Court Opinion

ID: 9915113
Source: CourtListenerOpinion
Date Created: 2024-01-04 17:08:53.181747+00
Date Added: 2024-06-11T13:17:14.373989
License: Public Domain

8                      January 4, 2024               No. 2

          IN THE COURT OF APPEALS OF THE
                  STATE OF OREGON

            In the Medical Service Dispute of
                Jacob E. Mantle, Worker.
                   Jacob E. MANTLE,
                       Petitioner,
                            v.
                 SAIF CORPORATION;
              Whirlwind Services, Inc.; and
      Department of Consumer and Business Services
                      Respondents.
             Workers’ Compensation Division
                   DBV2359; A176516

    Argued and submitted January 17, 2023.
   Jodie Anne Phillips Polich argued the cause for peti-
tioner. Also on the briefs was Law Offices of Jodie Anne
Phillips Polich, P. C.
   Daniel Edward Walker argued the cause and filed the
brief for respondents SAIF Corporation and Whirlwind
Clean & Green.
  Denise G. Fjordbeck waived appearance for respondent
Department of Consumer and Business Services.
  Before Shorr, Presiding Judge, and Mooney, Judge, and
Pagán, Judge.
    SHORR, P. J.
    Reversed and remanded.
    Mooney, J., dissenting.
Cite as 330 Or App 8 (2024)   9
10                                           Mantle v. SAIF

        SHORR, P. J.
         Petitioner seeks judicial review of a final order of
the Director of the Department of Consumer and Business
Services (“the director”). In the administrative proceed-
ing, petitioner had requested that the director declare that
petitioner was not liable to pay two medical providers’ bills
because the providers had not followed the otherwise appli-
cable workers’ compensation treatment rules. The director
dismissed petitioner’s request. The director concluded that,
under ORS 656.704(3), it lacked authority to address the
medical billing issue because the medical services were not
causally related to the worker’s accepted claim. We disagree
that the director lacked such authority. We reverse and
remand for further proceedings.
         The relevant facts are taken from the direc-
tor’s Final Order, which adopted the findings of the
Administrative Law Judge. Those findings are undisputed
on judicial review. Petitioner sustained a compensable
injury on April 4, 2016. That injury was ultimately accepted
for non-disabling thoracic and lumbar strains. Because the
claim was nondisabling, no notice of closure was required or
issued. Petitioner later sought medical treatment from April
to July 2018 at Columbia Medical Clinic (Columbia), which
resulted in a referral to Gateway Sports Medicine & Rehab
(Gateway) where petitioner participated in physical therapy.
Petitioner and respondent SAIF Corporation stipulated that
neither of those providers provided a treatment plan nor did
they obtain pre-authorization for the services they provided.
As we will discuss in more detail later, that is significant,
because the workers’ compensation statutes and rules pro-
vide that a worker is not obligated to pay for medical treat-
ment when the medical provider does not follow the applica-
ble rules. See, e.g., ORS 656.327(2) (stating that “the worker
is not obligated to pay for medical treatment determined not
to be compensable under this subsection.”); OAR 436-010-
0230(7)(a) (2015) (stating that certain providers “must pre-
pare a treatment plan before beginning treatment.”).
        In March 2019, petitioner requested administrative
review by the “Medical Resolution Team” (MRT) regarding
Cite as 330 Or App 8 (2024)                                                   11

