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Carriers Own Motion Recommendation 2806 - Oregon
| Carriers Own Motion Recommendation Form. This is a Oregon form and can be used in Hearings Workers Comp . |
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Carrier's Own Motion Recommendation Notice to Claimant The Workers' Compensation Board will review this recommendation. Copies of all evidence considered by the carrier will be sent to the Board and to you. If you disagree with the carrier's recommendation(s), it is recommended that you obtain an attorney. You may have an attorney of your choice, whose fee will be limited to a percentage of any additional compensation you may receive. In addition, you may contact the Workers' Compensation Ombudsman, whose job it is to assist injured workers about workers' compensation matters: Workers' Compensation Ombudsman, P.O Box 14480, Salem, OR 97309-0405. Phone (503) 378-3351 or 1-800-927-1271 (V/TTY) (within the State of Oregon). You may submit your written position and/or additional evidence. If you send the Board additional material, please include a cover letter listing claim number and date of injury identified at items A-10 and A-11 on page 4 of this form. A copy of any material you submit to the Board must also be sent to the carrier at the address given at item A-3 on page 4 of this form. To be considered, any material must be submitted within 14 days after your receipt of this recommendation form. The Board's mailing address is: Own Motion Unit, Workers' Compensation Board, 2601 25th St. SE Ste. 150, Salem, OR 97302-1282. NOTE: (1) If your Own Motion claim is based on a worsening of your compensable injury (that is, your previously accepted condition(s)), the claim is eligible to be reopened only if there is a worsening of your compensable injury that: (a) results in a partial or total inability for you to work; (b) requires hospitalization or inpatient or outpatient surgery, or other curative treatment prescribed in lieu of hospitalization that is necessary to enable you to return to work; and (c) you are in the work force at the time of disability. [If the carrier contends that you were not in the work force at the time of disability, it must send you a copy of page 9 of this form, which explains the work force requirements]. If these three requirements are satisfied, the claim qualifies for reopening for the payment of benefits. Benefits on a reopened "worsened condition" claim may include temporary disability compensation from the time your attending physician authorizes temporary disability compensation for the hospitalization, surgery or other curative treatment until your condition becomes medically stationary. (2) If your Own Motion claim is based on a new medical condition or an omitted medical condition, it is eligible to be reopened only if: (a) you clearly request formal written acceptance from the carrier of the new/omitted medical condition; and (b) the carrier formally accepts the new/omitted medical condition or the condition is found compensable through litigation. If these two requirements are satisfied, the claim qualifies for reopening for the payment of benefits. Form 440-2806 (09/2003/WCB) Page 1 Benefits on a reopened new/omitted medical condition claim may include: (a) temporary disability compensation from the time your attending physician authorizes temporary disability compensation for the hospitalization, surgery or other curative treatment until your condition becomes medically stationary; and/or (b) permanent disability benefits. If you need further assistance in this matter, please contact the Own Motion Coordinator at (503) 378-3308 or 1-877-311-8061 (within the State of Oregon). Instructions to the Carrier The carrier must process as a request for Own Motion relief under ORS 656.278 any claim that reasonably notifies it of: (1) medical services, worsened condition(s), and/or "post-aggravation rights" new/omitted medical condition(s) where the date of injury is before January 1, 1966 (OAR 438-012-0020(3), (4), (5); OAR 438-012-0030)); (2) worsening of a compensable injury which is filed after the expiration of aggravation rights under ORS 656.273(4) (OAR 438-0120020(3); OAR 438-012-0030)); and/or (3) new or omitted medical condition(s) filed after the expiration of aggravation rights under ORS 656.273(4) (OAR 438-012-0020(4); OAR 438-0120030)). Claims for medical services where the date of injury is on or after January 1, 1966 must be processed under ORS 656.245. The carrier is not required to submit a written recommendation to the Board if it voluntarily reopens the claim under ORS 656.278(5) to provide benefits allowable under ORS 656.278. In addition, pursuant to ORS 656.625, a carrier's voluntary claim reopening under ORS 656.278 qualifies the carrier for reimbursement from the Reopened Claims Program. However, if the carrier voluntarily reopens the claim under ORS 656.278(5), it must submit a Form 3501 to the Workers' Compensation Division, with copies to claimant and claimant's attorney (if any). If the date of injury for the original claim is before January 1, 2002, the carrier must, within 90 days of receipt of claimant's written request for Own Motion relief, either: (1) voluntarily reopen the claim (Form 3501); or (2) submit its written recommendation, with supporting documentation, to the Board at the address given above. OAR 438-012-0030(1). If the date of injury for the original claim is on or after January 1, 2002, the carrier must, within 60 days of receipt of claimant's written request for Own Motion relief, either: (1) voluntarily reopen the claim (Form 3501); or (2) submit its written recommendation, with supporting documentation, to the Board at the address given above. OAR 438-012-0030(2). If the carrier chooses not to voluntarily reopen the claim, it must send claimant and claimant's attorney, if any, a copy of its completed Carrier's Own Motion Recommendation, including copies of any material it submits with this form. The carrier must provide documentary evidence that a copy of the written recommendation and attachments was forwarded to claimant and claimant's attorney, if any. If the carrier answers "NO" to items B-5 B-7 on page 5 of this form, the carrier must submit a separate denial of medical services under ORS 656.262, and/or a denial of responsibility under ORS 656.308(2), and/or a request for Director review of medical treatment under ORS 656.245, ORS 656.260, and/or ORS 656.327. Form 440-2806 (09/2003/WCB) Page 2 If the carrier answers "NO" to item B-4 on page 5 or item D-10 on page 7 or of this form, the carrier must also send page 9 of this form to claimant. If the carrier answers "YES" to items C-3 and/or D-1
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