Major-Contributing Cause Study

Author Subject: Major-Contributing Cause Study
Kay Posted At 20:38:09 04/26/2000
Workers' Compensation Focus, Spring 2000 Vol.IV,No.2
by John Shilts, Manager, Benefits Section, WCD

The Workers' Compensation Center of Michigan State University was awarded the
contract for conducting Oregon's major-contributing-cause study. The study
resulted from (MLAC) recommendation. The legislature commissioned the study
with these objectives in mind:

1. Determine and report the number of recent major-contributing-cause (MCC)
and combined-condition denials that would not have been denied prior to
1990 and 1995. Identify types or categories of such denials and what is
denied. The study should determine, for each kind of MCC denial (whole-
claim, partial claim, denials of closure, and aggravation denials) a
destribution of those denials by nature of injury or illness, body part,
gender,industry, occcupation, insurer, etc., to determine the varying
rates of denials among the various kinds of injuries.

2. Determine the financial effect of MCC and combined-condition denials on
premium rates and workers.

3. The workers' compensation reform bills, SB 1197(1990) and SB 369(1995),
have provisions that are entwined. The contractor will determine whether
the data can identify effects of SB 1197 and SB 369 upon major contribut-
ing cause, and will identify those separately in the final report.

4. Evaluate disputed-claims settlements(DCSs) to determine if they are among
the remedies available to workers when a claim is wholly or partially denied
under the MCC or combined-condition criteria. Part of this evaluation
should determine how much of the DCS pays for outstanding medical bills
and how much is left for the worker.

5. Survey and report the views of attending an examining physicians about
the level of difficulty, validity and accuracy of their opinions regard-
ing MCC and combined condition.

6. Review and evaluate statutory and case-law developments in Oregon, as
well as the development of the pertinent standards and the legal inter-
pretations that have ensued. Through this evaluation, provide an ob-
jective analysis of the background and the current status of the major-
contributing cause and combined-condition standards, as well as review-
ing similar standards in other jurisdictions in order to develop alter-

The study is expected to be completed within 60 days of the contract execution.
Written reports will be submitted to the department, including a proposed
report to the Legislative Interim Committee by June 1, 2000, and a proposed
final report to the department for review by September 15, 2000.

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