Or. Rev. Stat. » Oregon Revised Statutes

Or. Rev. Stat. § 656.327

Review of medical treatment of worker; findings; review; costs

Find cases: SyfertCases citing this section ORSoregonlegislature.gov JustiaChapter on Justia CornellLII Search CasesGoogle Scholar

      656.327 Review of medical treatment of worker; findings; review; costs. (1)(a) If an injured worker, an insurer or self-insured employer or the Director of the Department of Consumer and Business Services believes that the medical treatment, not subject to ORS 656.260, that the injured worker has received, is receiving, will receive or is proposed to receive is excessive, inappropriate, ineffectual or in violation of rules regarding the performance of medical services, the injured worker, insurer or self-insured employer must request administrative review of the treatment by the director prior to requesting a hearing on the issue and so notify the parties.

      (b) Unless the director issues an order finding that no bona fide medical services dispute exists, the director shall review the matter as provided in this section. Appeal of an order finding that no bona fide medical services dispute exists shall be made directly to the Workers’ Compensation Board within 30 days after issuance of the order. The board shall set aside or remand the order only if the board finds that the order is not supported by substantial evidence in the record. Substantial evidence exists to support a finding in the order when the record, reviewed as a whole, would permit a reasonable person to make that finding. The decision of the board is not subject to review by any other court or administrative agency.

      (c) The insurer or self-insured employer shall not deny the claim for medical services nor shall the worker request a hearing on any issue under this section until the director issues an order under subsection (2) of this section.

      (2) The director shall review medical information and records regarding the treatment. The director may cause an appropriate medical service provider to perform reasonable and appropriate tests, other than invasive tests, upon the worker and may examine the worker. Notwithstanding ORS 656.325 (1), the worker may refuse a test without sanction. Review of the medical treatment shall be completed and the director shall issue an order within 60 days of the request for review. The director shall create a documentary record sufficient for purposes of judicial review. If the worker, insurer, self-insured employer or medical service provider is dissatisfied with that order, the dissatisfied party may request review under ORS 656.704. The administrative order may be modified at hearing only if it is not supported by substantial evidence in the record or if it reflects an error of law. No new medical evidence or issues shall be admitted. The worker is not obligated to pay for medical treatment determined not to be compensable under this subsection.

      (3) Upon request of either party, the director may delegate to a physician or a panel of physicians the review of medical treatment under this section. At least one member of any such panel shall be a practitioner of the healing art of the medical service provider whose treatment is being reviewed. No member of any such panel shall be a physician whose treatment is the subject of review. The panel shall be chosen in such manner as the director may prescribe, in consultation with the committee referred to in ORS 656.790. The physician or panel shall submit findings to the director within the time limits as prescribed by the director.

      (4) The physician or the panel of physicians and the medical arbiter or panel of medical arbiters appointed pursuant to ORS 656.268 acting pursuant to the authority of the director are agents of the Department of Consumer and Business Services and are subject to the provisions of ORS 30.260 to 30.300. The findings of the physician or panel of physicians, the medical arbiter or panel of medical arbiters, all of the records and all communications to or before a panel or arbiter are privileged and are not discoverable or admissible in any proceeding other than those proceedings under this chapter. No member of a panel or a medical arbiter shall be examined or subject to administrative or civil liability regarding participation in or the findings of the panel or medical arbiter or any matter before the panel or medical arbiter other than in proceedings under this chapter.

      (5) The costs of review of medical treatment by the physician or panel of physicians pursuant to this section and costs incurred by the worker in attending any examination required under this section, including child care, transportation, lodging and meals, shall be paid by the insurer or self-insured employer. [1987 c.884 §29; 1990 c.2 §26; 1995 c.332 §41; 2005 c.26 §12]

