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Resolution Team
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Purpose
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Resolve medical disputes
between injured workers and insurers, medical providers, or managed care organizations
in a fair, just, and timely manner.
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Responsibilities
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Resolve disputes for:
Medical services:
provided to the worker - Bulletin 293 - Form 440-2842
Medical fees: bill reduction or non-payment - 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
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Functions
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medical reviewers of the Resolution Team (RT) 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. RT resolves 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, RT 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, RT 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. |
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Primary
governing rules
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OAR 436-009: The Oregon
Medical Fee
OAR 436-010: Medical Services Rules
ORS 656.245, .247, .248, .260, .327, .704, .726
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For
more information contact:
Medical
Section : 503-947-7606
FAX: 503-947-7629
E-mail: wcd.medicalquestions@state.or.us
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