It's Just Paperwork...

You were injured at work. You filed a claim for workers’ compensation and it was accepted.

Your employer is cooperative. Your medical bills have been paid and you are being paid "time loss" while you heal. You look forward to getting back to work. Things are going smoothly ... or so you think.

Then, out of the blue, a letter arrives from the insurance company – they have denied a claim for a medical condition you had not requested. What in the heck is going on?

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Unknown to many injured workers, your physician can file a legal form created by the State of Oregon to demand additional medical conditions be added to your claim. These claims for "new medical conditions" are poorly understood by physicians and frequently create problems for workers who do not understand what their doctor has done.

Left unchallenged, a denial of a new medical condition claim can haunt a worker whose injury seemed straightforward and not controversial in the beginning. There may be medical bills left unpaid, problems getting diagnostic tests such as MRIs or nerve studies, and even complications with private health insurance.

All because of paperwork filed by mistake.

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This problem legal form is called an "827" and commonly is used by physicians in conjunction with medical billings. It has check boxes for medical services for a new injury, a worsened former injury, or simple pain control – all routine medical matters.

But the state also has added a checkbox on the 827 form for a physician to request acceptance of a "new or omitted medical condition" – most decidedly not a medical matter, and one of the most confusing bureaucratic blunders in the Oregon workers’ compensation system as far as I am concerned.

There are complicated legal rules for requesting additional medical conditions in a comp claim. Even for the most well-intentioned physician, misfiling an 827 form can throw a patient’s medical care into a tailspin. Some doctors believe the request must be filed so they can be paid for ordering diagnostic tests (wrong) or simply to protect their patient (also wrong).

Once the 827 has been signed and submitted, claiming a new medical condition, an employer must respond to the request even if the form is left blank at the space on it for listing the new condition. If the doctor filed the form by mistake, the injured worker risks losing important future claim rights if they do not appeal the denial. It is an alarming problem that should not be
ignored.

For most injured workers, this is a very good time to talk to a qualified attorney (and hope your physician sticks to medicine in the future).

~ Jim Edmunson