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]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.