(1)
General. A worker must
submit to independent medical examinations reasonably requested by the
insurer
or the
director.
(a) The conditions of the
examination must be consistent with conditions described in OAR
436-010-0265.
(b) If the worker refuses or fails to submit
to, or otherwise obstructs, an independent medical examination reasonably
requested by the
insurer or the
director under ORS
656.325(1), the
director may suspend compensation by order:
(A) The worker must have the opportunity to
dispute the suspension of compensation before the director will issue the
order; and
(B) Compensation will be
suspended until the examination has been completed. The worker is not entitled
to compensation during or for the period of suspension.
(c) Any action of a worker's observer allowed
under OAR
436-010-0265(6)
that obstructs the examination may be considered an obstruction of the
examination by the worker for the purpose of this rule.
(d) The director may determine whether
special circumstances exist that would not warrant suspension of compensation
for failure to attend or obstruction of the examination.
(e) The
director may impose a monetary
penalty against the worker under OAR
436-010-0265.
(2)
Number of
examinations. The
insurer may request no more than three separate
independent medical examinations for each opening of a claim, except as
provided under OAR
436-010. Examinations after the worker's claim is closed are
subject to limitations in ORS
656.268(8).
(3)
Scheduling and notice to
worker. The
insurer may contract with a third party to schedule
independent medical examinations. When an examination is scheduled by the
insurer, or by a third party at the request of the
insurer:
(a) The worker and the worker's attorney, if
any, must be simultaneously notified in writing of the scheduled medical
examination;
(b) The notice must be
mailed at least 10 days before the examination;
(c) If the third party notifies the worker of
a scheduled examination on behalf of the insurer, the appointment notice must
be sent on the insurer's stationery;
(d) The
insurer must include with each
appointment notice it sends to the worker:
(A)
Form 3921, "Request for Reimbursement of Expenses," or a similar form for
requesting reimbursement; and
(B)
Form 3923, "Important Information about Independent Medical Exams";
and
(e) The notice sent
for each appointment, including those which have been rescheduled, must contain
the following:
(A) The name of the examiner or
facility;
(B) A statement of the
specific purpose for the examination and, identification of the medical
specialties of the examiners;
(C)
The date, time, and place of the examination;
(D) The first and last name of the attending
physician or authorized nurse practitioner and verification that the attending
physician or authorized nurse practitioner was informed of the examination by,
at least, a copy of the appointment notice, or a statement that there is no
attending physician or authorized nurse practitioner, whichever is
appropriate;
(E) If applicable,
confirmation that the director has approved the examination;
(F) A statement that the reasonable cost of
public transportation or use of a private vehicle will be reimbursed and that,
when necessary, reasonable cost of child care, meals, lodging and other related
services will be reimbursed. A request for reimbursement must be accompanied by
a sales slip, receipt or other evidence necessary to support the request.
Should an advance of these costs be necessary for attendance, a request for
advancement must be made in sufficient time to ensure a timely
appearance;
(G) A statement that an
amount will be paid equivalent to net lost wages for the period during which it
is necessary to be absent from work to attend the medical examination if
benefits are not received under ORS
656.210(4)
during the absence;
(H) A statement
that the worker has the right to have an observer present at the examination,
but the observer may not be compensated in any way for attending the exam;
however, for a psychological examination, the notice must explain that an
observer is allowed to be present only if the examination provider approves the
presence of an observer; and
(I)
The following notice:
(i) In prominent or
bold text:
"You must attend this examination. If there is any reason
you cannot attend, you must tell the insurer as soon as possible before the
date of the examination. If you fail to attend and do not have a good reason
for not attending, or you fail to cooperate with the examination, your workers'
compensation benefits may be suspended in accordance with the workers'
compensation law and rules, ORS
656.325 and OAR 436-060. You may
be charged a $100 penalty if you fail to attend without a good reason or if you
fail to notify the insurer before the examination. The penalty is taken out of
future benefits.
