Mantle v. SAIF Corp.

ORS 656.327(1)(a) provides, in relevant part: “If an injured worker, an insurer or self-insured employer the Director of the Department of Consumer and Business Services believes that the medical treatment … that the injured worker has received, is receiving, will receive or is proposed to receive is excessive, inappropriate, ineffectual or in violation of rules regarding the performance of medical services, the injured worker, insurer or self-insured employer must request administrative review of the treatment by the director prior to requesting a hearing on the issue and so notify the parties.” ORS 656.327(2) provides, in relevant part: “The worker is not obligated to pay for medical treatment determined not to be compensable under this section.”

Petitioner sought medical treatment for an injury under Oregon’s workers’ compensation statutes. The Office of the Director of the Department of Consumer and Business Services determined that it did not have the authority under ORS 656.704(3) to order that Petitioner was not liable to pay the bills associated with the medical services provided by the non-complying medical providers who provided services to Petitioner because of an Administrative Law Judge’s determination that those medical services were not causally related to Petitioner’s workers’ compensation claim, and thus non-compensable. Petitioner then sought judicial review of the Director’s determination. ORS 656.327(1)(a) provides, in relevant part: “If an injured worker, an insurer or self-insured employer the Director of the Department of Consumer and Business Services believes that the medical treatment … that the injured worker has received, is receiving, will receive or is proposed to receive is excessive, inappropriate, ineffectual or in violation of rules regarding the performance of medical services, the injured worker, insurer or self-insured employer must request administrative review of the treatment by the director prior to requesting a hearing on the issue and so notify the parties.” ORS 656.327(2) provides, in relevant part: “The worker is not obligated to pay for medical treatment determined not to be compensable under this section.” The Court reasoned that the provisions of ORS 656.327 confer upon the Director the requisite authority to decide whether Petitioner was liable for the provided medical treatment even though that treatment has been determined to be non-compensable and also when the treatment has been determined to be “excessive, inappropriate, ineffectual” or in “violation of rules regarding the performance of medical services.” The Court also pointed out that at the time the treatment was rendered, there had not been a determination that Petitioner’s claim was non-compensable. Thus, the Court held the Director’s determination that it lacked authority over Petitioner’s claim was legal error. Reversed and remanded.