OAR 436-030-0035: Temporary rule language in effect until 10/04/2026. Determining Medically Stationary Status

(1) A worker is medically stationary in the following circumstances: (a) In initial injury claims. In an initial injury claim, a worker is medically stationary when the attending physician or a preponderance of medical opinion declares that all accepted conditions and direct medical sequelae of accepted conditions are either "medically stationary" or "medically stable" or when the provider uses other language meaning the same thing. (b) In new or omitted condition claims. In a new or omitted condition claim, a worker is medically stationary when the attending physician or a preponderance of medical opinion declares that all accepted new or omitted conditions and direct medical sequelae of accepted new or omitted conditions are either "medically stationary" or "medically stable" or when the provider uses other language meaning the same thing. (c) In aggravation claims. In an aggravation claim, a worker is medically stationary when the attending physician or a preponderance of medical opinion declares that all accepted worsened conditions and direct medical sequelae of accepted worsened conditions are either "medically stationary" or "medically stable" or when the provider uses other language meaning the same thing. (d) In occupational disease claims. In an occupational disease claim, a worker is medically stationary when the attending physician or a preponderance of medical opinion declares that all accepted occupational diseases and direct medical sequela of accepted occupational diseases are either "medically stationary" or "medically stable" or when the provider uses other language meaning the same thing. (2) When there is a conflict in the medical opinions as to whether a worker is medically stationary, more weight is given to medical opinions that are based on the most accurate history, on the most objective findings, on sound medical principles, and clear and concise reasoning. (3) Where there is not a preponderance of medical opinion stating a worker is or is not medically stationary, deference will generally be given to the opinion of the attending physician. However, in cases where expert analysis is important, deference is given to the opinion of the health care provider with the greatest expertise in, and understanding of, the worker’s medical condition. (4) When there is a conflict as to the date upon which a worker became medically stationary, the following conditions govern the determination of the medically stationary date. The date a worker is medically stationary is the earliest date that a preponderance is established under sections (1) and (2) of this rule. The date of the examination, not the date of the report, controls the medically stationary date. (5) The insurer may request that the attending physician concur with or comment on the closing examination when the attending physician arranges or refers the worker for a closing examination with another health care provider. When the insurer closes a claim relying on an independent medical examination to support a preponderance of opinion establishing medically stationary status, before issuing the closure the insurer must request the attending physician to concur with or comment on the independent medical examination. A concurrence with another health care provider’s report is an agreement in every particular, including the medically stationary impression and date, unless the attending physician expressly states to the contrary and explains the reasons for disagreement. Concurrence cannot be presumed in the absence of the attending physician’s response. (6) A worker is medically stationary on the date so specified by a health care provider. When a specific date is not indicated, a worker is presumed medically stationary on the date of the last examination, prior to the date of the medically stationary opinion. Health care provider projected medically stationary dates cannot be used to establish a medically stationary date. (7) If the worker is incarcerated or confined in some other manner and unable to freely seek medical treatment, the insurer must arrange for closing medical examinations to be completed at the facility where the worker is located or at some other location accessible to the worker. (8) If a worker dies and the attending physician has not established a medically stationary date, for purposes of claim closure, the medically stationary date is the date of death. (9) Notwithstanding any other provision of this rule, a health care provider may not retroactively determine a worker to be medically stationary more than 60 days prior to the date of the determination, except in the case of claims that are subject to ORS 656.268 (13). If the medically stationary date under sections (1), (4), (5), or (6) of this rule is more than 60 days prior to the date of the determination, the medically stationary date is the 60th day prior to the date of the determination.