal to close is at issue in a hearing on the claim and if a finding is made at the hearing that the notice of closure or refusal to close was not reasonable, a penalty shall be assessed against the insurer or self-insured employer and paid to the worker in an amount equal to 25 percent of all compensation determined to be then due the claimant.
(g) If, upon reconsideration of a claim closed by an insurer or self-insured employer, the director orders an increase by 25 percent or more of the amount of compensation to be paid to the worker for permanent disability and the worker is found upon reconsideration to be at least 20 percent permanently disabled, a penalty shall be assessed against the insurer or self-insured employer and paid to the worker in an amount equal to 25 percent of all compensation determined to be then due the claimant. If the increase in compensation results from information that the insurer or self-insured employer demonstrates the insurer or self-insured employer could not reasonably have known at the time of claim closure, from new information obtained through a medical arbiter examination or from a determination order issued by the director that addresses the extent of the worker’s permanent disability that is not based on the standards adopted pursuant to ORS 656.726 (Duties and powers to carry out workers’ compensation and occupational safety laws) (4)(f), the penalty shall not be assessed.
(6)(a) Notwithstanding any other provision of law, only one reconsideration proceeding may be held on each notice of closure. At the reconsideration proceeding:
(A) A deposition arranged by the worker, limited to the testimony and cross-examination of the worker about the worker’s condition at the time of claim closure, shall become part of the reconsideration record. The deposition must be conducted subject to the opportunity for cross-examination by the insurer or self-insured employer and in accordance with rules adopted by the director. The cost of the court reporter, interpreter services, if necessary, and one original of the transcript of the deposition for the Department of Consumer and Business Services and one copy of the transcript of the deposition for each party shall be paid by the insurer or self-insured employer. The reconsideration proceeding may not be postponed to receive a deposition taken under this subparagraph. A deposition taken in accordance with this subparagraph may be received as evidence at a hearing even if the deposition is not prepared in time for use in the reconsideration proceeding.
(B) Pursuant to rules adopted by the director, the worker or the insurer or self-insured employer may correct information in the record that is erroneous and may submit any medical evidence that should have been but was not submitted by the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) at the time of claim closure.
(C) If the director determines that a claim was not closed in accordance with subsection (1) of this section, the director may rescind the closure.
(b) If necessary, the director may require additional medical or other information with respect to the claims and may postpone the reconsideration for not more than 60 additional calendar days.
(c) In any reconsideration proceeding under this section in which the worker was represented by an attorney, the director shall order the insurer or self-insured employer to pay to the attorney, out of the additional compensation awarded, an amount equal to 10 percent of any additional compensation awarded to the worker.
(d) Except as provided in subsection (7) of this section, the reconsideration proceeding shall be completed within 18 working days from the date the reconsideration proceeding begins, and shall be performed by a special evaluation appellate unit within the department. The deadline of 18 working days may be postponed by an additional 60 calendar days if within the 18 working days the department mails notice of review by a medical arbiter. If an order on reconsideration has not been mailed on or before 18 working days from the date the reconsideration proceeding begins, or within 18 working days plus the additional 60 calendar days where a notice for medical arbiter review was timely mailed or the director postponed the reconsideration pursuant to paragraph (b) of this subsection, or within such additional time as provided in subsection (8) of this section when reconsideration is postponed further because the worker has failed to cooperate in the medical arbiter examination, reconsideration shall be deemed denied and any further proceedings shall occur as though an order on reconsideration affirming the notice of closure was mailed on the date the order was due to issue.
(e) The period for completing the reconsideration proceeding described in paragraph (d) of this subsection begins upon receipt by the director of a worker’s or a beneficiary’s request for reconsideration pursuant to subsection (5)(e) of this section. If the insurer or self-insured employer requests reconsideration, the period for reconsideration begins upon the earlier of the date of the request for reconsideration by the worker or beneficiary, the date of receipt of a waiver from the worker or beneficiary of the right to request reconsideration or the date of expiration of the right of the worker or beneficiary to request reconsideration. If a party elects not to file a separate request for reconsideration, the party does not waive the right to fully participate in the reconsideration proceeding, including the right to proceed with the reconsideration if the initiating party withdraws the request for reconsideration.
(f) Any medical arbiter report may be received as evidence at a hearing even if the report is not prepared in time for use in the reconsideration proceeding.
(g) If any party objects to the reconsideration order, the party may request a hearing under ORS 656.283 (Hearing rights and procedure) within 30 days from the date of the reconsideration order.
(7)(a) The director may delay the reconsideration proceeding and toll the reconsideration timeline established under subsection (6) of this section for up to 45 calendar days if:
(A) A request for reconsideration of a notice of closure has been made to the director within 60 days of the date of the notice of closure;
(B) The parties are actively engaged in settlement negotiations that include issues in dispute at reconsideration;
(C) The parties agree to the delay; and
(D) Both parties notify the director before the 18th working day after the reconsideration proceeding has begun that they request a delay under this subsection.
(b) A delay of the reconsideration proceeding granted by the director under this subsection expires:
(A) If a party requests the director to resume the reconsideration proceeding before the expiration of the delay period;
(B) If the parties reach a settlement and the director receives a copy of the approved settlement documents before the expiration of the delay period; or
(C) On the next calendar day following the expiration of the delay period authorized by the director.
(c) Upon expiration of a delay granted under this subsection, the timeline for the completion of the reconsideration proceeding shall resume as if the delay had never been granted.
(d) Compensation due the worker shall continue to be paid during the period of delay authorized under this subsection.
(e) The director may authorize only one delay period for each reconsideration proceeding.
(8)(a) If the basis for objection to a notice of closure issued under this section is disagreement with the impairment used in rating of the worker’s disability, the director shall refer the claim to a medical arbiter appointed by the director.
(b) If the director determines that insufficient medical information is available to determine disability, the director may appoint, and refer the claim to, a medical arbiter.
(c) At the request of either of the parties, the director shall appoint a panel of as many as three medical arbiters in accordance with criteria that the director sets by rule.
(d) The arbiter, or panel of medical arbiters, must be chosen from among a list of physicians qualified to be attending physicians referred to in ORS 656.005 (Definitions) (12)(b)(A) whom the director selected in consultation with the Oregon Medical Board and the committee referred to in ORS 656.790 (Workers’ Compensation Management-Labor Advisory Committee).
(e)(A) The medical arbiter or panel of medical arbiters may examine the worker and perform such tests as may be reasonable and necessary to establish the worker’s impairment.
(B) If the director determines that the worker failed to attend the examination without good cause or failed to cooperate with the medical arbiter, or panel of medical arbiters, the director shall postpone the reconsideration proceedings for up to 60 days from the date of the determination that the worker failed to attend or cooperate, and shall suspend all disability benefits resulting from this or any prior opening of the claim until such time as the worker attends and cooperates with the examination or the request for reconsideration is withdrawn. Any additional evidence regarding good cause must be submitted prior to the conclusion of the 60-day postponement period.
(C) At the conclusion of the 60-day postponement period, if the worker has not attended and cooperated with a medical arbiter examination or established good cause, the worker may not attend a medical arbiter examination for this claim closure. The reconsideration record must be closed, and the director shall issue an order on reconsideration based upon the existing record.
(D) All disability benefits suspended under this subsection, including all disability benefits awarded in the order on reconsideration, or by an Administrative Law Judge, the Workers’ Compensation Board or upon court review, are not due and payable to the worker.
(f) The insurer or self-insured employer shall pay the costs of examination and review by the medical arbiter or panel of medical arbiters.
(g) The findings of the medical arbiter or panel of medical arbiters must be submitted to the director for reconsideration of the notice of closure.