Notes of Decisions
Cited in 36 cases (1 in the last 5 years), 1993–2024 · leading case: Martin v. City of Albany
Sort: Relevance Newest Treatment
Martin v. City of Albany (1994) or · cites it 32× “” On review, the Board held that the referee lacked jurisdiction over issues surrounding the proposed medical procedure, because “disputes regarding proposed medical services, as well as those regarding current medical services, are within the Director’s original jurisdiction…”
Meyers v. Darigold, Inc. (1993) orctapp · cites it 41× “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
O'NEIL v. National Union Fire (1998) orctapp · cites it 19× “Claimant seeks review of the final order of the Director of the Department of Consumer and Business Services 1 under ORS 656.327, holding that the prescribed medication Prozac is not “appropriate” to the treatment of a low back condition that claimant suffers as the result of an…”
Schoch v. Leupold & Stevens (1997) or · cites it 2× “ORS 656.327(1) (1991) (since amended by Or Laws 1995, ch 332, § 41).”
SAIF Corp. v. Leland (1999) orctapp · cites it 6× “The MRU stated that rule but, according to the ALJ, failed to state any reasons, “persuasive, or otherwise, for finding Dr. Bert’s rationale less persuasive than the rationale of the doctors in opposition to the surgery.”
Aetna Cas. & Sur. v. SUE A. BLANTON, DC (1996) orctapp · cites it 4× “Reviewing for errors of law, ORS 656.327; ORS 183.482(7), we disagree with the director’s reading of the rule and reverse.”
Liberty Northwest Ins. Corp. v. Watkins (2010) or “In turn, ORS 656.327(l)(a) provides that, when an injured worker, insurer, self-insured employer, or the director believes that a proposed medical service is excessive, inappropriate, ineffectual, or in violation of rules regarding the performance of medical services, the…”
Mount v. Department of Consumer & Business Services (2002) orctapp · cites it 2× “) In addition, ORS 656.327(4) provides, in part: "No member of a panel or a medical arbiter shall be examined or subject to administrative or civil liability regarding participation in or the findings or the panel or medical arbiter or any matter before the panel or medical…”
Hathaway v. Health Future Enterprises (1993) orctapp · cites it 9× “704(3) is to determine the respective authority of the director and the Board, we held that, if no party invokes the director’s authority under ORS 656.327 *553 (l)(a), then the conditions necessary to confer exclusive jurisdiction on the director do not exist, there is no…”
Providence Health System v. Walker (2012) orctapp “”); ORS 656.327(1)(b) (appeal of a director’s order finding that no bona fide medical services dispute exists “shall be made directly to the [board]” and “[t]he board shall set aside or remand the order only if the board finds that the order is not supported by substantial…”
Baar v. Fairview Training Center (1996) orctapp · cites it 2× “245(1)(b), housekeeping services were not reimbursable medical services related to his accepted left knee claim.”
Hathaway v. Health Future Enterprises (1994) or · cites it 3× “245(l)(b) to the attending physician’s procedural options does not indicate that disapproval of a request for noncompensable palliative care is a “question concerning a claim” under ORS 656.283(1). We have examined the other subsections of ORS 656.”
Show all 36 citing cases →
— Or. Rev. Stat. § 656.327(1) — 13 cases
Martin v. City of Albany (1994) or “” On review, the Board held that the referee lacked jurisdiction over issues surrounding the proposed medical procedure, because “disputes regarding proposed medical services, as well as those regarding current medical services, are within the Director’s original jurisdiction…”
Schoch v. Leupold & Stevens (1997) or “ORS 656.327(1) (1991) (since amended by Or Laws 1995, ch 332, § 41).”
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
O'NEIL v. National Union Fire (1998) orctapp “Claimant seeks review of the final order of the Director of the Department of Consumer and Business Services 1 under ORS 656.327, holding that the prescribed medication Prozac is not “appropriate” to the treatment of a low back condition that claimant suffers as the result of an…”
Jefferson v. Sam's Cafe (1993) orctapp
— Or. Rev. Stat. § 656.327(1)(a) — 5 cases
Martin v. City of Albany (1994) or “” On review, the Board held that the referee lacked jurisdiction over issues surrounding the proposed medical procedure, because “disputes regarding proposed medical services, as well as those regarding current medical services, are within the Director’s original jurisdiction…”
