(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 (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 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. 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 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 to 30.300. 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]
Structure 2021 Oregon Revised Statutes
Volume : 16 - Trade Practices, Labor and Employment
Chapter 656 - Workers’ Compensation
Section 656.005 - Definitions.
Section 656.012 - Findings and policy.
Section 656.018 - Effect of providing coverage; exclusive remedy.
Section 656.020 - Damage actions by workers against noncomplying employers; defenses outlawed.
Section 656.025 - Individuals engaged in commuter ridesharing not subject workers; conditions.
Section 656.027 - Who are subject workers.
Section 656.031 - Coverage for municipal volunteer personnel.
Section 656.041 - City or county may elect to provide coverage for adults in custody.
Section 656.056 - Subject employers must post notice of manner of compliance.
Section 656.070 - Definitions for ORS 656.027, 656.070 and 656.075.
Section 656.132 - Coverage of minors.
Section 656.135 - Coverage of deaf school work experience trainees.
Section 656.138 - Coverage of apprentices, trainees participating in related instruction classes.
Section 656.140 - Coverage of persons operating equipment for hire.
Section 656.156 - Intentional injuries.
Section 656.160 - Effect of incarceration on receipt of compensation.
Section 656.172 - Applicability of and criteria for establishing program under ORS 656.170.
Section 656.206 - Permanent total disability.
Section 656.209 - Offsetting permanent total disability benefits against Social Security benefits.
Section 656.210 - Temporary total disability; payment during medical treatment; election; rules.
Section 656.212 - Temporary partial disability.
Section 656.214 - Permanent partial disability.
Section 656.225 - Compensability of certain preexisting conditions.
Section 656.228 - Payments directly to beneficiary or custodian.
Section 656.230 - Lump sum award payments.
Section 656.232 - Payments to aliens residing outside of United States.
Section 656.264 - Compensable injury, denied claim and other reports.
Section 656.265 - Notice of accident from worker.
Section 656.266 - Burden of proving compensability and nature and extent of disability.
Section 656.267 - Claims for new and omitted medical conditions.
Section 656.278 - Board has continuing authority to alter earlier action on claim; limitations.
Section 656.291 - Expedited Claim Service; jurisdiction; procedure; representation; rules.
Section 656.319 - Time within which hearing must be requested.
Section 656.327 - Review of medical treatment of worker; findings; review; costs.
Section 656.360 - Confidentiality of worker medical and vocational claim records.
Section 656.362 - Liability for disclosure of worker medical and vocational claim records.
Section 656.382 - Penalties and attorney fees payable by insurer or employer in processing claim.
Section 656.383 - Attorney fees in cases prior to decision or after request for hearing.
Section 656.390 - Frivolous appeals, hearing requests or motions; expenses and attorney fee.
Section 656.403 - Obligations of self-insured employer.
Section 656.407 - Qualifications of insured employers.
Section 656.419 - Workers’ compensation insurance contracts.
Section 656.423 - Cancellation of coverage by employer; notice required.
Section 656.434 - Certification effective until canceled or revoked; revocation of certificate.
Section 656.440 - Notice of certificate revocation; appeal; effective date.
Section 656.443 - Procedure upon default by employer or self-insured employer group; rules.
Section 656.447 - Sanctions against insurer for failure to comply with contracts, orders or rules.
Section 656.508 - Authority to fix premium rates for employers.
Section 656.526 - Distribution of dividends from surplus in Industrial Accident Fund.
Section 656.554 - Injunction against employer failing to comply with deposit requirements.
Section 656.560 - Default in payment of premiums, fees, assessments or deposit; remedies.
Section 656.566 - Lien on property of employer for amounts due.
Section 656.583 - Paying agency may compel election and prompt action.
Section 656.595 - Precedence of cause of action; compensation paid or payable not to be an issue.
Section 656.605 - Workers’ Benefit Fund; uses and limitations.
Section 656.612 - Assessments for department activities; amount; collection procedure.
Section 656.625 - Reopened Claims Program; rules.
Section 656.630 - Oregon Institute of Occupational Health Sciences funding; report of activities.
Section 656.632 - Industrial Accident Fund.
Section 656.634 - Trust fund status of Industrial Accident Fund.
Section 656.635 - Reserve accounts in Industrial Accident Fund.
Section 656.642 - Emergency Fund.
Section 656.702 - Disclosure of records of corporation, department and insurers.
Section 656.709 - Ombudsman for injured workers; ombudsman for small business; duties.
Section 656.714 - Removal of board member.
Section 656.718 - Chairperson; quorum; panels.
Section 656.725 - Duties and status of Administrative Law Judges.
Section 656.727 - Rules for administration of benefit offset.
Section 656.730 - Assigned risk plan.
Section 656.752 - State Accident Insurance Fund Corporation; purpose and functions.
Section 656.754 - Manager; appointment; functions.
Section 656.795 - Informational materials for nurse practitioners.
Section 656.797 - Certification by nurse practitioner of review of required materials.
Section 656.802 - Occupational disease; mental disorder; presumptions as to stress disorders; proof.
Section 656.807 - Time for filing of claims for occupational disease; procedure.
Section 656.850 - License; compliance with workers’ compensation and safety laws.