by Kathy Thomas
Oregon Workers' Compensation Division

Section 13 of SB485, passed in the last legislative session, entitles an injured worker to have a medical examination by a physician selected by the director and paid for by the insurer. In order to qualify for this exam the following qualifications must be met:

1. The worker’s claim was denied for compensability on or after January 1, 2002.
2. A timely request for hearing was made.
3. The denial was based on a lack of concurrence between the insurer medical exam (IME) and the attending physician.

The worker must submit a written request for this exam to WCD. The request must include claim-identifying information, names of doctors who have previously been involved with the claim, a copy of the hearing request and the denial letter, and proof that the attending physician did not concur with the independent medical examination (IME). Once the request is received, the Benefit Consultation Unit will ensure that the worker has met the qualifications; select a physician to perform the exam; and notify the worker, doctor, and the insurer of the selection.

It is the responsibility of the worker or the worker’s attorney to schedule the exam. Unlike the arbiter program, WCD will not be scheduling these exams. The questions to be addressed in the examination will be sent to the physician by the worker or the worker’s representative 14 days prior to the date of the exam. The insurer will provide a copy of the medical record to the physician prior to the examination date. The physician will provide a copy of the exam report to the worker and the insurer.