656.247
Payment for medical services prior to claim acceptance or denial; review of
disputed services; duty of health benefit plan to pay for certain medical
services in denied claim.
(1) Except for medical services provided to workers subject to ORS 656.245
(4)(b)(B), payment for medical services provided to a subject worker in
response to an initial claim for a work-related injury or occupational disease
from the date of the employer’s notice or knowledge of the claim until the date
the claim is accepted or denied shall be payable in accordance with subsection
(4) of this section.
(2)
Notwithstanding subsection (1) of this section, no payment shall be due from
the insurer or self-insured employer if the insurer or self-insured employer
denies the claim within 14 days of the date of the employer’s notice or
knowledge of the claim.
(3)(a) Disputes
about whether the medical services provided to treat the claimed work-related
injury or occupational disease under subsection (1) of this section are
excessive, inappropriate or ineffectual or are consistent with the criteria in
subsection (1) of this section shall be resolved by the Director of the
Department of Consumer and Business Services. The director may order a medical
review by a physician or panel of physicians pursuant to ORS 656.327 (3) to aid
in the review of such services. If a party is dissatisfied with the order of
the director, the dissatisfied party may request review under ORS 656.704
within 60 days of the date of the director’s order. The order of the director
may be modified only if it is not supported by substantial evidence in the
record or if it reflects an error of law.
(b) Disputes
about the amount of the fee or nonpayment of bills for medical treatment and
services pursuant to this section shall be resolved pursuant to ORS 656.248.
(c) Except as
provided in subsection (2) of this section, when a claim is settled pursuant to
ORS 656.289 (4), all medical services payable under subsection (1) of this
section that are provided on or before the date of denial shall be paid in
accordance with subsection (4) of this section. The insurer or self-insured
employer shall notify each affected service provider of the results of the
settlement.
(4)(a) If the
claim in which medical services are provided under subsection (1) of this
section has not been accepted or denied and a health benefit plan provides
benefits to the worker, the health benefit plan shall expedite
preauthorizations and guarantee payment of expenses for medical services
provided prior to acceptance or denial of the claim according to the terms,
conditions and benefits of the plan.
(b) If the claim
for which medical services are provided under subsection (1) of this section is
accepted, after the claim has been accepted the insurer or self-insured
employer shall pay for the medical services provided for accepted conditions,
including reimbursements for medical expenses, copayments and deductibles paid
by the injured worker or the health benefit plan. Payments made under this
subsection are subject to the fee schedules, limitations and conditions of this
chapter.
(c) If the claim
for which medical services are provided under subsection (1) of this section is
denied and a health benefit plan provides benefits to the worker, after the
claim is denied the health benefit plan shall pay for medical services provided
according to the terms, conditions and benefits of the plan.
(d) As used in
this subsection, “health benefit plan” has the meaning given that term in ORS
743B.005 and also means self-insured benefit plans and health benefit plans
offered by the Oregon Educators Benefit Board and the Public Employees’ Benefit
Board. [2001 c.865 §14; 2005 c.26 §5; 2011 c.99 §3; 2014 c.94 §1]
Notes of Decisions
Brown v. SAIF Corp., 391 P.3d 773 (Or. 2017).
“, ORS 656.247(4)(b). Compounding those ambiguities is the fact that some of the terms themselves are reasonably capable of more than one meaning.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
· cites it 27× “262(6) provides, in part, that, “[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Darling v. Johnson Controls Battery Grp., Inc., 70 P.3d 894 (Or. Ct. App. 2003).
· cites it 3× “As employer correctly points out, that statement is subject to one limitation: the worker filing the claim must be a “subject worker” as defined in ORS 656.027.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
· cites it 27× “262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Brown v. SAIF (Or. 2017).
“, ORS 656.247(4)(b). Compounding those ambiguities is the fact that some of the terms themselves are reasonably capable of more than one meaning.”
— Or. Rev. Stat. § 656.247(1) — 3 cases
Darling v. Johnson Controls Battery Grp., Inc., 70 P.3d 894 (Or. Ct. App. 2003).
“As employer correctly points out, that statement is subject to one limitation: the worker filing the claim must be a “subject worker” as defined in ORS 656.027.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, “[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
— Or. Rev. Stat. § 656.247(4) — 2 cases
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, “[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
— Or. Rev. Stat. § 656.247(4)(a) — 2 cases
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, “[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
— Or. Rev. Stat. § 656.247(4)(b) — 5 cases
Brown v. SAIF Corp., 391 P.3d 773 (Or. 2017).
“, ORS 656.247(4)(b). Compounding those ambiguities is the fact that some of the terms themselves are reasonably capable of more than one meaning.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, “[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Blacknall v. Manpower, Inc., 243 P.3d 794 (Or. Ct. App. 2010).
“262(6) provides, in part, that, "[e]xcept as provided in ORS 656.247, pending acceptance or denial of a claim, compensation payable to a claimant does not include the costs of medical benefits[.”
Brown v. SAIF (Or. 2017).
“, ORS 656.247(4)(b). Compounding those ambiguities is the fact that some of the terms themselves are reasonably capable of more than one meaning.”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.