Or. Admin. R. 438-012-0037

Current through Register Vol. 63, No. 6, June 1, 2024

Section 438-012-0037 - Payment of Medical Benefits

Except as otherwise provided in OAR 438-012-0020(7), for every condition resulting from a compensable injury occurring before January 1, 1966, the Own Motion insurer may pay for reasonable and necessary medical services when:

(1) Undertaken for curative purposes;

(2) Provided to a claimant who has been determined to have permanent total disability;

(3) Provided in the form of prescription medications;

(4) Necessary to administer prescription medication or to monitor administration of prescription medication;

(5) Provided in the form of prosthetic devices, braces and supports;

(6) Necessary to maintain and monitor the status, replacement or repair of a prosthetic device, brace or support;

(7) Necessary to diagnose the claimant's condition;

(8) Necessary to enable the claimant to continue current employment;

(9) Provided in the form of life-preserving modalities similar to insulin therapy, dialysis and transfusions; or

(10) The Board determines that special circumstances justify the provision of further medical services.

Or. Admin. R. 438-012-0037

WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06

Stat. Auth.: ORS 656.726(5)

Stats. Implemented: ORS 656.278(1)(c), 656.278(2)(c) & 656.726(5)