(h) After reconsideration, no subsequent medical evidence of the worker’s impairment is admissible before the director, the Workers’ Compensation Board or the courts for purposes of making findings of impairment on the claim closure.
(i)(A) If the basis for objection to a notice of closure issued under this section is a disagreement with the impairment used in rating the worker’s disability, and the director determines that the worker is not medically stationary at the time of the reconsideration or that the closure was not made pursuant to this section, the director is not required to appoint a medical arbiter before completing the reconsideration proceeding.
(B) If the worker’s condition has substantially changed since the notice of closure, upon the consent of all the parties to the claim, the director shall postpone the proceeding until the worker’s condition is appropriate for claim closure under subsection (1) of this section.
(9) No hearing shall be held on any issue that was not raised and preserved before the director at reconsideration. However, issues arising out of the reconsideration order may be addressed and resolved at hearing.
(10) If, after the notice of closure issued pursuant to this section, the worker becomes enrolled and actively engaged in training according to rules adopted pursuant to ORS 656.340 (Vocational assistance procedure) and 656.726 (Duties and powers to carry out workers’ compensation and occupational safety laws), any permanent disability payments due for work disability under the closure shall be suspended, and the worker shall receive temporary disability compensation and any permanent disability payments due for impairment while the worker is enrolled and actively engaged in the training. When the worker ceases to be enrolled and actively engaged in the training, the insurer or self-insured employer shall again close the claim pursuant to this section if the worker is medically stationary or if the worker’s accepted injury is no longer the major contributing cause of the worker’s combined or consequential condition or conditions pursuant to ORS 656.005 (Definitions) (7). The closure shall include the duration of temporary total or temporary partial disability compensation. Permanent disability compensation shall be redetermined for work disability only. If the worker has returned to work or the worker’s attending physician has released the worker to return to regular or modified employment, the insurer or self-insured employer shall again close the claim. This notice of closure may be appealed only in the same manner as are other notices of closure under this section.
(11) If the attending physician or nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) has approved the worker’s return to work and there is a labor dispute in progress at the place of employment, the worker may refuse to return to that employment without loss of reemployment rights or any vocational assistance provided by this chapter.
(12) Any notice of closure made under this section may include necessary adjustments in compensation paid or payable prior to the notice of closure, including disallowance of permanent disability payments prematurely made, crediting temporary disability payments against current or future permanent or temporary disability awards or payments and requiring the payment of temporary disability payments which were payable but not paid.
(13) An insurer or self-insured employer may take a credit or offset of previously paid workers’ compensation benefits or payments against any further workers’ compensation benefits or payments due a worker from that insurer or self-insured employer when the worker admits to having obtained the previously paid benefits or payments through fraud, or a civil judgment or criminal conviction is entered against the worker for having obtained the previously paid benefits through fraud. Benefits or payments obtained through fraud by a worker may not be included in any data used for ratemaking or individual employer rating or dividend calculations by an insurer, a rating organization licensed pursuant to ORS chapter 737, the State Accident Insurance Fund Corporation or the director.
(14)(a) An insurer or self-insured employer may offset any compensation payable to the worker to recover an overpayment from a claim with the same insurer or self-insured employer. When overpayments are recovered from temporary disability or permanent total disability benefits, the amount recovered from each payment shall not exceed 25 percent of the payment, without prior authorization from the worker.
(b) An insurer or self-insured employer may suspend and offset any compensation payable to the beneficiary of the worker, and recover an overpayment of permanent total disability benefits caused by the failure of the worker’s beneficiaries to notify the insurer or self-insured employer about the death of the worker.
