Bill Text: OR SB173 | 2011 | Regular Session | Enrolled
Bill Title: Relating to recovery of amounts owing for medical services provided in workers' compensation claims.
Sponsorship: Unknown
Status: (Passed) 2011-05-19 - Effective date, January 1, 2012. [SB173 Detail]
Download: Oregon-2011-SB173-Enrolled.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
Enrolled
Senate Bill 173
Printed pursuant to Senate Interim Rule 213.28 by order of the
President of the Senate in conformance with presession filing
rules, indicating neither advocacy nor opposition on the part
of the President (at the request of Senate Interim Committee on
Commerce and Workforce Development)
CHAPTER ................
AN ACT
Relating to recovery of amounts owing for medical services
provided in workers' compensation claims; creating new
provisions; and amending ORS 656.313.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 656.313 is amended to read:
656.313. (1)(a) Filing by an employer or the insurer of a
request for hearing on a reconsideration order before the
Hearings Division, a request for Workers' Compensation Board
review or court appeal or request for review of an order of the
Director of the Department of Consumer and Business Services
regarding vocational assistance stays payment of the compensation
appealed, except for:
(A) Temporary disability benefits that accrue from the date of
the order appealed from until closure under ORS 656.268, or until
the order appealed from is itself reversed, whichever event first
occurs;
(B) Permanent total disability benefits that accrue from the
date of the order appealed from until the order appealed from is
reversed;
(C) Death benefits payable to a surviving spouse prior to
remarriage, to children or dependents that accrue from the date
of the order appealed from until the order appealed from is
reversed; and
(D) Vocational benefits ordered by the director pursuant to ORS
656.340 (16). If a denial of vocational benefits is upheld by a
final order, the insurer or self-insured employer shall be
reimbursed from the Workers' Benefit Fund pursuant to ORS 656.605
for all costs incurred in providing vocational benefits as a
result of the order that was appealed.
(b) If ultimately found payable under a final order, benefits
withheld under this subsection shall accrue interest at the rate
provided in ORS 82.010 from the date of the order appealed from
through the date of payment. The board shall expedite review of
appeals in which payment of compensation has been stayed under
this section.
(2) If the board or court subsequently orders that compensation
to the claimant should not have been allowed or should have been
awarded in a lesser amount than awarded, the claimant shall not
Enrolled Senate Bill 173 (SB 173-A) Page 1
be obligated to repay any such compensation which was paid
pending the review or appeal.
(3) If an insurer or self-insured employer denies the
compensability of all or any portion of a claim submitted for
medical services, the insurer or self-insured employer shall send
notice of the denial to each provider of such medical services
and to any provider of health insurance for the injured worker.
Except for medical services payable in accordance with ORS
656.247, after receiving notice of the denial, a medical service
provider may submit medical reports and bills for the disputed
medical services to the provider of health insurance for the
injured worker. The health insurance provider shall pay all such
bills in accordance with the limits, terms and conditions of the
policy. If the injured worker has no health insurance, such bills
may be submitted to the injured worker. A provider of disputed
medical services shall make no further effort to collect disputed
medical service bills from the injured worker until the issue of
compensability of the medical services has been finally
determined.
(4) Except for medical services payable in accordance with ORS
656.247:
(a) When the compensability issue has been finally determined
or when disposition or settlement of the claim has been made
pursuant to ORS 656.236 or 656.289 (4), the insurer or
self-insured employer shall notify each affected service provider
and health insurance provider of the results of the disposition
or settlement.
(b) If the services are determined to be compensable, the
insurer or self-insured employer shall reimburse each health
insurance provider for the amount of claims paid by the health
insurance provider pursuant to this section. Such reimbursement
shall be in addition to compensation or medical benefits the
worker receives. Medical service reimbursement shall be paid
directly to the health insurance provider.
(c) If the services are settled pursuant to ORS 656.289 (4),
the insurer or self-insured employer shall reimburse, out of the
settlement proceeds, each medical service provider for billings
received by the insurer or self-insured employer on and before
the date on which the terms of settlement are agreed as specified
in the settlement document that are not otherwise partially or
fully reimbursed.
(d) Reimbursement under this section shall be made only for
medical services related to the claim that would be compensable
under this chapter if the claim were compensable and shall be
made at one-half the amount provided under ORS 656.248. In no
event shall reimbursement made to medical service providers
exceed 40 percent of the total present value of the settlement
amount, except with the consent of the worker. If the settlement
proceeds are insufficient to allow each medical service provider
the reimbursement amount authorized under this subsection, the
insurer or self-insured employer shall reduce each provider's
reimbursement by the same proportional amount. Reimbursement
under this section shall not prevent a medical service provider
or health insurance provider from recovering the balance of
amounts owing for such services directly from the worker { + ,
unless the worker agrees to pay all medical service providers
directly from the settlement proceeds the amount provided under
ORS 656.248 + }.
(5) As used in this section, 'health insurance' has the meaning
for that term provided in ORS 731.162.
Enrolled Senate Bill 173 (SB 173-A) Page 2
SECTION 2. { + The amendments to ORS 656.313 by section 1 of
this 2011 Act apply to settlements of workers' compensation
claims entered into on or after the effective date of this 2011
Act. + }
----------
Passed by Senate March 14, 2011
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House May 11, 2011
.............................................................
Bruce Hanna, Speaker of House
.............................................................
Arnie Roblan, Speaker of House
Enrolled Senate Bill 173 (SB 173-A) Page 3
Received by Governor:
......M.,............., 2011
Approved:
......M.,............., 2011
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2011
.............................................................
Kate Brown, Secretary of State
Enrolled Senate Bill 173 (SB 173-A) Page 4
