When an Oregon Workers’ Compensation carrier or claims administrator accepts a claim, it owns that claim, and must provide benefits. It may later regret its decision to accept the claim, but nonetheless must carry through with its responsibility.
There is an exception, however to this general. If the insurance company discovers “new and material” evidence that it did not have at the time the claim was accepted, it may be able to issue a “backup” denial. The evidence must be “new” and “material.” New evidence is pretty self-explanatory. There may be some prior medical treatment that the insurance company did not know about.
However, whether the new evidence is “material” is another issue. Usually, medical treatment prior to the date of injury is material evidence, and if an injured worker denies the existence of pre-injury medical care, there is a very good chance this will be considered “material” evidence, depending on the severity of the prior medical problem.
This is why it is so important for an injured worker to be honest and forthright when going through the claims process. In many cases, an injured worker may have a prior medical issue with the same area the body injured at work, but even so, the new injury may be covered nonetheless.
If you have a claim denial for an on-the-job injury in Oregon, call us at 503-325-8600 with your questions. We help injured workers every day.