(15) Conditions that are direct medical sequelae to the original accepted condition shall be included in rating permanent disability of the claim unless they have been specifically denied. [1965 c.285 §31; 1973 c.620 §3; 1973 c.634 §2; 1977 c.804 §5; 1977 c.862 §1; 1979 c.839 §4; 1981 c.535 §7a; 1981 c.854 §19; 1981 c.874 §13; 1985 c.425 §1; 1985 c.600 §8; 1987 c.884 §10; 1990 c.2 §16; 1991 c.502 §1; 1995 c.332 §30; 1997 c.111 §1; 1997 c.382 §1; 1999 c.313 §1; 1999 c.1020 §3; 2001 c.349 §1; 2001 c.377 §63; 2001 c.865 §12; 2003 c.429 §1; 2003 c.657 §§7,8; 2003 c.811 §§11,12; 2005 c.221 §§1,2; 2005 c.461 §§3,4; 2005 c.569 §§1,2; 2007 c.241 §§11,12; 2007 c.270 §§4,5; 2007 c.274 §4; 2007 c.365 §6; 2007 c.835 §§2,3; 2011 c.99 §1; 2015 c.144 §1; 2017 c.68 §1]
Employer has burden of proof at redetermina­tion stage to show improve­ment in claimant’s condi­tion. Bentley v. SAIF, 38 Or App 473, 590 P2d 746 (1979)
Legislature did not intend claimant’s ap­peal rights should prematurely terminate when aggrava­tion rights expire, and where claim is opened during time claimant still has ap­peal rights, closure of claim carries with it right of ap­peal whenever issued. Coombs v. SAIF, 39 Or App 293, 592 P2d 242 (1979)
Require­ment for disclosure of medical reports to claimant is not intended as limita­tion on power of board to order discovery. Morgan v. Stimson Lumber Co., 288 Or 595, 607 P2d 150 (1980)
Because claim was reopened during time claimant had right to ap­peal, closing order was not on board’s own mo­tion and was therefore ap­pealable. Carter v. SAIF, 52 Or App 1027, 630 P2d 397 (1981)
After voca­tional rehabilita­tion, claimant’s disability may be determined to be more or less than pre­vi­ously supposed even absent change in medical condi­tion. Hanna v. SAIF, 65 Or App 649, 672 P2d 67 (1983)
District court had no jurisdic­tion over case re­gard­ing overpay­ment of workers’ compensa­tion benefits. SAIF v. Harris, 66 Or App 165, 672 P2d 1384 (1983)
Where insurer’s notice to claimant contained all in­for­ma­­tion to be provided in notice of closure except for fact it was notice of closure, claim remained in open status. Davison v. SAIF, 80 Or App 541, 723 P2d 331 (1986), modified 82 Or App 546, 728 P2d 582 (1986)
Require­ment that party seek hearing within one year of issuance of determina­tion order is not tolled pending claimant’s ap­peal from board order finding claim non-compensable, because extent of disability is independent determina­tion. Weyerhaeuser Co. v. Roller, 85 Or App 500, 737 P2d 625 (1987)
Subsequent determina­tion by Court of Appeals that claim was not compensable did not alter employer’s processing obliga­tions during period prior to determina­tion order. Weyerhaeuser Co. v. McCullough, 92 Or App 204, 757 P2d 871 (1988)
Where claimant is initially injured or becomes disabled as result of occupa­tional disease while in work force, claimant is entitled to temporary total disability benefits until medically sta­tionary and released for work, even though claimant voluntarily withdrew from work force prior to closure of claim. Weyerhaeuser Co. v. Kepford, 100 Or App 410, 786 P2d 745 (1990), Sup Ct review denied; Forshee & Langley Logging v. Peckham, 100 Or App 717, 788 P2d 487 (1990)
Where determina­tion order was pending review and had not become final, worker could request hearing on benefit calcula­tion error. Drews v. EBI Companies, 310 Or 134, 795 P2d 531 (1990); Hammon Stage Line v. Stinson, 123 Or App 418, 859 P2d 1180 (1993)
Employer must continue to pay temporary disability benefits for period after date claimant would otherwise have been laid off. Interna­tional Paper Co. v. Huntley, 106 Or App 107, 806 P2d 188 (1991)
