656.313 Stay
of compensation pending request for hearing or review; procedure for denial of
claim for medical services; reimbursement. (1)(a) Filing by an employer or the insurer of a
request for hearing on a reconsideration order before the Hearings Division, a
request for Workers’ Compensation Board review or court appeal or request for
review of an order of the Director of the Department of Consumer and Business
Services regarding vocational assistance stays payment of the compensation
appealed, except for:
(A) Temporary
disability benefits that accrue from the date of the order appealed from until
closure under ORS 656.268, or until the order appealed from is itself reversed,
whichever event first occurs;
(B) Permanent
total disability benefits that accrue from the date of the order appealed from
until the order appealed from is reversed;
(C) Death
benefits payable to a surviving spouse prior to remarriage, to children or
dependents that accrue from the date of the order appealed from until the order
appealed from is reversed; and
(D) Vocational
benefits ordered by the director pursuant to ORS 656.340 (16). If a denial of
vocational benefits is upheld by a final order, the insurer or self-insured
employer shall be reimbursed from the Workers’ Benefit Fund pursuant to ORS
656.605 for all costs incurred in providing vocational benefits as a result of
the order that was appealed.
(b) If ultimately
found payable under a final order, benefits withheld under this subsection, and
attorney fees and costs, shall accrue interest at the rate provided in ORS
82.010 from the date of the order appealed from through the date of payment.
The board shall expedite review of appeals in which payment of compensation has
been stayed under this section.
(2) If the board
or court subsequently orders that compensation to the claimant should not have
been allowed or should have been awarded in a lesser amount than awarded, the
claimant shall not be obligated to repay any such compensation which was paid
pending the review or appeal.
(3) If an insurer
or self-insured employer denies the compensability of all or any portion of a
claim submitted for medical services, the insurer or self-insured employer
shall send notice of the denial to each provider of such medical services and
to any provider of health insurance for the injured worker. Except for medical
services payable in accordance with ORS 656.247, after receiving notice of the
denial, a medical service provider may submit medical reports and bills for the
disputed medical services to the provider of health insurance for the injured
worker. The health insurance provider shall pay all such bills in accordance
with the limits, terms and conditions of the policy. If the injured worker has
no health insurance, such bills may be submitted to the injured worker. A
provider of disputed medical services shall make no further effort to collect
disputed medical service bills from the injured worker until the issue of
compensability of the medical services has been finally determined.
(4) Except for
medical services payable in accordance with ORS 656.247:
(a) When the
compensability issue has been finally determined or when disposition or
settlement of the claim has been made pursuant to ORS 656.236 or 656.289 (4),
the insurer or self-insured employer shall notify each affected service
provider and health insurance provider of the results of the disposition or
settlement.
(b) If the
services are determined to be compensable, the insurer or self-insured employer
shall reimburse each health insurance provider for the amount of claims paid by
the health insurance provider pursuant to this section. Such reimbursement
shall be in addition to compensation or medical benefits the worker receives.
Medical service reimbursement shall be paid directly to the health insurance
provider.
(c) If the
services are settled pursuant to ORS 656.289 (4), the insurer or self-insured
employer shall reimburse, out of the settlement proceeds, each medical service
provider for billings received by the insurer or self-insured employer on and
before the date on which the terms of settlement are agreed as specified in the
settlement document that are not otherwise partially or fully reimbursed.
(d) Reimbursement
under this section shall be made only for medical services related to the claim
that would be compensable under this chapter if the claim were compensable and
shall be made at one-half the amount provided under ORS 656.248. In no event shall
reimbursement made to medical service providers exceed 40 percent of the total
present value of the settlement amount, except with the consent of the worker.
If the settlement proceeds are insufficient to allow each medical service
provider the reimbursement amount authorized under this subsection, the insurer
or self-insured employer shall reduce each provider’s reimbursement by the same
proportional amount. Reimbursement under this section shall not prevent a
medical service provider or health insurance provider from recovering the
balance of amounts owing for such services directly from the worker, unless the
worker agrees to pay all medical service providers directly from the settlement
proceeds the amount provided under ORS 656.248.
