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    Jim Van Ness   
503-947-7753   

Claim closure reconsideration

My Insurer issued a Notice of Closure (NOC). What does it mean?

I disagree with the NOC. Now what do I do?

Should I appeal my claim closure?

What is reconsideration?

Who are appellate reviewers?

How do I request reconsideration?

What happens after I request reconsideration?

What is a medical arbiter exam?

Who is a medical arbiter?

Do I get a hearing in front of the appellate reviewer?

What is an Order on Reconsideration?

Can an Order on Reconsideration reduce my benefits?

What do I do if I disagree with the Order on Reconsideration?

Where else can I get help?

 

My insurer issued a Notice of Closure (NOC). What does it mean?

The insurer decided either:
  You are medically stationary and it has enough information to close your claim and rate permanent disability, or
  Your claim meets the criteria allowing it to close your claim without you being medically stationary.
 

I disagree with the NOC. Now what do I do?

Your appeal rights are on back of the NOC. They read:

"This Notice of Closure is a legal document that closes your claim. It tells you periods of time you qualified for temporary disability (time loss) and how much permanent disability you have, if any.

Appeal rights: If you disagree with this Notice of Closure, you have the right to appeal the closure of your claim by asking for a "Reconsideration" within 60 days from the mailing date printed in box 1 on the front of this form. If you do not appeal within 60 days, you will lose all rights to appeal your claim closure. A "Request for Reconsideration" form is available from the Workers' Compensation Division (WCD) in Salem. Call 503-947-7816 or write to the Workers' Compensation Division, Appellate Review Unit, 350 Winter St. NE, Rm. 27, PO Box 14480, Salem, OR 97309-0405. The form (223a or 223b) is also available on the WCD website.

After completing the form, mail or deliver it to:

Workers’ Compensation Division
Appellate Review Unit
350 Winter St. NE, RM. 27
P.O. Box 14480
Salem, OR 97309-0405

You have the right to have an attorney represent you during the appeal process, although it is not required.”

See Request for reconsideration form (223a and 223b)

 

Should I appeal my claim closure?

You may ask for reconsideration of the claim closure any time within 60 days after the "mailing date" (see box 1 on the NOC) of the claim closure. The decision to appeal is up to you. You may contact a lawyer for help making this decision. You may also talk with the Ombudsman for Injured Workers by calling 503-378-3351 in Salem, or toll free at 800-927-1271.

 

 

Some reasons to appeal the closure:

 

You do not think the insurer should have closed your claim because you are not medically stationary.

  You think the insurer should have paid temporary disability benefits for a period other than those indicated on the closure.
  You think the insurer should have granted permanent disability.
  You think the insurer should have granted more permanent disability than is on the NOC.
 

What is Reconsideration?

Reconsideration is a review of information about the claim closure by an appellate reviewer in WCD.

 

Who are appellate reviewers?

Appellate reviewers are specialists who:

  Help workers understand the reconsideration process
  Send out or help workers fill out the Request for Reconsideration form
  Explain options and answer questions
   
  Help from an appellate reviewer is free, but he or she cannot act as an advocate or provide legal advice. You can contact an appellate reviewer by calling the WCD/Appellate Review Unit at 503-947-7816 or toll-free at 800-452-0288.

How do I request reconsideration?:

 

If you decide to ask for reconsideration of your claim closure, you can do so by:

  Filling out and mailing in a Request for Reconsideration
   (Form 440-2223a)
  Filling out the form and submitting it by electronic transmission (facsimile/FAX)
  Filling out the form and hand delivering it to the division office in Salem
  Calling the division and asking an appellate reviewer for help filling out the form over the phone or
  Coming to the Salem office in person and asking an appellate reviewer to help you fill out the form
 

What happens after I request reconsideration?

When the Appellate Review Unit receives your request for reconsideration, it sends a letter to you, the insurer, and any attorneys involved. This letter tells you that the reconsideration process has begun.

On the 18th working day after the division receives the worker's request, the appellate reviewer will either issue an Order on Reconsideration or delay issuing the Order for an additional 60 calendar days. The division postpones issuing the Order if it needs more information or needs to schedule a medical arbiter exam. If the division postpones the process, you will receive a letter telling you that we are postponing making a decision so we can request additional information or schedule a medical arbiter exam.

After the medical arbiter examines you and sends the report to us, the appellate reviewer will review all information, including anything received from you or your insurer. After completing this review, the appellate reviewer will issue an Order on Reconsideration and the process will be finished.

