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Medical Resolution Team
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Purpose
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Resolve medical disputes
between injured workers and insurers, medical providers, or managed care organizations
in a fair, just, and timely manner.
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Responsibilities
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Resolve disputes for:
Medical services:
provided to the worker - Bulletin 293 - Form 440-2842
Medical fees: bill reduction or non-payment - Bulletin 293 - Forms 440-2842,
440-2842a
Medical treatment: determine if the treatment is excessive, inappropriate,
ineffectual, or in violation of the workers' compensation rules - Bulletin 293 -
Form 440-2842
Managed care organizations (MCO): when an injured worker or medical
provider disagrees with an MCO decision - Bulletin 293 - Form 440-2842
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Functions
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medical reviewers of the Medical Resolution Team (MRT) review
issues such as when the provider and the insurer do not agree
on payment for medical services for workers or appropriateness
of a surgery. RT resolves these disputes in a timely manner by
alternative dispute resolution (ADR) processes and education.
If the dispute cannot be resolved through ADR, the reviewer gathers
additional information from the parties and reviews it to make
a decision. In reviewing a medical treatment issue, MRT may schedule
an impartial physician's examination and record review. The consultation
report becomes part of the record and final decision. Once the
review is complete, MRT issues a legally binding Order based on
the Oregon Revised Statutes, Oregon Administrative Rules, and
relevant case law. These orders may be appealed to the Workers'
Compensation Board (WCB). If a party is still not satisfied, it
can appeal the WCB Order to the Oregon Court of Appeals. |
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Primary
governing rules
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OAR 436-009: The Oregon
Medical Fee
OAR 436-010: Medical Services Rules
ORS 656.245, .247, .248, .260, .327, .704, .726
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For
more information contact:
Phone:
503-947-7606
FAX: 503-947-7629
E-mail: wcd.medicalquestions@state.or.us
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