Or. Admin. Code § 436-010-0280 - Determination of Impairment/Closing Exams
(1) When a worker
becomes medically stationary and there is a reasonable expectation of permanent
disability, the attending physician must complete a closing exam or refer the
worker to a consulting physician for all or part of the closing exam. If the
worker is under the care of an authorized nurse practitioner, physician
associate, or a naturopathic physician, the provider must refer the worker to a
type A attending physician to do a closing exam.
(2) The closing exam must be completed under
OAR 436-030 and 436-035 and Bulletin 239. (See Appendix A "Matrix for Health
Care Provider Types".)
(3) When the
attending physician completes the closing exam, the attending physician has 14
days from the medically stationary date to send the closing report to the
insurer. When the attending physician does not complete the closing exam, the
attending physician must arrange, or ask the insurer to arrange, a closing exam
with a consulting physician within seven days of the medically stationary
date.
(4) When an attending
physician or authorized nurse practitioner requests a consulting physician to
do the closing exam, the consulting physician has seven days from the date of
the exam to send the report to the attending physician for concurrence or
objections. Within seven days of receiving the closing exam report, the
attending physician must state in writing whether the physician concurs with or
objects to all or part of the findings of the exam, and send the concurrence or
objections with the report to the insurer.
(5) The attending physician must specify the
worker's residual functional capacity if:
(a)
The attending physician has not released the worker to the job held at the time
of injury because of a permanent work restriction caused by the compensable
injury, and
(b) The worker has not
returned to the job held at the time of injury, because of a permanent work
restriction caused by the compensable injury.
(6) Instead of specifying the worker's
residual functional capacity under section (5) of this rule, the attending
physician may refer the worker for:
(a) A
second-level physical capacities evaluation (see OAR
436-009-0060) when the worker
has not been released to return to the job held at the time of injury, has not
returned to the job held at the time of injury, has returned to modified work,
or has refused an offer of modified work; or
(b) A work capacities evaluation (see OAR
436-009-0060) when there is a
question of the worker's ability to return to suitable and gainful employment.
The provider may also be required to specify the worker's ability to perform
specific job tasks.
(7)
When the insurer issues a major contributing cause denial on an accepted claim
and the worker is not medically stationary:
(a) The attending physician must do a closing
exam or refer the worker to a consulting physician for all or part of the
closing exam; or
(b) An authorized
nurse practitioner, physician associate, or naturopathic physician, must refer
the worker to a type A attending physician for a closing
exam.
(8) The closing
report must include all of the following:
(a)
Findings of permanent impairment.
(A) In an
initial injury claim, the closing report must include objective findings of any
permanent impairment that is caused in any part by an accepted condition or a
direct medical sequela of an accepted condition.
(B) In a new or omitted condition claim, the
closing report must include objective findings of any permanent impairment that
is caused in any part by an accepted new or omitted condition or a direct
medical sequela of an accepted new or omitted condition.
(C) In an aggravation claim, the closing
report must include objective findings of any permanent impairment that is
caused in any part by an accepted worsened condition or a direct medical
sequela of an accepted worsened condition.
(D) In an occupational disease claim, the
closing report must include objective findings of any permanent impairment that
is caused in any part by an accepted occupational disease or a direct medical
sequela of an accepted occupational disease.
(b) Findings documenting permanent work
restrictions.
(A) If the worker has no
permanent work restriction, the closing report must include a statement
indicating that:
(i) The worker has no
permanent work restriction; or
(ii)
The worker is released, without restriction, to the job held at the time of
injury.
(B) In an initial
injury claim, the closing report must include objective findings documenting
any permanent work restriction that:
(i)
Prevents the worker from returning to the job held at the time of injury;
and
(ii) Is caused in any part by
an accepted condition or a direct medical sequela of an accepted
condition.
(C) In a new
or omitted condition claim, the closing report must include objective findings
documenting any permanent work restriction that:
(i) Prevents the worker from returning to the
job held at the time of injury; and
(ii) Is caused in any part by an accepted new
or omitted condition or a direct medical sequela of an accepted new or omitted
condition.
(D) In an
aggravation claim, the closing report must include objective findings
documenting any permanent work restriction that:
(i) Prevents the worker from returning to the
job held at the time of injury; and
(ii) Is caused in any part by an accepted
worsened condition or a direct medical sequela of an accepted worsened
condition.
(E) In an
occupational disease claim, the closing report must include objective findings
documenting any permanent work restriction that:
(i) Prevents the worker from returning to the
job held at the time of injury; and
(ii) Is caused in any part by an accepted
occupational disease or a direct medical sequel of an accepted occupational
disease.
(c) A
statement regarding the validity of an impairment finding is required in the
following circumstances:
(A) If the examining
physician determines that a finding of impairment is invalid, the closing
report must include a statement that identifies the basis for the determination
that the finding is invalid.
(B) If
the examining physician determines that a finding of impairment is valid but
the finding is not addressed by any applicable validity criteria under Bulletin
239, the closing report must include a statement that identifies the basis for
the determination that the finding is valid.
(C) If the examining physician chooses to
disregard applicable validity criteria under Bulletin 239 because the criteria
are medically inappropriate for the worker, the closing report must include a
statement that describes why the criteria would be inappropriate.
Notes
Appendices referenced are available from the agency.
Statutory/Other Authority: ORS 656.726(4) & 656.245(2)(b)
Statutes/Other Implemented: ORS 656.245 & 656.252
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