Oregon Workers' Comepnsation allows you to enter into a settlement on your claim. There are two basic kinds of settlements, depending on whether your claim is accepted or denied. When an injured worker settles a denied claim that is in dispute, the settlement is referred to as a disputed claims settlement, also known as a "DCS." The rules set out how medical expenses are accounted for in the settlement.
Generally, any medical bills in the posession of the insurance company or employer must be paid out of the settlement. However, the payment is not the face value of the medical bill, but the "audited" amount. This is the amount that would have been paid to the medical provider under the Workers Compensation medical payment schedule had the claim been accepted.
Up to forty percent of the settlement can be used to pay medical bills. If the settlement amount is less than the total outstanding medical bills, then the bills are paid on a pro rata basis. The medical provider can still seek to collect the remaining bill amount from the injured worker. If the insurance company does not have an outstanding bill, then it may not be included in the settlement, and the injured worker would be responsible for that bill as well.
If you are looking at resolving a denied claim, or even an accepted claim, there is a lot to consider. Call us with quesitons at 503-325-8600. We have extensive experience dealing with the many issues an injured worker faces in deciding whether or how to resolve a Workers' Compensation Claim.
