WORKERS' COMP ALERTS & CURRENT EVENTS
Reinisch Mackenzie, P.C.
July 2008
REINISCH MACKENZIE Approaches the Quarter-Century Mark
This summer marks our firm's 25th year of providing workers' compensation defense services to our Pacific Northwest clients. We plan to celebrate this special event in a special way with a live-music gathering at the Portland Art Museum on the evening of September 25, 2008. Mark your calendars, and watch your mail.
Department Adopts Emergency Rule Enforcing PPO Medical Fee Discounts
Effective July 7, 2008, the Workers' Compensation Division has adopted a temporary emergency rule clarifying that medical service providers who agree to fee reductions as part of a Preferred Provider Network must abide by such agreements when billing workers' compensation claims. The Department has received scores of claims by providers, mostly physical therapists, asserting a right to full payment under the Oregon Fee Schedule notwithstanding their contracts with a PPO. They asserted the contracts were not enforceable because, outside of Managed Care Organization contracts, the previous rules clearly provided for payment of all services at full fee schedule rates. The Departments temporary will only be in force for 180 days. Before then, the Department will consider whether to propose and hold hearings on a permanent rule. The ultimate decision will have a major impact on Oregon's system in that PPOs may now be allowed to compete with more intensely regulated MCOs.
Update Regarding Rules Prohibiting Vocational Assistance to Unlawful Workers
At least for now, Oregon insurers and employers may continue to rely on OAR 436-120-0320(10((a) in denying eligibility for vocational assistance benefits to workers not "authorized to work in the United States."" Last year, in the case of Carmen Carreon, a hearings judge issued an order invalidating the rule, holding that undocumented workers are still "workers"" under the workers' compensation laws. On appeal, WCD Administrator John Shilts reversed the ALJ's Order and reinstated the rule as a valid exercise of its statutory authority to place reasonable conditions on benefits. The matter was appealed to the Court of Appeals, but the parties recently settled the dispute in a way that leaves the rule in place. That situation may change, however, because other claims involving the same issue are currently making their way up the appeal ladder to the courts.
Oregon Self Insurers Association To Contract with New Lobbyist
OSIA lobbyist Rob Douglas ("RPD Company") will discontinue his 26-year relationship with OSIA this year. Over the years, Douglas and his partner Joan Buck were instrumental in helping OSIA maintain its high-profile involvement in workers' compensation issues and reforms at the Legislature and the Department. A committee has been formed to advise the OSIA Board in retaining a new government relations firm.