the medical providers’ bills.1 ORS 656.327(3). The MRT
then transferred the matter to the Workers’ Compensation
Board (the board) for an initial determination of whether
a causal relationship existed between the disputed medical
services and the accepted conditions. In August 2019, an
Administrative Law Judge (ALJ) within the board’s Hearing
Division issued an Opinion and Order, concluding that there
was no causal relationship between the accepted April 2016
thoracic and lumbar strain claim and the medical treatment
provided to petitioner by Columbia and Gateway.2 The ALJ
then determined that the remaining dispute over the pro-
priety of the billing for medical services, which were pro-
vided by Columbia and Gateway without preauthorization
or an approved treatment plan, was within the director’s
authority. The ALJ concluded that “[l]acking jurisdiction to
address that dispute, that medical services dispute is trans-
ferred back to the Director. See ORS 656.704(3)(b)(B).”
         The MRT, which acts under the director’s delegated
authority, reviewed the transferred matter. It noted that “[t]he
worker requests an order finding that he is not responsi-
ble for the medical services in question [those provided by
Columbia and Gateway] due to the provider[s’] failure to fol-
low the OARs and the statutes which control medical ser-
vices.” The MRT then reviewed those rules and stated:
    “The MRT finds according to OAR 436-010-0230(7)(a-c),
    ancillary medical service providers must send a treatment
    plan to the prescribing provider within seven days of begin-
    ning treatment. Further, if no treatment plan is sent, the
    insurer is not required to pay for the services provided prior
    to the date the treatment plan was sent. * * * SAIF and
    [petitioner] stipulated that there was no request for preau-
    thorization for the disputed 2018 medical services and that
    no treatment plan was ever provided. As such, the MRT
    could not order SAIF liable for medical services where no
    treatment plan was provided, even if the medical services
    were causally related to the worker’s accepted claim.”

     1
       The MRT is a physician or panel of physicians delegated by the authority
of the Director to review the propriety of medical treatments of injured workers
under ORS 656.327.
     2
       The board adopted that ALJ decision regarding lack of causation. Petitioner
did not seek further review of that decision.
12                                                   Mantle v. SAIF

As a result, according to the MRT, SAIF was not liable to
pay the medical service providers Columbia and Gateway
even assuming that the medical services were causally
related to petitioner’s accepted claim. That left unanswered
petitioner’s potential liability for the providers’ bills when
those providers did not follow the rules for medical services
related to workers’ compensation claims in this particular
circumstance. The MRT then, at least in part, answered
that question:
        “[I]n this case, the [ALJ Opinion and Order] address-
     ing the causal relationship between the medical services
     and the accepted claim found the medical services were
     not causally related to [petitioner’s] accepted 2016 non-dis-
     abling claim. As such, the medical services fall outside the
     MRT’s jurisdiction.
         “The worker requested an order finding him not respon-
     sible for the treatment due to the provider[s’] failure to fol-
     low OARs and the statutes which control medical services;
     however, since the MRT has no jurisdiction over medical
     services that are not related to an accepted claim, the MRT
     is unable to find the worker not responsible for the disputed
     medical services.”
Thus, at least as far as the workers’ compensation system
is concerned, petitioner was still responsible for paying the
medical bills despite the medical service providers not fol-
lowing the rules for providing medical services relating to
a workers’ compensation claim. Or, stated differently, the
MRT concluded that it at least did not have authority to
decide that the worker was not responsible to pay the dis-
puted medical bills.
         Petitioner then sought review of that decision before
a new ALJ, one different from the one that had found there
was no causal relationship between the medical services
and the original April 2016 accepted back strain. That ALJ
reviewed the relevant statutes, particularly ORS 656.704
and ORS 656.327, which we will discuss further below. He
came to a different conclusion, that “even if disputed med-
ical treatment has been found not to be causally related to
the accepted injury and is consequently not compensable,
the director has jurisdiction to review issues concerning
provision of medical treatment in violation of the rules, and
Cite as 330 Or App 8 (2024)                                       13

may order that a worker is not obligated to pay for such ser-
vices.” The ALJ then did just that; it ordered that petitioner
was “not obligated to pay for medical services, if they were
performed in violation of the rules.” The ALJ then ordered
that the matter should be transferred back to the director
(or the MRT acting under the director’s delegated authority)
to determine precisely which medical services, and result-
ing bills, were provided in violation of the workers’ compen-
sation rules.
         The MRT then filed exceptions to the ALJ’s order,
arguing to the director that the ALJ had erred in concluding
that the director, and by extension the MRT, had authority
to order that a worker was not obligated to pay for medical
services provided in violation of the workers’ compensation
rules in circumstances where the services were not causally
related to the worker’s accepted claim. The director, exam-
ining ORS 656.704 and ORS 656.327, but also heavily rely-
ing on historical practice, reversed the ALJ and concluded
that
   “[b]ecause the treatment was ultimately determined not to
   be related to the worker’s compensable claim, it falls out-
   side of the workers’ compensation system; ORS 656.327
   and the corresponding administrative rules do not apply;
   and MRT was correct to dismiss the propriety issue.”
The director further stated:
      “In holding that the director’s authority to review the
   propriety aspect of a medical services dispute is contingent
   upon the services being causally related to the worker’s
   accepted claim – in other words, that ORS 656.327 applies
   only to treatment that is causally related to the worker’s
   accepted claim – it could be argued that MRT is insert-
   ing into the workers’ compensation statute what has been
   omitted. MRT’s interpretation, however, is consistent with
   the way in which the statute and rules have historically
   been applied, and it is not inconsistent with the wording or
   context of the statute and rules themselves.”
That brings this matter up to the current moment.
        Petitioner seeks our review of the director’s deci-
sion. The issue before us is solely one of law. We therefore
review the director’s decision for legal error. Zach v. Chartis
14                                                 Mantle v. SAIF