Aetna Cas. & Sur. v. SUE A. BLANTON, DC (1996) orctapp “Reviewing for errors of law, ORS 656.327; ORS 183.482(7), we disagree with the director’s reading of the rule and reverse.”
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
Roseburg Forest Products v. Humbert (2007) orctapp
Mantle v. SAIF (2024) orctapp
— Or. Rev. Stat. § 656.327(1)(b) — 2 cases
Providence Health System v. Walker (2012) orctapp “”); ORS 656.327(1)(b) (appeal of a director’s order finding that no bona fide medical services dispute exists “shall be made directly to the [board]” and “[t]he board shall set aside or remand the order only if the board finds that the order is not supported by substantial…”
Roseburg Forest Products v. Humbert (2007) orctapp
— Or. Rev. Stat. § 656.327(1)(c) — 1 case
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
— Or. Rev. Stat. § 656.327(2) — 10 cases
Martin v. City of Albany (1994) or “” On review, the Board held that the referee lacked jurisdiction over issues surrounding the proposed medical procedure, because “disputes regarding proposed medical services, as well as those regarding current medical services, are within the Director’s original jurisdiction…”
O'NEIL v. National Union Fire (1998) orctapp “Claimant seeks review of the final order of the Director of the Department of Consumer and Business Services 1 under ORS 656.327, holding that the prescribed medication Prozac is not “appropriate” to the treatment of a low back condition that claimant suffers as the result of an…”
SAIF Corp. v. Leland (1999) orctapp “The MRU stated that rule but, according to the ALJ, failed to state any reasons, “persuasive, or otherwise, for finding Dr. Bert’s rationale less persuasive than the rationale of the doctors in opposition to the surgery.”
Baar v. Fairview Training Center (1996) orctapp “245(1)(b), housekeeping services were not reimbursable medical services related to his accepted left knee claim.”
Liberty Northwest Insurance v. Mundell (2008) orctapp
— Or. Rev. Stat. § 656.327(3) — 6 cases
Hathaway v. Health Future Enterprises (1994) or “245(l)(b) to the attending physician’s procedural options does not indicate that disapproval of a request for noncompensable palliative care is a “question concerning a claim” under ORS 656.283(1). We have examined the other subsections of ORS 656.”
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
Hathaway v. Health Future Enterprises (1993) orctapp “704(3) is to determine the respective authority of the director and the Board, we held that, if no party invokes the director’s authority under ORS 656.327 *553 (l)(a), then the conditions necessary to confer exclusive jurisdiction on the director do not exist, there is no…”
Nicholson v. Salem Area Transit & Saif Corp. (1994) or
Mantle v. SAIF (2024) orctapp
— Or. Rev. Stat. § 656.327(4) — 1 case
Mount v. Department of Consumer & Business Services (2002) orctapp “) In addition, ORS 656.327(4) provides, in part: "No member of a panel or a medical arbiter shall be examined or subject to administrative or civil liability regarding participation in or the findings or the panel or medical arbiter or any matter before the panel or medical…”
— Or. Rev. Stat. § 656.327(l)(a) — 10 cases
Martin v. City of Albany (1994) or “” On review, the Board held that the referee lacked jurisdiction over issues surrounding the proposed medical procedure, because “disputes regarding proposed medical services, as well as those regarding current medical services, are within the Director’s original jurisdiction…”
Liberty Northwest Ins. Corp. v. Watkins (2010) or “In turn, ORS 656.327(l)(a) provides that, when an injured worker, insurer, self-insured employer, or the director believes that a proposed medical service is excessive, inappropriate, ineffectual, or in violation of rules regarding the performance of medical services, the…”
Hathaway v. Health Future Enterprises (1993) orctapp “704(3) is to determine the respective authority of the director and the Board, we held that, if no party invokes the director’s authority under ORS 656.327 *553 (l)(a), then the conditions necessary to confer exclusive jurisdiction on the director do not exist, there is no…”
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
Liberty Northwest Insurance v. Mundell (2008) orctapp
— Or. Rev. Stat. § 656.327(l)(c) — 1 case
Meyers v. Darigold, Inc. (1993) orctapp “She also set aside employer's partial denial of the medical services claim on the basis that employer had failed to submit the matter to the director for review under ORS 656.327. The Board reinstated the aggravation denial and vacated the order setting aside the denial of…”
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.