Published in the Winter 2002 Issue of Workers' Compensation Focus
Worker-requested medical examination
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:
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 workers 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 workers 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.
Administrative rules about this process can be found in 436-060-0147. If you have any questions about this new program, please contact the Benefit Consultation Unit, (800) 452-0288, or send e-mail to email@example.com.
Kathy Thomas is assistant manager of the Benefits & Policy Services
Phone: (503) 947-7583