Oregon Workers' Compensation Claim Closure
Our experienced workers' compensation attorney in Portland can help you with your claim closure.
How to fight a claim closure in the Oregon workers' compensation system
Every injured worker will eventually reach "maximum medical improvement," which means they are "medically stationary." At that point the insurance company will begin the process of closing the claim. Disabling claims receive a formal "Notice of Closure" that the worker may appeal by filing a timely Request for Reconsideration with the Workers' Compensation Division's Appellate Review Unit.
Steps in Fighting an Oregon Workers' Compensation Claim Closure
Clarify the Basis for Closure
Ideally, the worker's attending physician will discuss claim closure with the worker before performing a closing examination. Unfortunately, many physicians fail to do this. Workers are frequently shocked to discover their claim was closed. Calls to their physician's office rarely produce an explanation for why the claim was closed and, in many cases, the physician is reluctant to meet with them again to discuss the case. We refer to these as "mystery closures."
Mystery closures usually occur because the attending physician signed a letter from the insurance company stating the worker was medically stationary or, alternatively, the physician deferred to an independent medical examiner. In some instances, the physician is unaware their deferral would result in closure. In other instances, the physician no longer feels capable of treating the worker and simply opts to facilitate closure of the claim instead of referring the worker to another provider.
Other closures, known as administrative or "bug letter" closures, occur when the worker fails to treat every 30 days.
The first step to challenging a closure is determining why the claim was closed to begin with. Records should be requested and carefully evaluated once the closure issues. Follow-up teleconferences or meetings with the attending physician may also be necessary to clarify their opinion regarding the worker's medically stationary status. In many instances, claims are closed without appropriate impairment findings, which means a physical capacities evaluation or work capacity evaluation will be necessary before a valid closure can issue.
File a Request for Reconsideration
Notices of Closure issued on disabling claims are appealed by filing a Request for Reconsideration with the Appellate Review Unit of the Oregon Workers' Compensation Division. The Request for Reconsideration must be filed within 60 days of the mailing date of the Notice of Closure. A copy of the Appellate Review Unit's Request for Reconsideration form can be obtained by clicking here.
The Appellate Review Unit will request documentation from the parties regarding the claim. Pertinent documentation in support of the appeal should be sent to the Appellate Review Unit. If the Appellate Review Unity concludes the worker is medically stationary, they may be scheduled for an arbiter evaluation if the worker challenged their impairment award. Arbiter examinations may result in an increase or decrease to the final impairment award. Once any necessary examinations have been performed, an Order on Reconsideration will issue that either affirms, modifies or sets aside the Notice of Closure.
It is possible to appeal an Order on Reconsideration by filing a timely Request for Review within 30 days of the Order. Either party may file an appeal.
Common Reasons Why Workers' Comp Claims are Closed in Oregon
Insurers actively attempt to close claims as quickly as possible to avoid paying ongoing costs. Some insurers even use a "closure ratio" when evaluating an adjuster's performance. If the adjuster fails to meet the insurer's closure ratio for the year their performance review will be negatively impacted and they may not receive a bonus or annual pay increase. Insurers and adjusters are thus highly motivated to close claims as quickly as possible,
Some claims are closed without enough information. In essence the adjuster is simply hoping the worker no longer requires treatment and will not file an appeal. Other closures are issued in an attempt to force settlement of a claim the insurer believes has been too costly. Many closures occur because the attending physician signs a form without first considering the consequences of doing so.
As with denials, a closure of the claim does not mean the claim is bad or the worker has done something wrong. It may not even mean the worker is actually medically stationary. The facts underpinning every Oregon workers' compensation Notice of Closure should be fully investigated. In the event those facts do not support closure, a timely Request for Reconsideration should be filed.
Call our Portland Workers’ Compensation Attorney for Assistance with Your Workers’ Compensation Surgery or Treatment Denial Today
Nathan Goin began his career as a claims examiner for one of the major workers' compensation insurers in Oregon. Through this experience, he learned firsthand how workers' compensation insurers view injured workers, manage their claims, value settlements and, ultimately, attempt to close claims while paying as little as possible. Nathan's legal career now focuses on fighting for the rights of injured workers to ensure that they receive the benefits they deserve.
We understand how difficult the workers' compensation process can be for an injured worker. Goin Law Group values every client and will work tirelessly to maximize your benefits. Schedule a free consultation with an experienced Oregon workers' compensation attorney today. Call now for assistance with your claim. You don't have to do this alone.