SAIF may seek review of order re-examining award of permanent total disability. Lehman v. SAIF, 107 Or App 207, 811 P2d 924 (1991)
Claimant who fails to report for physician approved modified work in order to participate in labor dispute has refused wage earning employ­ment and is not entitled to continued temporary total disability benefits. Roseburg Forest Products v. Wilson, 110 Or App 72, 821 P2d 426 (1991)
Claimant is not entitled to overpay­ment of temporary disability benefits for period between medically sta­tionary date and claim closure. Lebanon Plywood v. Seiber, 113 Or App 651, 833 P2d 1367 (1992); Santos v. Caryall Transport, 152 Or App 322, 954 P2d 187 (1998)
Where claimant’s attending physician was unable to verify claimant’s inability to work, insurer or self-insured employer may suspend pay­ment of temporary total disability, but claimant’s entitle­ment to temporary total disability does not terminate. Sandoval v. Crystal Pine, 118 Or App 640, 848 P2d 1224 (1993), Sup Ct review denied; Cameron v. Norco Contract Service, 128 Or App 422, 875 P2d 1196 (1994), Sup Ct review denied
Where redetermina­tion order reducing disability is issued before pay­ment under original award becomes due, redetermina­tion effectively reduces award and excuses employer duty to pay original award. SAIF v. Sweeney, 121 Or App 142, 854 P2d 487 (1993)
Where pay­ment under original award becomes due prior to issuance of redetermina­tion order, original award obliga­tion must be paid prior to redetermina­tion date. SAIF v. Sweeney, 121 Or App 142, 854 P2d 487 (1993)
Workers’ compensa­tion insurance carrier can offset amount of temporary disability overpaid to claimant by deducting amount from permanent disability award. Cravens v. SAIF Corp., 121 Or App 443, 855 P2d 1129 (1993)
Order to pay penalty for late pay­ment to temporary total disability (TTD) is not final determina­tion of TTD rate for purposes of claim preclusion analysis of res judicata. Cravens v. SAIF Corp., 121 Or App 443, 855 P2d 1129 (1993)
Where claimant had accepted employer’s offer of modified work, employer lockout of claimant during labor dispute effectively withdrew offer of modified work and claimant was entitled to temporary disability pay­ments for period of lockout. Safeway Stores, Inc. v. Hanks, 122 Or App 582, 857 P2d 911 (1993), Sup Ct review denied
“No sub­se­quent medical evidence” means medical evidence sub­se­quent to medical arbiter’s report, not medical arbiter’s report. Pacheco-Gonzalez v. SAIF, 123 Or App 312, 860 P2d 822 (1993); Wickstrom v. Norpac Foods, Inc., 125 Or App 520, 865 P2d 491 (1993)
Whether worker is “20 percent disabled” is based on combined effect of all scheduled and unscheduled disability arising out of claim. Nero v. City of Tualatin, 127 Or App 458, 873 P2d 390 (1994), Sup Ct review denied. But see SAIF v. C­line, 135 Or App 155, 897 P2d 1172 (1995), Sup Ct review denied
Appoint­ment of medical arbiter does not make prior impair­ment evalua­tions by other than attending physician admissible. Roseburg Forest Products v. Owen, 129 Or App 442, 879 P2d 1317 (1994)
Challenge to zero impair­ment rating was disagree­ment with impair­ment used. Sedgwick James of Oregon v. Hendrix, 130 Or App 564, 883 P2d 226 (1994)
Penalty awarded at reconsidera­tion for disability above threshold level should not be sustained if disability is later reduced to be below threshold level. Mast v. Cardinal Services, Inc., 132 Or App 108, 887 P2d 814 (1994)
Where claimant refused examina­tion by appointed medical arbitrator, submission of findings by medical arbitrator were not prerequisite to preclusion of sub­se­quent medical evidence of impair­ment. Jackson v. Tuality Community Hospital, 132 Or App 182, 888 P2d 35 (1994), Sup Ct review denied
