by Gary Helmer


The Legislature states in the Oregon Revised Statutes (ORS) 656.012(2)(c) that one objective of Workers’ Compensation Law is:

To restore the injured worker physically and economically to a self-sufficient status in an expeditious manner and to the greatest extent practicable.


Many injured workers need vocational assistance, such as training and job-search assistance (see ORS 656.340 and Oregon Administrative Rules (OAR) 436-120), to accomplish this objective. Workers are eligible for vocational assistance if they are unable to return to their previous job or other suitable, available work with the same employer and if they have a substantial handicap to employment. Insurers determine injured workers’ eligibility for vocational assistance. Insurers and workers jointly select vocational assistance providers. Data about the program are provided in the publication Vocational Assistance in the Oregon Workers’ Compensation System, 1986-1994, and in the executive summary Vocational Assistance in the Oregon Workers’ Compensation System, 1997.

This executive summary provides data on the disputes arising from the vocational assistance program. The Rehabilitation Review Unit (RRU) of the Department of Consumer and Business Services, Workers’ Compensation Division (WCD) resolves these disputes. The dispute process is defined in ORS 656.283(2):

(2)(a) The Legislative Assembly finds that vocational rehabilitation of injured workers requires a high degree of cooperation between all of the participants in the vocational assistance process. Based on this finding, the Legislative Assembly concludes that disputes regarding eligibility for and extent of vocational assistance services should be resolved through nonadversarial procedures to the greatest extent possible consistent with constitutional principles. The director is hereby charged with the duty of creating a procedure for resolving vocational assistance disputes....

(b) If a worker is dissatisfied with an action of the insurer or self-insured employer regarding vocational assistance, the worker must apply to the director for administrative review of the matter. Such application must be made not later than the 60th day after the date the worker was notified of the action. The director shall complete the review within a reasonable time. If the worker’s dissatisfaction is resolved by agreement of the parties, the agreement shall be reduced to writing, and the director and the parties shall review the agreement and either approve or disapprove it. If the worker’s dissatisfaction is not resolved by agreement of the parties, the director shall resolve the matter in a written order containing findings of fact and conclusions of law....

Resolution requests and disputed issues

There were 717 requests for the resolution of vocational assistance disputes in 1998 (see Table 1). The number of requests has fallen throughout the 1990’s, chiefly because insurers and self-insured employers have made fewer vocational assistance eligibility determinations. Until 1998, approximately 20 percent of the claims for which vocational assistance determinations have been made had at least one dispute.

In 1998, the issue in 87 percent of the disputes was claimants’ original eligibility for vocational assistance. Insurers can terminate workers’ eligibility when they receive information that affects workers’ eligibility status. Disputes about the ending of eligibility were the second most frequent cause of a dispute (6 percent).

Vocational benefits fall into three main categories: professional services provided by private rehabilitation organizations; timeloss (temporary disability) payments to claimants who are in authorized training programs; and direct purchases, such as tuition and books, tools required for training programs, work clothing, etc. Professional services include vocational evaluation and the development of training plans and direct employment plans. In 1998, 4 percent of the disputes were about eligibility for or the continuation of training programs or about the quality of the professional services.


Dispute resolutions

Vocational assistance disputes are resolved in three ways: through agreements, by dismissals, and through orders. When the parties in the dispute agree to a resolution, RRU issues an agreement letter. In 1998, 30 percent of the resolutions consisted of agreement letters (see Table 2).


Disputes can be dismissed for several reasons. The most common occurrence is the agreement to a Claim Disposition Agreement (CDA), in which the worker usually gives up future non-medical benefits, including vocational assistance, for a cash settlement. In 1998, 14 percent of the resolutions were dismissals because of CDAs. (In other cases, the parties agreed to CDAs after they saw the results of the resolution orders.) Other disputes were dismissed when the worker requested the withdrawal of the review or failed to provide the needed information. RRU also dismissed untimely disputes.

RRU resolved 37 percent of the 1998 disputes through Director’s Review and Orders (orders). Most orders resolve the dispute in favor of either the insurer or the worker, although there are a few cases in which both parties prevail on some issues. In 1998, the insurer prevailed in 74 percent of the disputes in which RRU issued orders.

Different types of initial disputes often have different types of resolution (see Table 3 and Table 4). Eligibility disputes are more likely to be resolved through orders than are the other disputes. In 1998, 96 percent of the orders involved these issues. In contrast, disputes about training and the quality of service were more likely to be resolved by agreement among the parties.



Dispute processing

In 1998, RRU processed vocational disputes in an average of 27 days (all time periods in this section are the median number of calendar days). The processing times vary, however, depending on the availability of information and the parties’ plans. Twenty-six percent of the disputes were deferred at some point in the resolution process. Disputes were deferred while the parties negotiated CDAs, when necessary information was not available for a prolonged period of time, such as medical information or the results of hearings, or when the worker was unable to participate in the dispute process for a time (see OAR 436-120-0(1)(c)). This deferral time can be quite long. For the disputes that were not deferred, the median time for resolution was 21 days (see Table 5); for disputes that were deferred, the median time from request to resolution was 142 days.


Appeals of vocational dispute orders

The RRU’s vocational dispute orders may be appealed to Contested Case Hearings (CCH). The appeal must be made within 60 days of the order. In general, only orders are appealed. On occasion, however, workers appeal dismissals that were made for reasons other than a CDA. At the contested case hearing, the original decision can be modified only if it violates a statute or rule, exceeds the agency’s authority, was based on an unlawful procedure, or was characterized by the abuse of discretion or clearly unwarranted exercise of discretion (see ORS 656.283(2)(c)).

Of the 1996 through 1998 orders, 189 (18 percent) were appealed to Contested Case Hearings. Fifty-seven percent of these appeals were withdrawn or dismissed. Of the cases for which CCH issued orders, 26 were affirmed, 11 were remanded to RRU, and 10 were reversed. (Some appeals were still pending at the time of this report.)


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If you have questions, about the information contained in this document please contact by e-mail or phone: Gary Helmer, Research Analyst, Research & Analysis Section, Information Management Division (503) 947-7325

This web page was last revised: 0519/99. Document URL: http://www.cbs.state.or.us/external/imd/8_3196.html

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