Or. Admin. Code § 436-030-0035 - Determining Medically Stationary Status
(1) A worker is
medically stationary in the following circumstances:
(a)
In initial injury claims. In
an initial injury claim, a worker is medically stationary when the attending
physician, authorized nurse practitioner, or a preponderance of medical opinion
declares that all accepted conditions and direct medical sequelae of accepted
conditions are either "medically stationary" or "medically stable" or when the
provider uses other language meaning the same thing.
(b)
In new or omitted condition
claims. In a new or omitted condition claim, a worker is medically
stationary when the attending physician, authorized nurse practitioner, or a
preponderance of medical opinion declares that all accepted new or omitted
conditions and direct medical sequelae of accepted new or omitted conditions
are either "medically stationary" or "medically stable" or when the provider
uses other language meaning the same thing.
(c)
In aggravation claims. In an
aggravation claim, a worker is medically stationary when the attending
physician, authorized nurse practitioner, or a preponderance of medical opinion
declares that all accepted worsened conditions and direct medical sequelae of
accepted worsened conditions are either "medically stationary" or "medically
stable" or when the provider uses other language meaning the same
thing.
(d)
In occupational
disease claims. In an occupational disease claim, a worker is medically
stationary when the attending physician, authorized nurse practitioner, or a
preponderance of medical opinion declares that all accepted occupational
diseases and direct medical sequela of accepted occupational diseases are
either "medically stationary" or "medically stable" or when the provider uses
other language meaning the same thing.
(2) When there is a conflict in the medical
opinions as to whether a worker is medically stationary, more weight is given
to medical opinions that are based on the most accurate history, on the most
objective findings, on sound medical principles, and clear and concise
reasoning.
(3) Where there is not a
preponderance of medical opinion stating a worker is or is not medically
stationary, deference will generally be given to the opinion of the attending
physician. However, in cases where expert analysis is important, deference is
given to the opinion of the physician with the greatest expertise in, and
understanding of, the worker's medical condition.
(4) When there is a conflict as to the date
upon which a worker became medically stationary, the following conditions
govern the determination of the medically stationary date. The date a worker is
medically stationary is the earliest date that a preponderance is established
under sections (1) and (2) of this rule. The date of the examination, not the
date of the report, controls the medically stationary date.
(5) The insurer may request that the
attending physician or authorized nurse practitioner concur with or comment on
the closing examination when the attending physician or authorized nurse
practitioner arranges or refers the worker for a closing examination with
another physician. When the insurer closes a claim relying on an independent
medical examination to support a preponderance of opinion establishing
medically stationary status, before issuing the closure the insurer must
request the attending physician or authorized nurse practitioner to concur with
or comment on the independent medical examination. A concurrence with another
physician's report is an agreement in every particular, including the medically
stationary impression and date, unless the physician expressly states to the
contrary and explains the reasons for disagreement. Concurrence cannot be
presumed in the absence of the attending physician's response.
(6) A worker is medically stationary on the
date so specified by a physician. When a specific date is not indicated, a
worker is presumed medically stationary on the date of the last examination,
prior to the date of the medically stationary opinion. Physician projected
medically stationary dates cannot be used to establish a medically stationary
date.
(7) If the worker is
incarcerated or confined in some other manner and unable to freely seek medical
treatment, the insurer must arrange for closing medical examinations to be
completed at the facility where the worker is located or at some other location
accessible to the worker.
(8) If a
worker dies and the attending physician has not established a medically
stationary date, for purposes of claim closure, the medically stationary date
is the date of death.
Notes
Statutory/Other Authority: ORS 656.268 & 656.726
Statutes/Other Implemented: ORS 656.268
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