Where party fails to request reconsidera­tion of determina­tion order, issue of determina­tion order propriety may not be raised at sub­se­quent hearing. Duncan v. Liberty Northwest Ins. Corp., 133 Or App 605, 894 P2d 477 (1995)
Where determina­tion order not challenged by party is changed by reconsidera­tion order, at sub­se­quent hearing where either party challenges propriety of change, determina­tion order defines min­i­mum or max­i­mum award allowable. Duncan v. Liberty Northwest Ins. Corp., 133 Or App 605, 894 P2d 477 (1995)
Determina­tion whether claimant is 20 percent disabled for purposes of award of attorney fees requires that impair­ment of body part be translated into measure­ment of total worker disability. SAIF v. C­line, 135 Or App 155, 897 P2d 1172 (1995), Sup Ct review denied
Reconsidera­tion hearing held upon request of one party did not prevent later timely request by other party for addi­tional reconsidera­tion. Guardado v. J. R. Simplot Co., 137 Or App 95, 902 P2d 1225 (1995)
Reports “not prepared in time” for reconsidera­tion pro­ceed­ing do not include supple­mental or clarifying medical arbiter reports. Tinh Xuan Pham Auto v. Bourgo, 143 Or App 73, 922 P2d 1255 (1996)
Notice of closure sets forth claimant’s award of benefits and precludes sub­se­quent challenge to erroneous benefits awarded. Bowman v. Esam, Inc., 145 Or App 46, 928 P2d 359 (1996)
Medical evidence provided before claimant has become medically sta­tionary may be considered for purpose of determining extent of disability. Liberty Mutual Insurance v. Englestadter, 145 Or App 330, 930 P2d 264 (1996)
Educa­tion factor used in determining disability must be rated as of reconsidera­tion date. Baggett v. The Boeing Co., 150 Or App 269, 945 P2d 663 (1997)
Order denying reconsidera­tion is reconsidera­tion order for which party may request hearing before Workers’ Compensa­tion Board under ORS 656.283 (Hearing rights and procedure). Jordan v. Brazier Forest Products, 152 Or App 15, 952 P2d 560 (1998)
1997 amend­ment imposing limit of one reconsidera­tion pro­ceed­ing did not apply retroactively. Franzen v. Liberty Mutual Fire Ins. Co., 154 Or App 503, 962 P2d 729 (1998)
For mandatory reconsidera­tion to preclude further review under ORS 656.283 (Hearing rights and procedure), matter that claimant objects to must be manifest in notice of closure. Venetucci v. Metro, 155 Or App 559, 964 P2d 1090 (1998)
Cases where benefits have been paid in full are subject to require­ment that disability be redetermined following training. SAIF v. Coburn, 159 Or App 413, 977 P2d 412 (1999), Sup Ct review denied
Cases where original determina­tion order or notice of closure has become final are subject to require­ment that disability be redetermined following training. SAIF v. Coburn, 159 Or App 413, 977 P2d 412 (1999), Sup Ct review denied
Where redetermina­tion of disability following training results in reduced disability rating, amounts correctly paid according to earlier rating do not result in “overpay­ment.” SAIF v. Coburn, 159 Or App 413, 977 P2d 412 (1999), Sup Ct review denied
Dead­line for issuance of reconsidera­tion order does not prevent withdrawal of timely order and post-dead­line issuance of amended order. Liberty Northwest Insurance Corp. v. Allenby, 166 Or App 331, 999 P2d 503 (2000), Sup Ct review denied; Boydston v. Liberty Northwest Insurance Corp., 166 Or App 336, 999 P2d 503 (2000), Sup Ct review denied
Under 1997 version of statute, closing examina­tion by attending physician was not prerequisite to insurer closing of claim. Ball v. The Halton Company, 167 Or App 468, 6 P3d 1106 (2000), Sup Ct review denied
Under 1997 version of statute, insurer may not deny consequential claim without closing underlying accepted claim. Roy v. McCormack Pacific Co., 171 Or App 526, 17 P3d 550 (2000), modified 172 Or App 663, 19 P3d 999 (2001)