(5) As used in
this section, “health insurance” has the meaning for that term provided in ORS
731.162. [1965 c.285 §41; 1979 c.673 §1; 1981 c.535 §8; 1981 c.854 §22; 1983
c.809 §2; 1990 c.2 §23; 1993 c.521 §1; 1995 c.332 §38; amendments by 1995 c.332
§38a repealed by 1999 c.6 §1; 1999 c.6 §11; 2001 c.865 §13a; 2005 c.588 §4;
2009 c.35 §4; 2011 c.80 §1; 2015 c.521 §4]
656.314 [Amended by 1965 c.285 §45;
renumbered 656.580]
656.316 [Amended by 1953 c.428 §2; 1965
c.285 §46; renumbered 656.583]
656.318 [Amended by 1965 c.285 §47;
renumbered 656.587]
Notes of Decisions
Georgia-Pac. Corp. v. Piwowar, 753 P.2d 948 (Or. 1988).
· cites it 15× “Georgia-Pacific also relies on ORS 656.313 as authority for terminating compensation payments awarded in a determination order pending a hearing on the order.”
Wisherd v. Paul Koch Volkswagen, Inc., 559 P.2d 1305 (Or. Ct. App. 1977).
· cites it 13× “ORS 656.313 provides: "(1) Filing by an employer or the State Accident Insurance Fund of a request for review or court appeal shall not stay payment of compensation to a claimant.”
Georgia-Pac. Corp. v. Hughes, 751 P.2d 775 (Or. 1988).
· cites it 17× “For the reasons set out below, we affirm the Court of Appeals’ conclusion that awards of interim compensation are subject to ORS 656.313, but reverse the reinstatement of that portion of the penalty stricken by the Board.”
State Accident Ins. Fund Corp. v. Casteel, 703 P.2d 1039 (Or. Ct. App. 1985).
· cites it 20× “ORS 656.313 provides: "(1) Filing by an employer or the insurer of a request for review or court appeal shall not stay payment of compensation to a claimant.”
Norgard v. Rawlinsons & New Sys. Laundry, 569 P.2d 49 (Or. Ct. App. 1977).
· cites it 4× “Before the effective date of 1977 statutory amendments, circuit courts had the statutory authority to review decisions of the Board.”
State Accident Ins. Fund Corp. v. Maddox, 667 P.2d 529 (Or. 1983).
· cites it 5× “In rejecting SAIF’s argument that ORS chapter 19 applies to appeals from the Workers’ Compensation Board we conclude that ORS 656.313 is controlling on the issue raised in this case.”
State Accident Ins. Fund Corp. v. Mathews, 639 P.2d 668 (Or. Ct. App. 1982).
· cites it 6× “The answer depends on whether ORS 656.313, as amended by Oregon Laws 1979, chapter 673, section l, 1 applies to a case in which the compensable injury arose before the effective date of the amendment.”
Tattoo v. Barrett Bus. Serv., 847 P.2d 872 (Or. Ct. App. 1993).
· cites it 4× “) 2 Temporary rule OAR 436-60-150(6)(c) was revised in 1992 to provide that the appeal must be pursuant to ORS 656.313. This provision was not in effect at the time of this proceeding.”
Anodizing, Inc. v. Heath, 879 P.2d 218 (Or. Ct. App. 1994).
· cites it 6× “In awarding temporary benefits pending the decision on its request for hearing, the Board relied on ORS 656.313, which provides, in part: “(l)(a) Filing by an employer or the insurer of a request for hearing on a reconsideration order * * * stays payment of the compensation…”
Armstrong v. Rogue Fed. Credit Union, 969 P.2d 382 (Or. 1998).
· cites it 3× “262(2) (workers’ compensation is payable “except where the right to compensation is denied by the insurer or self-insured employer”); ORS 656.313(1) (employer can suspend duty to pay compensation by requesting hearing, requesting Board review, appealing to a court, or requesting…”
Atchley v. GTE Metal Erectors, 945 P.2d 557 (Or. Ct. App. 1997).
· cites it 4× “We affirmed, holding that, because the claimant’s right to temporary disability benefits during the pendency of appeal arose directly from an earlier version of ORS 656.313(1), his entitlement to such benefits was unconditional, and payment was required regardless of the outcome…”
— Or. Rev. Stat. § 656.313(1) — 34 cases
Norgard v. Rawlinsons & New Sys. Laundry, 569 P.2d 49 (Or. Ct. App. 1977).
“Before the effective date of 1977 statutory amendments, circuit courts had the statutory authority to review decisions of the Board.”
State Accident Ins. Fund Corp. v. Maddox, 667 P.2d 529 (Or. 1983).
“In rejecting SAIF’s argument that ORS chapter 19 applies to appeals from the Workers’ Compensation Board we conclude that ORS 656.313 is controlling on the issue raised in this case.”
Georgia-Pac. Corp. v. Piwowar, 753 P.2d 948 (Or. 1988).
“Georgia-Pacific also relies on ORS 656.313 as authority for terminating compensation payments awarded in a determination order pending a hearing on the order.”
— Or. Rev. Stat. § 656.313(1)(B) — 1 case
— Or. Rev. Stat. § 656.313(1)(a) — 1 case
— Or. Rev. Stat. § 656.313(1)(a)(A) — 1 case
— Or. Rev. Stat. § 656.313(1)(b) — 1 case
— Or. Rev. Stat. § 656.313(2) — 9 cases
State Accident Ins. Fund Corp. v. Casteel, 703 P.2d 1039 (Or. Ct. App. 1985).
“ORS 656.313 provides: "(1) Filing by an employer or the insurer of a request for review or court appeal shall not stay payment of compensation to a claimant.”
— Or. Rev. Stat. § 656.313(3) — 10 cases
Georgia-Pac. Corp. v. Hughes, 751 P.2d 775 (Or. 1988).
“For the reasons set out below, we affirm the Court of Appeals’ conclusion that awards of interim compensation are subject to ORS 656.313, but reverse the reinstatement of that portion of the penalty stricken by the Board.”
— Or. Rev. Stat. § 656.313(4) — 12 cases
Georgia-Pac. Corp. v. Piwowar, 753 P.2d 948 (Or. 1988).
“Georgia-Pacific also relies on ORS 656.313 as authority for terminating compensation payments awarded in a determination order pending a hearing on the order.”
Georgia-Pac. Corp. v. Hughes, 751 P.2d 775 (Or. 1988).
“For the reasons set out below, we affirm the Court of Appeals’ conclusion that awards of interim compensation are subject to ORS 656.313, but reverse the reinstatement of that portion of the penalty stricken by the Board.”
— Or. Rev. Stat. § 656.313(4)(a) — 1 case
— Or. Rev. Stat. § 656.313(4)(b) — 1 case
Armstrong v. Rogue Fed. Credit Union, 969 P.2d 382 (Or. 1998).
“262(2) (workers’ compensation is payable “except where the right to compensation is denied by the insurer or self-insured employer”); ORS 656.313(1) (employer can suspend duty to pay compensation by requesting hearing, requesting Board review, appealing to a court, or requesting…”
— Or. Rev. Stat. § 656.313(l)(a) — 6 cases
Tattoo v. Barrett Bus. Serv., 847 P.2d 872 (Or. Ct. App. 1993).
“) 2 Temporary rule OAR 436-60-150(6)(c) was revised in 1992 to provide that the appeal must be pursuant to ORS 656.313. This provision was not in effect at the time of this proceeding.”
— Or. Rev. Stat. § 656.313(l)(a)(A) — 4 cases
Atchley v. GTE Metal Erectors, 945 P.2d 557 (Or. Ct. App. 1997).
“We affirmed, holding that, because the claimant’s right to temporary disability benefits during the pendency of appeal arose directly from an earlier version of ORS 656.313(1), his entitlement to such benefits was unconditional, and payment was required regardless of the outcome…”
Anodizing, Inc. v. Heath, 879 P.2d 218 (Or. Ct. App. 1994).
“In awarding temporary benefits pending the decision on its request for hearing, the Board relied on ORS 656.313, which provides, in part: “(l)(a) Filing by an employer or the insurer of a request for hearing on a reconsideration order * * * stays payment of the compensation…”
— Or. Rev. Stat. § 656.313(l)(b) — 2 cases
Armstrong v. Rogue Fed. Credit Union, 969 P.2d 382 (Or. 1998).
“262(2) (workers’ compensation is payable “except where the right to compensation is denied by the insurer or self-insured employer”); ORS 656.313(1) (employer can suspend duty to pay compensation by requesting hearing, requesting Board review, appealing to a court, or requesting…”
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