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Workers' CompensationF. Treatment after Claim Closure and in Aggravation SituationsPrepared by members of Oregon Workers' Compensation Attorneys 38. Are insurers obliged to pay for medical treatment for an injured worker after their claim is closed? Yes, provided that the treatment is necessary, curative or diagnostic, and not experimental. The need for treatment must be caused by the work place injury. Specifically, insurers must pay for the following medical treatment after claim closure, without requiring preauthorization: a) Treatment to a partly or totally disabled worker b) Prescriptive medication and office visit to monitor the above c) Prosthetic devices d) Medical treatment for a worsened condition e) Diagnostic services f) Life preserving services g) Curative care to stabilize temporary acute waxing and waning of symptoms. Please note: After a worker's condition has been declared stationary, the doctor must obtain the insurer's preauthorization before proceeding on a course of palliative care. Call the Medical Review Unit at (503) 947-7816 for advice. 39. Must a doctor obtain authorization for curative treatment for an injured worker whose claim has been closed? No, provided that the treatment arises from the accepted conditions, and is medically appropriate. In fact, if authorization is requested, the insurer will probably not respond, because no response is required until a bill for the services has been tendered. The best way to handle the situation is to call the Medical Review Unit at (503) 947-7816 for advice. 40. What is the legal meaning of the phrase "palliative care"? Palliative care means services rendered to reduce or moderate temporarily the intensity of an otherwise stable condition. Such care does not include diagnostic or curative treatment. 41. Are insurers obliged to pay for any palliative care after the patient is medically stationary? Yes. They must pay for:
These services can be provided without preauthorization. With preauthorization, insurers must pay for palliative care such as physical therapy, if the doctor finds that the worker needs such care to continue current employment, or to participate in an authorized training program. Return to Answers to Medical Questions Front Page Collection: Rates, Bills, Settlements | Aggravation | Communication with Attorneys, Insurers and Patients | Notices for Return to Work and Modified or Light Duty | Report Writing, Magic Words; Standards for Injury, Aggravation and Occupational Disease | Treatment after Claim Closure and in Aggravation Situations | Time Loss Authorization Last update: June 1, 2001
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