Chapter 50 Oregon Laws 2005

AN ACT

HB 2405

Relating to workers’ compensation aggravation claims; amending ORS 656.273.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 656.273 is amended to read:

656.273. (1) After the last award or arrangement of compensation, an injured worker is entitled to additional compensation for worsened conditions resulting from the original injury. A worsened condition resulting from the original injury is established by medical evidence of an actual worsening of the compensable condition supported by objective findings. However, if the major contributing cause of the worsened condition is an injury not occurring within the course and scope of employment, the worsening is not compensable. A worsened condition is not established by either or both of the following:

(a) The worker’s absence from work for any given amount of time as a result of the worker’s condition from the original injury; or

(b) Inpatient treatment of the worker at a hospital for the worker’s condition from the original injury.

(2) To obtain additional medical services or disability compensation, the injured worker must file a claim for aggravation with the insurer or self-insured employer. In the event the insurer or self-insured employer cannot be located, is unknown, or has ceased to exist, the claim shall be filed with the Director of the Department of Consumer and Business Services.

(3) A claim for aggravation must be in writing in a form and format prescribed by the director and signed by the worker or the worker’s representative[. The claim for aggravation must be accompanied by the attending physician’s report establishing by written medical evidence supported by objective findings that the claimant has suffered a worsened condition attributable to the compensable injury] and the worker’s attending physician. When an insurer or self-insured employer receives a completed aggravation form, the insurer or self-insured employer shall process the claim.

(4) The claim for aggravation must be filed within five years:

(a) After the first notice of closure made under ORS 656.268 for a disabling claim; or

(b) After the date of injury, provided the claim has been classified as nondisabling for at least one year after the date of acceptance.

(5) The director may order the claimant, the insurer or self-insured employer to pay for such medical opinion.

(6) A claim submitted in accordance with this section shall be processed by the insurer or self-insured employer in accordance with the provisions of ORS 656.262[, except that]. The first installment of compensation due under ORS 656.262 shall be paid no later than the 14th day after the subject employer [has notice or knowledge of medically verified] or paying agent of the subject employer receives a written report that verifies the worker’s inability to work resulting from a compensable worsening under subsection (1) of this section and that establishes by medical evidence supported by objective findings that the claimant has suffered a worsened condition attributable to the compensable injury.

(7) A request for hearing on any issue involving a claim for aggravation must be made to the Workers’ Compensation Board in accordance with ORS 656.283.

(8) If the worker submits a claim for aggravation of an injury or disease for which permanent disability has been previously awarded, the worker must establish that the worsening is more than waxing and waning of symptoms of the condition contemplated by the previous permanent disability award.

Approved by the Governor May 13, 2005

Filed in the office of Secretary of State May 13, 2005

Effective date January 1, 2006

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