In an attempt to answer frequently asked questions relating to the enforcement of Gov. Kate Brown’s
Executive Order 20-12 “Stay Home, Save Lives,” the Workers’ Compensation Division (WCD) is offering guidance about workers’ compensation issues.
Oregon Workers' Compensation COVID-19 claims data |
COVID claims by insurer and industry
COVID-19 Denied Claims Audit
COVID-19 informational fliers (English |
Frequently Asked Questions
Q: Is the Workers’ Compensation Division still open?
A: Yes, the division is maintaining all current services and expects minimal disruptions. We are prioritizing the health of our staff members and helping to flatten the curve of the pandemic by having our employees work remotely, staggering work schedules, canceling in-person events, and avoiding nonessential travel. Most of our physical locations are closed to the public. However, contact us to make arrangements if something needs to be delivered in person.
Q: Will the division waive or modify reporting requirements and time frames?
A: The division cannot waive statutory requirements. However, the division will consider the impact of COVID-19 in areas where the director has discretion to penalize or take action against an employer, worker, insurer, self-insured employer, service company, medical provider, or others.
All parties are encouraged to communicate with the division ahead of time if you cannot meet timelines, such as providing a timely response to inquiries. Where possible, the division will determine whether an extension or procedural waiver should be granted on a case-by-case basis, including whether COVID-19 is considered “good cause” or “reasons beyond a worker’s control,” where applicable. If there are specific areas of concern, please send them to email@example.com and we will review them.
Q: Why is documentation important?
A: Claims processors should document their claim files to explain why certain actions or inactions are happening. The division will consider these documented impacts when reviewing disputes and claims processing decisions for possible penalties or sanctions. We encourage as much reasonable flexibility and cooperation as possible. All parties should document their actions during this situation. For example, providers should include information in chart notes.
Q: What is the fee schedule for telehealth services?
A: Effective September 21, 2020, the division published permanent rules adopting the increased payment rates that were first adopted through temporary rules for telephonic and online digital evaluation/assessment and management services provided on or after March 8, 2020. This will allow providers to maintain their increased capacity to serve patients by telephone and online digital means.
Q: Are there restrictions to using telehealth?
A: The division’s rules do not restrict the services that may be provided through telehealth or the provider types that may use these services. However, all services, regardless of the form of communication, must also be appropriate for the services provided.
Q: What about temporary disability (time loss) authorization?
A: Every claim is unique, based on the facts of the case and the laws, and rules applicable to the circumstance. In general:
- An open-ended temporary disability authorization continues until changed by the worker’s attending physician or authorized nurse practitioner (unless the provider’s authority to authorize time loss expires under the statute).
- If a provider believes it is medically appropriate, he or she may extend temporary disability authorizations without physically seeing the patient, so long as the provider has the authority to authorize temporary disability under law and rule. See Appendix A of OAR 436-010 for a summary of who can authorize temporary disability and for how long (outside of a managed care organization).
- If the provider gives the insurer or employer an oral verification of the worker’s inability to work, temporary disability is authorized. Insurers should include written documentation of this authorization in their records and providers should forward the release when they are able.
MEDICAL ARBITER EXAMINATIONS
Q: What measures are doctors and facilities taking to limit exposure to Covid-19?
A: The examining doctors and facilities are following safety guidelines from the Centers for Disease Control and the Oregon Health Authority as directed by the governor.
Each doctor and clinic may set requirements for attending examinations, including observation of social distancing guidelines. Some facilities are scheduling appointments, so that only one patient is in the waiting room at a time. Others are requesting that workers wear their own protective face covering in the clinic and during the examination. You should check with the doctor’s office or facility before the examination to confirm these requests. If you still have questions, contact the ARU resource noted in your Arbiter Exam Notice.
Q: What if I am not sick, but I do not attend the arbiter examination due to Covid-19 concerns?
A: If you communicate this to ARU at 503-947-7816, 48 hours before the medical arbiter examination, ARU will not suspend your benefits and will reschedule the examination, if the statutory time frame allows. ARU is already scheduling the examinations as close as possible to the order due date. If we cannot reschedule your arbiter exam, ARU will proceed with a medical arbiter record review.
CONTINUING EDUCATION UNITS
Q: Will claims examiners get an extension for their Continuing Education Units (CEUs) since there are limited training opportunities at this time?
A: OAR 436-055-0070(4) gives claims examiners a 12-month grace period to renew their certification. During that 12-month grace period, between an examiner’s three-year period expiring and their 24 credits being obtained, an examiner would still be “certified” under the rules. For example, examiners whose certifications expire on March 31, 2020, have until March 30, 2021, to complete the 24 credits. In this example, the their new certification period (with another 24 credits required) would still start April 1, 2020, so the examiners would need to ensure they do not count the grace period “catch up” toward that new certification period. Online training and classes may be used to satisfy the credit requirement.
Q: Does the Workers’ Compensation Division have DVDs we can check out for training?
A: The division no longer has DVDs available (many of them were getting outdated), but we still have a few videos available. The first two groups (independent contractor vs. subject worker and provider training) are each worth one hour if you watch all of the modules. The third option, What happens if I’m hurt on the job? is worth a half hour of training credit. These videos will count towards general claims examiner Continuing Education Credit Units (CEUs). Please track these hours and communicate with your employer.
Workers’ Compensation Division
350 Winter St. NE
P.O. Box 14480
Salem, OR 97309-0405
503-947-7585 (general questions)
503-947-7810 (central reception)
Please call or send specific questions to: