Published in the Spring/Summer 2005 edition of Focus on page 15.
Focus is a publication of the Oregon Workers’ Compensation Division. It's at http://www.cbs.state.or.us/external/wcd/communications/publications/focus/focusind.html
IWA strongly suggests contacting the number below if considering this. Information does become outdated.
Frequently asked questions for the Benefit Consultation Unit
By Jennifer Perkey and Tasha Schliecher
Dear BCU: What is a worker-requested medical examination? My claim was denied. The denial letter says I may request an examination conducted by a physician selected by the director.
What does that mean?
Answer: If you meet the requirements, the Worker’s Compensation Division will choose a physician to provide an impartial exam. The fi ndings from this exam may be used as evidence at your hearing to determine your claim’s compensability.
Dear BCU: What are the requirements for a worker-requested medical examination and how do I request one?
Answer: You are eligible if:
1. Your claim was denied for compensability based on one or more independent medical examinations.
2. Your attending physician disagreed with the independent medical examination fi ndings.
3. You request a hearing at the Worker’s Compensation Board within 60 days of date of the denial letter.
To ask for this medical examination, send a letter to the Worker’s Compensation Division:
Benefi t Consultation Unit
350 Winter St. NE
P.O. Box 14480
Salem, OR 97309-0405
Your request must include:
• Your name and address
• Information that identifi es your claim (claim number, etc.)
• Names and addresses of physicians who have treated you on this claim
• The date on which you requested a hearing and a copy of your hearing request
• A copy of the insurer’s denial letter
• Documents that prove your attending physician disagreed with the IME report
• A copy of your request to your insurer
Jennifer Perkey and Tasha Schliecher are benefit consultants with the Benefit Consultation Unit.
E-mail: firstname.lastname@example.org, email@example.com
Phone: (800) 452-0288;
Jennifer Perkey, (503) 947-7558;
Tasha Schliecher, (503) 947-7561
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’s claim was denied for compensability on or after January 1, 2002.
- A timely request for hearing was made
- 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.
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 firstname.lastname@example.org.
Kathy Thomas is assistant manager of the Benefits & Policy Services Section.
Phone: (503) 947-7583