Claims, Inc., 279 Or App 557, 560, 379 P3d 721, rev den, 360
Or 697 (2016); ORS 183.482(8). The legal issue before us is
primarily one of statutory construction. We apply our usual
method of statutory construction, considering the text and
context of the relevant statutes and any relevant legislative
history we find helpful. State v. Gaines, 346 Or 160, 171-72,
206 P3d 1042 (2009).
        As noted, the relevant statutes include ORS 656.704
and ORS 656.327. Those statutes define and divide the
authority for resolving workers’ compensation related dis-
putes between the board and the director. ORS 656.704(3)(a)
provides:
         “For the purpose of determining the respective author-
     ity of the director and the board to conduct hearings, inves-
     tigations 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 com-
     pensation, or the amount thereof, are directly at issue.
     However, subject to paragraph (b) of this subsection, such
     matters do not include any disputes arising under ORS * * *
     656.327, any other provisions directly relating to the provi-
     sion of medical services or any disputes arising under ORS
     656.340 except as those provisions may otherwise provide.”
The parties agree with the basic division of authority
between the board and the director, and so do we. “Generally
speaking, under ORS 656.704, the board has review author-
ity over matters concerning a claim, and the director has
review authority over matters other than those concerning
a claim.” Martin v. SAIF, 247 Or App 377, 382, 270 P3d 296
(2011).
        The disputed issue is whether the director has
authority to resolve certain disputes regarding the provi-
sion of medical services to petitioner after the board con-
cludes that the worker’s claim is not compensable under the
workers’ compensation system.
           ORS 656.704(3)(b) provides:
         “The respective authority of the board and the direc-
     tor to resolve medical service disputes shall be determined
     according to the following principles:
Cite as 330 Or App 8 (2024)                                                   15

      “(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 perfor-
   mance of medical services, or a determination of whether
   medical services for an accepted condition qualify as com-
   pensable medical services among those listed in ORS
   656.245 (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 com-
   pensability is a matter concerning a claim.”

ORS 656.704(3)(b). ORS 656.704(3) certainly divides author-
ity between the board and director along the lines stated
above. See also OAR 436-010-0008 (similarly dividing
authority between the board and director).3 But nowhere
does it state that the director either loses or lacks author-
ity to resolve a pending dispute regarding “violation of the
rules regarding the performance of medical services,” which
is the issue here, when the board has concluded that the
claim is separately not compensable. We note, as we will dis-
cuss again later, that, at the time that petitioner sought ser-
vices from the medical providers for his condition and they

   3
     OAR 436-010-0008 provides:
        “(1) General.
        “(a) Except as otherwise provided in ORS 656.704, the director has
   exclusive jurisdiction to resolve all disputes concerning medical fees, nonpay-
   ment of compensable medical bills, and medical service and treatment dis-
   putes arising under ORS 656.245, 656.247, 656.248, 656.260, 656.325, and
   656.327. Disputes about whether a medical service provided after a worker is
   medically stationary is compensable within the meaning of ORS 656.245(1)
   (c), or whether a medical treatment is unscientific, unproven, outmoded, or
   experimental under ORS 656.245(3), are subject to administrative review
   before the director.
        “(b) As provided in ORS 656.704(3)(b), the following disputes are in the
   jurisdiction of the board and will be transferred:
        “(A) A dispute that requires a determination of the compensability of the
   medical condition for which medical services are proposed; and
        “(B) A dispute that requires a determination of whether a sufficient
   causal relationship exists between medical services and an accepted claim.”
16                                                   Mantle v. SAIF