What is a medical arbiter exam?

Appellate Review Unit staff members schedule a medical arbiter exam to settle disputes over impairment findings. Medical arbiter exams consider conditions the insurer has accepted when it is time to close your claim. The medical arbiter physician will do a physical examination of you and prepare a report to answer the appellate reviewer's questions about your accepted conditions. The exam focuses on determining your impairment, so the medical arbiter cannot offer you medical treatment. For more detailed information about the medical arbiter process, refer to "What is a medical arbiter examination?" (3213)| ¿Qué es un examen por un médico árbitro? (3213s) (Spanish).

If WCD schedules a medical arbiter exam, we will send you a letter saying when and where the exam will take place. The division can suspend your disability benefits if you:

  Miss your exam appointment without a good reason for missing it
  Do not call an Appellate Review Unit staff member within 24 hours after the missed appointment to explain why you missed it.

Who is a medical arbiter?

A medical arbiter is a physician who:

  Is a medical doctor as defined by Oregon statute and in good standing with the Oregon Medical Board Examiners
  Has undergone training from WCD to provide services as a medical arbiter
  Has not seen you as a patient in this claim
  Was chosen by WCD at random from a list of doctors within the medical specialty appropriate for your claim
  Reviews your records and performs an examination as needed
  Provides a report of findings to WCD
   

Do I get a hearing in front of the appellate reviewer?

Reconsideration is an informal review process, not a hearing. This is your last chance to provide information about your claim closure. You may:

  Submit a written statement to tell us your story, explain your condition, and say why you disagree with the claim closure
  Provide statements from others to support your position
  Talk to the assigned appellate reviewer for help filing a statement
 

Sample Statement:

I was working as a waitress when I was injured. I have returned to work as a cashier. My hours have been cut back to only 34 hours per week, and I was working 40 hours when I got hurt. My doctor told me I would probably need further surgery in the future. I am still treating with my doctor and had an appointment on (date). My doctor sent me for more physical therapy. My claim should remain open because I feel that I still need medical care and I am unable to return to my regular job. There is an error in the paperwork, in that I did not graduate from high school and I do not have a GED.

   

What is an Order on Reconsideration?

An Order on Reconsideration is the legal document an appellate reviewer issues. It includes a brief medical history, the facts considered in making a decision, and the results of reviewing information about each issue you raised (for example, temporary disability, impairment findings, permanent disability).

   

Can an Order on Reconsideration reduce my benefits?

Yes, an Order on Reconsideration can reduce benefits. Reconsideration is a review of those issues raised about a claim closure, so benefits may increase, decrease, or stay the same.

   

What do I do if I disagree with the Order on Reconsideration?

The worker or the insurer can request a hearing with the Hearings Division of the Workers' Compensation Board within 30 days of the date the division issues the Order on Reconsideration. You must send your request for a hearing in writing to:

       Workers' Compensation Board
     Hearings Division
     2601 25th Street SE, Suite 150
     Salem, Oregon 97302-1282
   

Where else can I get help?

Other things you can read to help you understand the reconsideration process:

Workers’ Compensation Administrative Rules (OAR 436)For determining permanent partial disability
Workers’ Compensation Law Chapter 656 Oregon Revised StatutesLaws relating to workers’ compensation and safe employment in Oregon

  What happens if I’m hurt on the job? (1138) (Spanish)
  Understanding Claim Closure and Your Rights (2876) (Spanish)
  Understanding the Reconsideration Process (1587)
  Oregon Administrative Rules (OAR) Chapter 436 (Rules for closing workers' compensation claims, rating permanent disability, and first level of appeal of claim closures)
     Div. 030: Claim Closure and Reconsideration
     Div. 035: Standards for Rating Permanent Disability
  Workers' Compensation Law (Oregon Revised Statutes, Chapter 656)-Laws relating to workers' compensation and safe employment in Oregon
 

These people can talk with you to explain some of your benefits, the claim closure, and reconsideration. There is no charge for their help.

Ombudsman for Injured Workers
503-378-3351 or 800-927-1271 (toll-free)

Benefit Consultation Unit
503-947-7810 or toll-free 800-452-0288

Rehabilitation Review (Vocational assistance)
Salem: 503-947-7816
Medford: 541-776-6032


If you have questions about this webpage, please contact Jim Van Ness, 503-947-7753.