If you object to the location of this appointment you
must contact the Workers' Compensation Division at 1-800-452-0288 or
503-947-7585 within six business days of the mailing date of this notice. If
you have questions about your rights or responsibilities, you may call the
Workers' Compensation Division at 1-800-452-0288 or 503-947-7585 or the Ombuds
Office for Oregon Workers at 1-800-927-1271."
(ii) Effective no later than Oct. 1, 2024,
the text in (I)(i) of this subsection must be replaced with the following
language in bold and formatted as follows:
You must attend this examination. If there is any reason
you cannot attend, you must tell us as soon as possible before the date of the
examination.
If you disagree with the location of this appointment,
you must contact the Workers' Compensation Division at 800-452-0288 or
503-947-7585 within six business days of the mailing date of this
notice.
Your workers' compensation benefits may be suspended
under Oregon laws and rules* if you:
- Do not attend the examination,
- Do not have a good reason for not attending the
examination, or
- Do not cooperate with the examination.
You may be charged a $100 penalty if you do not attend
the examination without good reason or if you do not notify the insurer before
the examination. The penalty is taken out of future benefits.
If you have any questions you may call:
- [Insurer] at [Insurer phone number]
- Workers' Compensation Division at 800-452-0288
(toll-free) or 503-947-7585
- Ombuds Office for Oregon Workers at 800-927-1271
(toll-free)
*Oregon Revised Statute 656.325 and Oregon Administrative
Rules, Chapter 436, division 60
(4)
Reimbursement of
costs. When a worker attends an independent medical examination the
insurer must reimburse the worker for reasonable costs in accordance with OAR
436-009-0025 regardless of claim
acceptance, deferral, or denial.
(5)
Forwarding of reports from
provider. Following completion of the examination, the insurer must
forward a copy of the examiner's signed report to the attending physician or
authorized nurse practitioner within three business days of the insurer's
receipt of the report.
(6)
Requests to authorize suspension. The
director will consider
requests to authorize suspension of benefits on accepted claims, deferred
claims, and denied claims in which the worker has appealed the
insurer's
denial. The request for suspension must be sent to the
division. A copy of the
request, including all attachments, must be sent simultaneously to the worker
and the worker's attorney by registered or certified mail or by personal
service in the same manner as a summons. The request must include the following
information:
(a) That the
insurer requests
suspension of compensation under ORS
656.325 and OAR
436-060-0095;
(b) The claim status and any accepted or
newly claimed conditions;
(c) What
specific actions of the worker prompted the request;
(d) The dates of any prior independent
medical examinations the worker has attended in the current open period of the
claim and the names of the examining physicians or facilities, or a statement
that there have been no prior examinations, whichever is appropriate;
(e) A copy of any approvals given by the
director for more than three independent medical examinations, or a statement
that no approval was necessary, whichever is appropriate;
(f) Any reasons given by the worker for
failing to comply, whether or not the insurer considers the reasons invalid, or
a statement that the worker has not given any reasons, whichever is
appropriate;
(g) The date and with
whom failure to comply was verified. Any written verification of the worker's
refusal to attend the exam received by the insurer from the worker or the
worker's attorney will be sufficient documentation with which to request
suspension;
(h) A copy of the
notice required in section (3) and a copy of any written verification received
under subsection (6)(g) of this rule;
(i) Any other information that supports the
request; and
(j) The following
notice:
(A) In prominent or bold text:
"Notice to worker: If you think this request to suspend
your compensation is wrong, you should immediately write to the Workers'
Compensation Division, 350 Winter Street NE, PO Box 14480, Salem, Oregon
97309-0405. Your letter must be mailed within 10 days of the date this request
was mailed or personally served on you. If the division grants this request,
you may lose all or part of your benefits. If your claim has not yet been
accepted, your future benefits, if any, will be jeopardized."
(B) Effective no later than Oct.