Unless direct medical sequela to original accepted condi­tion has been specifically denied, both condi­tion and its sequelae must be medically sta­tionary at time of claim closure. Manley v. SAIF, 181 Or App 431, 45 P3d 1027 (2002)
Where continuing compensability of combined condi­tion is denied because otherwise compensable injury is no longer major contributing cause of combined condi­tion, underlying accepted injury remains compensable and must be properly closed. South Lane County School District #45-J3 v. Arms, 186 Or App 361, 62 P3d 882 (2003), Sup Ct review denied
Permanent partial disability award that has become final remains substantive entitle­ment during period following comple­tion of training and prior to redetermina­tion of permanent disability compensa­tion. Holdren v. SAIF, 186 Or App 443, 63 P3d 1238 (2003)
Worker who accepts offer of modified employ­ment may not sub­se­quently claim right to refuse accepted employ­ment because it is not with employer at injury or not at work site of employer at injury. Hammock v. SAIF, 198 Or App 480, 108 P3d 1185 (2005)
Penalty is not available where employer fails to issue either notice of claim closure or notice of refusal to close. Red Robin Interna­tional v. Dombrosky, 207 Or App 476, 142 P3d 493 (2006)
For purposes of calculating penalty for failure to close claim, compensa­tion “due” claimant is amount awarded in notice of closure, reduced by allowable offset for overpay­ment. Johnson v. SAIF Corp., 219 Or App 82, 180 P3d 1237 (2008)
Penalties may be assessed against insurer or self-insured employer multiple times during processing of single claim if claimant satisfies predicates for assess­ment of penalty in each instance. Cayton v. Safelite Glass Corpora­tion, 232 Or App 454, 222 P3d 1134 (2009)
Insurer or self-insured employer who is penalized for refusing to close claim cannot be liable under other similar statute for same act of refusal. Cayton v. Safelite Glass Corpora­tion, 232 Or App 454, 222 P3d 1134 (2009)
Addi­tional in­for­ma­­tion submitted during reconsidera­tion pro­ceed­ing is not relevant to whether sufficient in­for­ma­­tion existed for insurer to close claim in first instance. Sanchez v. SAIF, 242 Or App 339, 255 P3d 592 (2011), Sup Ct review denied
To preserve issue that Director of the Depart­ment of Consumer and Business Services prematurely closed claim for hearing, claimant must raise issue on reconsidera­tion. Pressing Matters v. Carr, 248 Or App 41, 273 P3d 170 (2012)
Although statutory scheme provides separate review tracks for claim denials and notice of closure, statutes allow for dura­tion of temporary total disability benefits to be subject to review on reconsidera­tion of notice of closure. SAIF v. Otwell, 251 Or App 704, 284 P3d 581 (2012)
Read with ORS 656.340 (Vocational assistance procedure), worker may receive training-related temporary disability compensa­tion for indefinite period of time as long as worker remains enrolled and actively engaged in training. Intel Corp. v. Batchler, 267 Or App 782, 341 P3d 837 (2014)
For purposes of determining appor­tion­ment of impair­ment in combined condi­tion claims, this sec­tion states rule of closure for accepted, and then denied, combined condi­tion claim but does not preclude appor­tion­ment of impair­ment due to compensable industrial injury from loss caused by preexisting condi­tion or other causes in benefits award process. McDermott v. SAIF, 286 Or App 406, 398 P3d 964 (2017)
Bivens v. Weyerhaeuser Co., 6 Or App 100, 487 P2d 119 (1971)
Applicability of “medically sta­tionary” pro­vi­sion to workers injured before effective date of amend­ment, (1978) Vol 39, p 124
27 WLR 105 (1991); 32 WLR 217 (1996)