Oregon law (ORS 656.273) sets a five-year limit in which a worker is entitled to additional benefits when aggravation of a compensable injury or illness occurs. Beyond this aggravation period, workers must petition their insurer or the Workers’ Compensation Board in order to reopen a claim. Upon its own motion, the board may grant temporary total disability (TTD) benefits in these cases. According to ORS 656.278, the Workers’ Compensation Board retains the authority to modify, change, or terminate former findings, orders or awards. Effective January 1, 1988, House Bill 2900 restricted the board’s own motion authority to cases fulfilling either of the following conditions: (1) post-aggravation-period claims with worsening of a compensable injury requiring hospitalization or surgery or (2) necessary medical services on compensable claims with an injury date prior to 1966.
The reform legislation also established the Reopened Claims Reserve to reimburse insurers or self-insurers for compensation paid to injured workers under own motion action, creating an incentive for carriers to seek an own motion order. Effective 1/1/96, the Reopened Claims Reserve was renamed the Reopened Claims Program (RCP) and became a component of the newly created Workers’ Benefit Fund. While insurers have the authority to voluntarily reopen a claim, the board’s own motion authority is employed when the carrier denies a request for reopening. If the board authorizes a reopening, the insurer is ordered to pay benefits and is reimbursed from the RCP as applicable.
Figure 1 depicts the number of Board Own Motion (BOM) orders from 1989-1998. These data are yearly totals of final orders, including claims accepted for reopening, claims denied, and dismissals. In 1998, the Board issued 550 orders, continuing a declining trend of total orders since 1991. At a slower rate, the number of claims accepted for reopening has also been decreasing. Reopened claims totaled 278 in 1998, 50 percent of total orders. The decrease in orders and reopened claims is partially related to a period of unusually high activity from 1991-1993, when SAIF began requesting reimbursement from the board on medical services for pre-1966 injuries. Another factor affecting the trend is the 36 percent decline in all accepted disabling claims (ADC) from 1988 through 1997 (although BOM orders are only affected by claims that are beyond the five-year-aggravation period). This abatement in the number of ADC’s is attributed both to increased attention to workplace safety and health, and policy modifications which have resulted in more conservative methods of evaluating claims and compensability.
The RCP is funded by assessments paid by employers and workers; these costs are excluded from the premium base. As of May 1999, RCP reimbursements to insurers and self-insurers total $34.5 million on BOM cases with order dates of 1989-1998. Reimbursements on a cash-flow basis were $3.9 million in FY1998, an 8 percent increase from the 1997 total. The four-year average on a cash-flow basis is now $3.5 million per year.
The data reported herein include only reopened claims where insurers and self-insurers have been reimbursed; some BOM orders exist where the carrier has not requested RCP reimbursement. Unless otherwise noted, statistics are based on the most recent BOM order date affecting the case (interim order date), which is not necessarily the date the board first ordered the claim reopened. Thus, yearly totals of orders and reimbursements may fluctuate whenever the board amends an order.
As figure 2 shows, 19 own motion orders in 1998 were claims for medical services. This continues a general downward trend since 1992 when order activity peaked at 108 BOM orders for medical services, due to SAIF’s reimbursement requests, as mentioned above. With some costs still outstanding, the average reimbursement per medical claim was $55,605 as of September 1999, compared to the average of $19,162 for medical services on 6 BOM orders in 1997. The largest medical claim reimbursement for a case closed in 1998 was $444,176. Three additional case closures also exceeded the $100,000 mark, at $175,966, $109,675, and $106,375. The median reimbursement for 1998 was $18,680. Total reimbursements for medical services on 1998 orders stand at $1,056,503, compared to the high of $2.9 million for 1992 orders.
Claims with RCP reimbursements for TTD decreased 22 percent from 1997 to 210 for 1998 BOM orders. As of September 1999, TTD reimbursements accounted for 61.5 percent of total reimbursements on 1998 orders. The largest reimbursement for a post-aggravation TTD case closed in 1998 was $113,905. For TTD cases closed in 1998, the median reimbursement was $5,567, and the median time lag from date of BOM order to insurer closure was 7.5 months.
On claims reimbursed under a 1998 BOM order, the median time lag from date of injury to date of order was 12.6 years; the average time lag was 14.7 years ( the difference in figures due to some claims with lengthy time lags, the longest being 41.6 years). Broken down by type of insurer, SAIF was reimbursed in 49 percent of the 1998 TTD cases, a rate similar to those in previous years. Private insurers comprised 38 percent of the reimbursed cases in 1998, while self-insurers made up 13 percent.
Although these data describing characteristics of reopened TTD claims pertain to the original injury or illness rather than the circumstances of the aggravation, they may nonetheless shed some light on the types of cases that require reopening beyond the aggravation period.
For 1998 orders, the average age at the date of original injury was 33, similar to the average age of 34 for the last three years. This along with the median time lag from injury date to order date indicates the worsened condition usually flared up when the worker was around 45 years of age.
As in previous years, sprains and strains were the most common nature of the original injury in 1998 cases, with 48.6 percent of the total. Categories, other than sprains and strains, with the highest injury rates were fractures (10%), dislocations (6.7%), and carpal tunnel syndrome (6.7%). As depicted in table 1, the average distribution for strains and sprains for reopened claims is slightly less then that of all accepted disabling claims, suggesting this condition is less likely to cause long-term or chronic problems. These data also suggest that dislocations, fractures, multiple injuries and carpal tunnel syndrome, although less probable as original injuries, are more likely to lead to long-term medical problems.
The two most common sources of the original injury were structures and surfaces (21 percent) and bodily motion (21 percent), and the causal event with the highest frequency was overexertion (30.5 percent). Figure 3 shows the percent distribution of the body part originally injured in 1998 cases. Since 1991, BOM cases have reported the lower extremities as the part most frequently injured; the five year average of 32.9 percent is substantially higher then the 19.8 percent occurrence among all accepted disabling claims.
For 1998 orders, the industry with the highest percentage
of claimants was manufacturing (31.4 percent). Labor (excluding
farm labor) comprised the most common occupation group, with
15.2% of the total. Looking at gender, 23.3 percent of the claimants
were female, a figure lower than the 1994-1997 average of 25.8
percent. Median length of employment with the employer at the
time of injury was 1.1 years. Finally, at the time of the original
injury, the weekly wage earned by workers with a 1998 Board Own
Motion claim averaged 8 percent higher than the statewide weekly
If you have questions, about the information contained in this document please contact by e-mail or phone: Charles Forbes, Research Analyst, Research & Analysis Section, Information Management Division (503) 947-7352
This web page was last revised: 01/25/00.
In compliance with the Americans with Disabilities Act (ADA), all IMD publications are available in alternative formats by calling (503) 378-4100 (V/TTY). The information in IMD publications is in the public domain and may be reprinted without permission.
[Printed form 440-2425 (12/99 IMD)]