Oregon Supreme Court says IME reports can make denials eligible for worker-requested exams, WCB told

Lauren Eldridge, representing the Workers' Compensation Board, summarized a recent Oregon Supreme Court decision in Titleman v. SAFE that changes how workers become eligible for a worker-requested medical examination. "The rule of law to really take away from the Supreme Court decision is that a denial is based on an independent medical examination report for purposes of worker-requested medical examination entitlement if the denial is based on that report at the time the worker's request is decided," Eldridge said.

Eldridge walked the committee through the case facts: a worker filed a low-back claim, the carrier denied the claim, the worker requested a hearing, and the carrier later obtained and introduced an IME report that supported the denial. The Court of Appeals and the Supreme Court concluded that because the carrier submitted the IME report as evidence in support of its denial at the hearing, the denial could be considered based on that IME report for purposes of entitlement. Eldridge said the court viewed a denial as a continuing status that can change during litigation, and that limiting eligibility based on the timing of an IME would frustrate the statute's purpose of impartiality.

The presentation included legislative-history points and a review of how the Board had previously interpreted the statute to require the IME predate the denial. Eldridge urged members to note the new line of authority while the Board and staff consider whether rule or practice changes are needed. No formal action was taken during the update.