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Trial lawyers urge stricter WCD preauthorization rules, cite insurer delays
Summary
Representatives of the Oregon Trial Lawyers Association told the MLAC meeting that the proposed Workers’ Compensation Division preauthorization rule is too narrow, gives insurers excessive response time, and leaves workers at risk of missing review deadlines if insurers do not confirm receipt.
Keith Semple and Jovanna Patrick of the Oregon Trial Lawyers Association (OTLA) told the Workers' Compensation Management‑Labor Advisory Committee on March 5 that proposed WCD preauthorization rules fall short of fixing insurer delays that harm injured workers.
"The proposed rule is relatively narrow as it applies only to attending physicians," Semple said, arguing the draft limits remedies and leaves workers facing de‑facto denials if insurers fail to acknowledge receipt. He criticized a 14‑day insurer response window in the draft, saying it should mirror the seven‑day elective surgery standard and that the rule should be triggered by a provable send date or confirmed receipt. Jovanna Patrick added that the draft lacks incentives for insurers to document receipt and described a case in which a worker's surgery request went unanswered for a year despite repeated faxes, emails and calls.
WCD Administrator Matt West told the committee the division was reviewing stakeholder testimony and would consider whether to tweak rule language or pull a rule for further discussion; he also cautioned there are limits on staff comments while rulemaking is underway. OTLA requested broader stakeholder engagement and suggested coupling preauthorization discussions with physician compensation rulemaking so providers can see how administrative burdens will be handled.
The exchange left the committee with a clearer sense of OTLA's concerns: a broader scope (beyond attending physicians), tighter deadlines, and explicit standards for proving notice or receipt. WCD said it would digest the comments and follow up as part of the rulemaking process.
