Oregon Workers' Compensation is a highly regulated area. There are rules that govern how many times you can see certain doctors, how much you are reimbursed for your travel expense, and even how much you can spend for lunch when having to travel from the Oregon Coast to Portland for an insurance medical examination, or treatment with a specialist. These rules place responsibilities on the doctor that treats your injury, and as a result, the "attending physician" wields much power with your claim.
An "attending physician" is the physician who is primarily responsible for treatment of the injured worker's care. Only certain kinds of physicians can act as the attending physician, and even then, there may be some limits on the length of time a certain practitioner can assume this role. Why is the attending physician so powerful?
In many aspects of the claim, the attending physician is in the driver' as seat. An attending physician's opinion can help overcome a denied claim. Insurance carriers routinely send injured workers to independent medical examinations, and those doctors often find that a medical condition or injury is not the result of a work incident. That report is sent to the attending doctor for comment, and if he or she agrees with the insurance company's doctor's opinion, then overcoming the denial is that much more difficult, if not impossible.
However, if your physician disagrees with the independent medical examiner, then the injured worker has a fighting chance of overcoming the denial with a well reasoned opinion from the treating doctor. Although treating doctor opinions are not favored automatically, there are many reasons they should be, like the mere fact that your doctor has not seen you only one time, for fifteen minutes at the request of an insurance company that is the main source of income for that particular doctor. In addition, the injured worker might be able to get a worker requested medical examination, again a potentially valuable tool in overcoming a denial.
Even where the claim is accepted, the attending physician remains influential. For example, an attending physician makes referrals to specialists, and plays a large role in how an injured worker receives treatment. An attending physician authorizes an injured worker to be off work, which is a key requirement for obtaining temporary total disability.
The attending physician also decides when an injured worker is "medically stationary," which generally means that the passage of time or additional medical care is not reasonably expected to restore physical function and work ability. Once an injured worker is found to be medically stationary, her entitlement to temporary total disability benefit stops, and the insurance company is in a position to file a Notice of Closure.
A Notice of Closure determines whether an injured worker is entitled to permanent partial disability. An attending physician plays a key role in determining whether and how much permanent partial disability an injured worker may be entitled to as part of their claim.
For all these reasons, it is important to know about your attending physician. The Oregon Administrative Rules allow injured workers to change their attending physician, but there are limits.
If you are facing issues with an Oregon Workers' Compensation claim, and have questions about the role of an attending physician, contact us at 503-325-8600. We work with physicians and other health care practitioners every day, and can answer your questions.
