Injured workers who found themselves without a remedy when their work injury claims were denied were given another option when the Oregon Supreme Court issued its opinion in Smothers v. Gresham Transfer, Inc. in May 2001. Terry Smothers filed an “occupational disease” claim for a lung disorder developed after exposure to fumes and mist containing sulfuric … Read more
Your patient suffered an injury on the job. The injury is an accepted Workers’ Compensation claim. The comp insurance carrier (“the insurer”) has been paying your bills. Now, you think your patient needs surgery. Although not needed as an emergency measure to preserve life, function or health, you believe surgery is required to help your … Read more
Your primary focus as a physician is unquestionably the best possible diagnosis and treatment of your patients. Nevertheless, you, like all other professionals, work under the cloud of a constant presence, hovering like a Big Brother: the potential of being sued. I must state clearly at the outset: our firm does not handle lawsuits against … Read more
Injured workers are frequently sent for an “independent medical exam” (“IME”), so the employer’s comp insurance carrier can get a second opinion. This common practice sounds fair and innocent enough. In fact, it is laden with landmines which can be fatal to the injured worker’s compensation claim. Most of the hazards lurk just behind the … Read more
Your opinion is needed for your patient’s work injury claim. It seems obvious to you that your patient needed treatment, and possibly was disabled, because he/she was hurt at work. Yet you’ve heard Workers’ Compensation judges do not always accept treating doctors’ opinions. What are judges in comp claims looking for anyway? Your opinion as … Read more
A map of the area gives us the big picture and helps us to understand where we are. Likewise, an overview showing how a Workers’ Compensation claim unfolds in Oregon may be helpful to doctors – who play a very critical role in certain stages of the claim. First, the work event occurs. This may … Read more
Getting medical bills paid has become very complex. Billing for treating injured workers is no exception. This article offers guidelines in how you are paid for treating injured workers. You may wish to give this information to your billing office. The form required for billing is either DCBS Form UB-92 or Form HCFA-1500, “Health Insurance … Read more
This Journal has looked at a number of issues and terms of art used to consider medical evidence in Workers’ Compensation claims. This article is a quick review of some of these concepts, with references to past issues which discuss these matters in more detail. Medical evidence is critical in deciding these issues: Diagnosis … Read more
You may be among those physicians who found the emergence of managed care organizations (“MCO’s”) unsettling. The idea of others judging and second-guessing your treatment decisions and fees did not appeal to you. Well, MCO’s appear to be here to stay. Oregon has extensive administrative rules governing the delivery of medical services through MCO’s (OAR … Read more
If you are treating a patient with a work injury, it is important to establish yourself as the “attending physician.” This is important to get paid for your services, as well as to proper processing of your patient’s Workers’ Compensation claim. The “attending physician” is the doctor or physician who is primarily responsible for the … Read more