 |
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 they have enough information to close your claim and rate permanent
disability, or |
| | Your claim meets
the criteria allowing them 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
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
PO 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 form term definitions.
|
| |
| 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 they 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, they send 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
they need to get more information or 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 their 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 schedule a medical arbiter exam to settle disputes over impairment
findings. Medical arbiter exams consider condition(s) 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 condition(s). 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?" | ¿Qué
es un examen por un médico árbitro? (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, and |
| | Do not
call Appellate Review Unit staff 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, and |
| | 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, or |
| | 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 Statutes—Laws relating to workers’ compensation and safe employment
in Oregon |
| | What
happens if I’m hurt on the job? (Spanish) |
| | Understanding
Claim Closure and Your Rights (Spanish) |
| | Understanding
the Reconsideration Process |
| | 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 toll free, 800-927-1271
Benefits
& Certifications Unit
503-947-7810
Toll-free: 800-452-0288
Rehabilitation Review (Vocational assistance)
Salem: 503-947-7816
Medford: 541-776-6032 |
