The Oregon Division of Workers Compensation on Wednesday proposed a rule that would change the processing of COVID-19-related workers compensation claims in the state.

The rule would define what constitutes conducting a “reasonable investigation,” including investigating whether coronavirus exposure in the course and scope of the employee’s work was likely, whether the employee did not work for a period of time as a result of quarantining, and determining whether medical services were needed.

The change would also require auditing of denied COVID-19 claims if the insurer reported five or more COVID-19 claims — either accepted or denied — before Oct. 1, and audits of those claims would focus on whether a reasonable investigation was conducted. However, the rule provides an exception to investigation requirements if a claim is denied for procedural reasons.

The state will hold a public rulemaking hearing on the proposed change Jan. 5, 2021; the closing date for written comments on the proposed rule is Jan. 8, 2021.

More insurance and workers compensation news on the coronavirus crisis here.




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