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For
claims enrolled in a Managed Care Organization (MCO), billing or
treatment disputes must go to the MCO for dispute resolution before
the worker may request administrative review of the matter by the
Workers’ Compensation Division. Requests for review through
the MCO dispute resolution process must be made to the MCO within
30 days of the mailing date of the initial MCO decision. Requests
for review of the final decision of the MCO must be made to the
Workers' Compensation Division's Medical Section Resolution Team
within 60 days of the mailing date of the MCO decison.
For all other billing or treatment disputes, administrative review
by the director must be requested within 90 days. Mediation and
alternative dispute resolution processes are also available to resolve
disputes between parties.
For billing disputes (such as the insurer’s reduction of a
medical bill or failure to pay within 45 days), use Form
2842 with attachment 2842a.
Medical treatment disputes may be initiated by any party using Form
2842. The insurer can request WCD administrative review to allege
treatment is excessive, inappropriate or unnecessary, or in violation
of a medical services rules. The health care provider can request
administrative review by WCD if the insurer does not approve palliative
care, curative care, elective surgery, etc.
Medical
Resolution Team
Workers'
Compensation Division
350
Winter St NE
PO Box
14480
Salem,
OR 97309-0405
If the insurer denies the compensability of the condition,
it will issue a denial, which the worker can appeal to the Workers’
Compensation Board.
Workers'
Compensation Board
2601
25th St SE, Suite 150
Salem, OR
97302-1282
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