1, 2024, the text in (j)(A) of this section must be replaced with the following
language in bold and formatted as follows:
Notice to worker:
If the Workers' Compensation Division grants this
request, you may lose all or part of current or future benefits.
If you think this request to suspend your compensation is
wrong, write to the Workers' Compensation Division immediately.
- Your letter must be mailed within 10 days of the date
this request was mailed or personally served on you.
- Address your letter to:
Workers' Compensation Division
350 Winter Street NE
PO Box 14480
Salem OR 97309-0405
If you have any questions, you may call the Workers'
Compensation Division at 800-452-0288 (toll-free) or
503-947-7585.
(7)
Effective date of
suspension. If the director authorizes the suspension of compensation,
the suspension will be effective from the date the worker fails to attend an
examination or such other date the director deems appropriate until the date
the worker undergoes an examination scheduled by the insurer or director. Any
delay in requesting consent for suspension may result in authorization being
denied or the date of authorization being modified.
(8)
Reinstatement of benefits.
The insurer must assist the worker in meeting requirements necessary for the
resumption of compensation payments. When the worker has undergone the
independent medical examination, the insurer must verify the worker's
participation and reinstate compensation effective the date of the worker's
compliance.
(9)
Claim
closure. If the worker makes no effort to reinstate compensation in an
accepted claim within 60 days of the
mailing date of the consent to suspend
order, the
insurer must close the claim under OAR
436-030-0034.
(10)
Denial of suspension. If
the director denies the insurer's request for suspension of compensation, the
insurer will be notified of the reason for denial. Failure to comply with one
or more of the requirements addressed in this rule may be grounds for denial of
the insurer's request.
(11)
Other actions by the director. The
director may also take the
following actions concerning the
suspension of compensation:
(a) Modify or set aside the order of consent
before or after a request for hearing is filed;
(b) Order payment of compensation previously
suspended when the director finds the suspension to have been made in error;
and
(c) Reevaluate the necessity of
continuing a suspension.
(12)
Final orders. An order
becomes final unless, within 60 days after the date of mailing of the order, a
party files a request for hearing on the order with the board.
Notes
Or. Admin. Code §
436-060-0095
WCD 6-1989, f.
12-22-89, cert. ef. 1-1-90; WCD 9-1990(Temp), f. 6-18-90, cert. ef. 7-1-90; WCD
29-1990, f. 11-30-90, cert. ef. 12-26-90; WCD 7-1994, f. 8-11-94, cert. ef.
8-28-94, Renumbered from 436-060-0085(1),(2),(4); WCD 5-1996, f. 2-6-96, cert.
ef. 2-12-96; WCD 11-2000, f. 12-22-00, cert. ef. 1-1-01; WCD 11-2001, f.
11-30-01, cert. ef. 1-1-02; WCD 13-2003(Temp), f. 12-15-03, cert. ef. 1-1-04
thru 2-28-04; WCD 2-2004, f. 2-19-04 cert. ef. 2-29-04; WCD 9-2004, f.
10-26-04, cert. ef. 1-1-05; WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06; WCD
5-2006, f. 6-15-06, cert. ef. 7-1-06; WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10;
WCD 1-2011, f. 3-1-11, cert. ef. 4-1-11;
WCD
6-2016, f. 11-28-16, cert. ef.
1/1/2017;
WCD
6-2017, amend filed 12/14/2017, effective
1/1/2018;
WCD
3-2019, minor correction filed 04/01/2019, effective
4/1/2019; WCD 7-2020, amend filed 3/13/2020,
effective 4/1/2020;
WCD
14-2022, amend filed 12/20/2022, effective
1/1/2024;
WCD
14-2024, amend filed 06/07/2024, effective
7/1/2024
Statutory/Other Authority: ORS
656.325, ORS
656.704 & ORS
656.726(4)
Statutes/Other Implemented: ORS
656.325, ORS
656.704 & ORS
656.726(4)