failed to follow the workers’ compensation treatment rules,
petitioner’s claim had not been denied.
         We turn to ORS 656.327, which further discusses
the role of the director in considering disputes about whether
medical services are “excessive, inappropriate, ineffectual
or in violation of rules regarding the performance of med-
ical services.” ORS 656.327(1)(a). ORS 656.327 provides, in
relevant part:
         “(1)(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
     * * * that the injured worker has received, is receiving, will
     receive or is proposed to receive is excessive, inappropri-
     ate, ineffectual or in violation of rules regarding the per-
     formance 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.
        “* * * * *
         “(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(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. 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 admit-
     ted. The worker is not obligated to pay for medical treatment
     determined not to be compensable under this subsection.”
(Emphases added.) Here again, the statute defines the direc-
tor’s authority to resolve disputes, including this one, regard-
ing whether medical treatment has been provided in viola-
tion of rules regarding the performance of medical services.
Cite as 330 Or App 8 (2024)                                17

It does not, however, provide that the director’s authority
to resolve those disputes depends on the board first con-
cluding that the medical services are causally related to an
accepted claim. Indeed, the director’s authority under the
statute necessarily includes deciding, in response to a claim
that the medical provider has violated the rules regarding
performance of medical services, that “[t]he worker is not
obligated to pay for medical treatment determined not to be
compensable under this subsection.” ORS 656.327(2) (empha-
sis added). That is, the director has authority to conclude
that the worker is not obligated to pay for medical treatment
that is not compensable under that subsection because, hav-
ing reviewed the medical records under subsection (2), the
director has determined that the medical provider has been
“excessive, inappropriate, ineffectual” or, as claimed here,
acted in “violation of rules regarding the performance of
medical services” as required by ORS 656.327(1)(a).
          Were we to conclude that the director’s authority is
as limited as the director concluded, we would have to add
to ORS 656.327(2) that the director’s authority to review for
violation of the rules regarding the performance of medical
services is further confined to reviewing only those disputes
regarding medical services where the medical treatment
is otherwise determined to be compensable. But the stat-
ute does not provide that limitation. We respectfully dis-
agree with the dissent’s construction of ORS 656.327 and
the director’s authority within the overall statutory scheme.
ORS 656.327(2) uses the word “compensable” but only in the
context of declaring that a worker is not obligated to pay for
medical treatment that is determined “not to be compensa-
ble under this subsection.” ORS 656.327(2). As noted above,
that subsection addresses the director’s review of the medical
treatment provided to the worker and not to the compensabil-
ity of the claim more generally. The legislature did not limit
the director’s authority to review medical treatment disputes
to just those that involve generally compensable claims.
         Respondents SAIF and the employer contend that
the entire statutory scheme was designed to cover only those
medical services that are compensably related to a workers’
compensation claim. Thus, they contend, to the extent that
18                                                       Mantle v. SAIF

a claim is not compensable because the medical treatment
is not causally related to a worker’s accepted claim, it falls
entirely outside Oregon’s workers’ compensation system,
and the director would not have authority to address it.
That argument has logical appeal. However, as noted, the
statute does not state that the director’s authority is limited
in that way. The argument also fails to grapple with the fact
that, at the time petitioner sought care from Columbia and
Gateway, he had had a previously nondisabling accepted
claim that had not been closed. At that juncture, petitioner
was seeing medical providers to follow up on care that he
understood to be related to his accepted workers’ compensa-
tion claim. Further, as stipulated by the parties at least, the
providers had not obtained pre-authorization from SAIF or
the employer for the medical services.
        Respondents next contend that if a dispute arises
concerning both the causal relationship between medical
services and an accepted claim to establish compensability,
an issue for the board under ORS 656.704(3)(b)(C), and the
propriety of the medical services, an issue for the director
(or MRT) under ORS 656.704(3)(b)(B), the director must first
transfer the issue to the board to determine compensability.
That is, respondents contend that compensability must be
established by the board before the director (or MRT) may
decide whether the medical services are in violation of the
applicable rules. Respondents contend that, if the board
decides that the claim is not compensable, there is then no
need for the director or MRT to review the propriety of the
medical services. For that proposition, respondents rely on
a footnote from SAIF v. Martinez, 219 Or App 182, 182 P3d
873 (2008), which provides,
     “The MRU[4] may, at its discretion, transfer cases to the
     board via a Defer and Transfer Order if it believes that
     there is a dispute about both the propriety of the proposed
     treatment—which it may determine—and the compensa-
     bility of the condition itself. ORS 656.704(3)(b). That allows
     the board to determine whether the employer is liable for
     any medical payment before the MRU decides precisely
     what costs the employer must pay.”

     4
         The MRT was formerly known as the Medical Review Unit or “MRU.”
Cite as 330 Or App 8 (2024)                                                     19

Id. at 186 n 4 (emphasis in original). That footnote is true
as far as it goes. There is discretion to transfer matters
between the board and director and either or both may have
authority over parts of the dispute. See id. at 186 n 3 (noting
that either the MRU, the board, or both may have authority
to resolve the dispute); cf. Daugherty v. SAIF, 258 Or App
512, 514 n 1, 310 P3d 713 (2013) (“ ‘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.’ ”)
(quoting ORS 656.704(5)) (emphasis in Daugherty).5
         Further, it is true that, if the claim is not compen-
sable, the employer has no liability for the medical payment.
But that does not mean that the director loses authority
to resolve a dispute about whether a medical provider vio-
lated the rules regarding the provision of medical services
to a worker when the board first determines that there is
a non-compensable claim. Although the employer may not
have liability, there is still a remaining issue whether the
provider violated the workers’ compensation rules when pro-
viding medical services and whether the worker is required

    5
       ORS 656.704(3)(c) describes the process when a dispute includes both a
matter concerning a claim and a matter not concerning a claim:
         “Notwithstanding ORS 656.283(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 mat-
    ters 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.”
Here, the opposite occurred: The MRT determined that petitioner’s request
included a matter concerning a claim and transferred the matter to the board to
address first the relationship of the disputed services to the 2016 claim. That is a
process permitted by ORS 656.704(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.”
As noted, the board ultimately determined that the disputed services were not
related to the 2016 claim and returned the case to the MRT.
20                                                          Mantle v. SAIF

to pay. The workers’ compensation statutes provide that the
director has authority over those issues, and none of the rel-
evant statutes provide that the director loses that authority
if the board first concludes that the claim is not compensable.
         We therefore conclude that the director still had
authority under ORS 656.704(3)(b)(B) to determine whether
Columbia and Gateway provided medical services to peti-
tioner “in violation of [the] rules regarding the performance
of medical services.” ORS 656.327(1)(a).6
           Reversed and remanded.
           MOONEY, J., dissenting.
         I respectfully disagree with the majority’s conclu-
sion that the Director of the Department of Consumer and
Business Services erred in dismissing petitioner’s request to
resolve petitioner’s dispute with a medical service provider
over payment for physical therapy services, and therefore
dissent.
         As the majority notes, it has been conclusively
determined that the symptoms for which petitioner sought
medical services are not compensable. Petitioner nonethe-
less sought a determination by the director that he did not
have to pay for those services, because the provider had vio-
lated an administrative rule by failing to provide a treat-
ment plan. The director’s Medical Resolution Team (MRT)
dismissed the request based on its conclusion that the direc-
tor lacked authority to consider it, because the disputed
services had been determined to be not compensable. The
director upheld the MRT’s order.
         A complete understanding of the statutory con-
text persuades me that the director was correct. The direc-
tor’s authority is derived from ORS chapter 656. See ORS
656.726(4) (“The director hereby is charged with duties of
    6
      We note the limited nature of that conclusion. We conclude that the direc-
tor has authority to decide whether the medical providers provided medical ser-
vices to petitioner in violation of the applicable workers’ compensation rules and
the effect of that violation within the workers’ compensation system. We do not
decide, as it is not before us, what effect that decision may have in any further
private or court dispute directly between the medical providers and petitioner
regarding liability for payment for medical services that may have been provided
in violation of the workers’ compensation rules.
Cite as 330 Or App 8 (2024)                                         21

