Medical Treatment Concerns in Your Oregon Workers’ Compensation Claim

In this post, I will explain some of your basic rights concerning medical treatment, Independent Medical Examinations (IMEs), and elective surgery in Oregon workers’ compensation cases.  This post is the fifth in a series answering your questions about workers’ compensation claims in our state.  Previous posts covered the following topics:

  1. How to file an Oregon workers’ compensation claim.
  2. Obtaining medical treatment in your Oregon workers’ compensation claim.
  3. Recovering lost wages in your Oregon workers’ compensation claim.
  4. Acceptance or denial of your claim and the “interim period”.

Here are two basic points that you should keep in mind about medical treatment in Oregon workers’ compensation claims.  First, if your claim is denied, then you will have to pay for the medical treatment you have received.  Second, during the “interim period” the insurance company will only cover basic medical expenses that are necessary to stabilize you and prevent further immediate injury.

Independent Medical Examinations (IMEs)

Insurance companies often ask that injured workers get up to three independent medical examinations after they have filed their workers’ compensation claims.  IMEs are physical examinations conducted by someone other than the injured worker’s primary physician.  IME providers do not  treat patients, they only examine and diagnose them.  After the examination, the IME will write a report addressing questions that the insurer wants answered about your workplace injury or illness.

Elective Surgery

Any surgery that is not emergency surgery is considered elective surgery.  Before scheduling elective surgery, the healthcare provider must notify the insurer, who may request a second opinion.  If the insurer doesn’t think that surgery is necessary, then it can ask the Workers’ Compensation Division to review the request for surgery in order to determine whether or not surgery is necessary and within the scope of coverage.