LNI New Rules 2019

Oregon Workers Compensation Defense Lawyers

REMINDER: LNI’s new rules go into effect on July 1, 2019.  Please contact our office if you have questions or need assistance with these new changes.  In advance of these changes, please remember the following:

#1- Be careful what you put on Claim Allowance Request form: The new form requires you to correctly identify the type of claim (injury vs. disease), and the conditions under the claim.  What you put on this form will determine how injured workers and their attorneys view the scope of claim allowance.

#2- Don’t forget to request more time: Many claims require more than 60 days to investigate, to request prior medical records, and to schedule IME appointments. Fill out the Interlocutory Request form and send it to LNI before 60 days runs to request more time.

#3- Throw away SIF-4: Instead, use Claim Denial Request form.  Submit the request for denial within 60 days of notice of claim.

#4- Close the claim yourself: You can close the claim if: 1) it is medical only; 2) time-loss was paid, but no LNI order resolving dispute, worker returned to work with employer at same job or comparable job and no PPD award; 3) or if PPD is being paid, same as 2) but also the closing report was provided to the attending provider and given 14 days to respond. Also, no more SIF-5! Use Claim Closure Request form.

#5- 5-DAY Notification: Send corresponding forms to the worker within 5 days of the following: calculating monthly wage; starting, stopping, or denying time-loss and LEP benefits; acceptance or denial of a contended condition; authorization or denial of treatment; and assessment of underpayment or overpayment.

#6- Review chart notes and billings for newly contended conditions: If you see a new or different diagnosis- PAUSE BEFORE PAYING!  If it is not related, issue Deny Newly Contended Condition and Treatment Denied forms.  If you are not sure, investigate further before completing Accept Newly Contended Condition and Treatment Authorization forms.  Be careful in what you put in your forms!

Please don’t hesitate to contact Wallace Klor Mann Capener & Bishop if you have any questions regarding the changes noted above.