administration, regulation and enforcement of ORS 654.001
to 654.295, 654.412 to 654.423, 654.750 to 654.780 and this
chapter.”). OAR 436-010-0001(1) (2021) provides:
   “The purpose of these rules is to establish uniform stan-
   dards for administering the delivery of and payment for
   medical services to workers within the workers’ compensa-
   tion system.”
(Emphasis added.) Medical services that are not compensa-
ble under the Workers’ Compensation Act are not within the
workers’ compensation system and are not subject to OAR
chapter 436 or to the director’s administrative authority.
Thus, once the determination had been made that the dis-
puted services were not compensable, the procedures set out
in ORS 656.327 for the director’s review of medical service
disputes were not applicable.
        The majority focuses its analysis on ORS 656.327,
particularly ORS 656.327(1)(a), providing that
   “[i]f an injured worker * * * believes that the medical treat-
   ment * * * that the injured worker has received, is receiv-
   ing, will receive * * * is excessive, inappropriate, ineffec-
   tual 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 treat-
   ment by the director prior to requesting a hearing on the
   issue and so notify the parties.”
(Emphasis added.) Although that provision does unequivo-
cally give an injured worker the right to seek administrative
review of violations of rules relating to the provision of med-
ical treatment, the statutory context makes clear that the
right to request administrative review is limited to medical
treatment disputes relating to compensable claims.
         Additionally, unlike the majority, I do not think that
petitioner’s position is strengthened by the last sentence
of ORS 656.327(2) (“The worker is not obligated to pay for
medical treatment determined not to be compensable under
this subsection.”). As that subparagraph states, it applies to
“medical treatment determined not to be compensable under
this subsection.” (Emphasis added.) The director’s authority
under ORS 656.327 is circumscribed by ORS 656.704(3)(b),
22                                             Mantle v. SAIF

which limits the director’s authority to matters other than
matters concerning a claim. A matter concerning a claim is
a dispute concerning the compensability of a condition for
which medical treatment is sought or a dispute whether
there is a sufficient causal relationship between the services
and an accepted claim. Both such disputes are within the
exclusive authority of the board. ORS 656.704(3)(b)(A) (“Any
dispute that requires a determination of the compensability
of the medical condition for which medical services are pro-
posed is a matter concerning a claim.”); ORS 656.704(3)(b)(C)
(“Any dispute that requires a determination of whether a suf-
ficient causal relationship exists between medical services
and an accepted claim to establish compensability is a mat-
ter concerning a claim.”). A dispute relating to the propriety
of the treatment, i.e., whether it is “excessive, inappropriate,
ineffectual or in violation of the rules” is not a matter con-
cerning a claim and is within the exclusive authority of the
director. ORS 656.704(3)(b)(B). That latter determination
of “compensability” is the one made by the director under
ORS 656.327(2) and to which the last sentence of that sub-
paragraph refers. A worker will not be required to pay for
treatment of a compensable condition on an accepted claim
that bears a sufficient causal relationship to the accepted
claim if the director determines that the services are “exces-
sive, inappropriate, ineffectual or in violation of the rules.”
ORS 656.704(3)(b)(B). Here, the condition for which peti-
tioner sought treatment was not compensable, and the med-
ical services have been determined not to bear a sufficient
causal relationship to the accepted claim. Thus, contrary
to the majority’s view, the last sentence of ORS 656.327(2)
could not absolve petitioner of the obligation to pay for the
medical treatment.
         My final qualm with the majority’s analysis is that
it would seem to permit private persons not subject to the
Workers’ Compensation Act to turn to the MRT to resolve
their medical bills with a medical service provider also not
subject to the Act. I have not found within ORS chapter 656
a statute that provides a worker with a remedy of relief from
payment of medical bills for noncompensable medical ser-
vices that fall outside of the workers’ compensation system,
even when the service provider did not comply with OAR
Cite as 330 Or App 8 (2024)                                 23

chapter 436. SAIF’s unchallenged denial of compensabil-
ity and the board’s final determination that the disputed
services were not for a condition related to the 2016 claim
meant that the services were not within the Act. I would
conclude, therefore, that the director did not err in deter-
mining that it did not have authority to address petitioner’s
request for relief from payment of the bills and did not err in
dismissing petitioner’s request. I therefore dissent.