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503-947-7606   


Medical Resolution Team

 

Purpose

Resolve medical disputes between injured workers and insurers, medical providers, or managed care organizations in a fair, just, and timely manner.

 

Responsibilities

Resolve disputes for:

Medical services: Provided to the worker - Bulletin 293 - Form 440-2842
Medical fees: Bill reduction or nonpayment - Bulletin 293 - Forms 440-2842, 440-2842a
Medical treatment: Determine if the treatment is excessive, inappropriate, ineffectual, or in violation of the workers' compensation rules - Bulletin 293 - Form 440-2842
Managed care organizations (MCO): When an injured worker or medical provider disagrees with an MCO decision - Bulletin 293 - Form 440-2842

 

Functions

The medical reviewers of the Medical Resolution Team review issues such as when the provider and the insurer do not agree on payment for medical services for workers or appropriateness of a surgery. The team attempts to resolve these disputes in a timely manner by alternative dispute resolution (ADR) processes and education. If the dispute cannot be resolved through ADR, the reviewer gathers additional information from the parties and reviews it to make a decision. In reviewing a medical treatment issue, the team may schedule an impartial physician's examination and record review. The consultation report becomes part of the record and final decision. Once the review is complete, the team issues a legally binding order based on the Oregon Revised Statutes, Oregon Administrative Rules, and relevant case law. These orders may be appealed to the Workers' Compensation Board (WCB). If a party is still not satisfied, it can appeal the WCB order to the Oregon Court of Appeals.
 

Primary governing rules

OAR 436-009: Oregon Medical Fee Rules
OAR 436-010: Oregon Medical Services Rules
ORS 656.245, .247, .248, .260, .327, .704, .726

 

For more information contact:
Phone: 503-947-7606
FAX: 503-947-7629
E-mail: wcd.medicalquestions@state.or.us


If you have questions about this webpage, please contact medical resolution, 503-947-7606.