Narrative Opinion Summary
In this case, an insurer sought reimbursement for temporary total disability (TTD) payments made to a claimant during a vocational rehabilitation program. The claimant, who sustained a back injury, was initially denied vocational services after moving out of state. A Workers’ Compensation Board referee ordered vocational assistance, prompting the insurer to start TTD payments. However, the Board vacated this order, stating the claimant had not exhausted administrative remedies by failing to seek a review from the Director. The insurer's reimbursement request was denied, as TTD payments under ORS 656.268 require participation in an authorized program, which was lacking. The Department argued that the referee lacked jurisdiction to order the program without the Director's decision. The court agreed, ruling against the insurer's reimbursement claim. Further, the Board dismissed the insurer's review request, directing jurisdiction to the Court of Appeals. This decision underscores the necessity of departmental authorization for vocational programs and adherence to procedural requirements for disputes, as specified in relevant Oregon statutes.
Legal Issues Addressed
Authorization Requirement for Vocational Rehabilitation Programssubscribe to see similar legal issues
Application: TTD benefits are contingent on enrollment in an authorized vocational rehabilitation program, as required by former ORS 656.268(1).
Reasoning: Under former ORS 656.268(1), TTD benefits were contingent upon enrollment and active engagement in an authorized vocational rehabilitation program.
Jurisdiction of Court of Appealssubscribe to see similar legal issues
Application: The Court of Appeals holds jurisdiction for reviews related to vocational rehabilitation program participation under ORS 183.310 to ORS 183.550.
Reasoning: The insurer's request for review of the referee's order was dismissed by the Board, which ruled that the issue did not pertain to a claim under ORS 656.295 but fell under ORS 183.310 to ORS 183.550, indicating that the Court of Appeals held jurisdiction for such reviews.
Jurisdiction of Referees in Workers’ Compensation Casessubscribe to see similar legal issues
Application: The referee lacked jurisdiction to mandate vocational assistance without a director's decision, as the claimant did not seek a review from the director.
Reasoning: The court concurred, stating the referee could not mandate the insurer provide specific vocational assistance without a director's decision.
Procedural Requirements for Vocational Assistance Disputessubscribe to see similar legal issues
Application: Workers dissatisfied with vocational assistance decisions must seek a review from the director, as stipulated by former ORS 656.728(6).
Reasoning: Workers dissatisfied with decisions regarding vocational assistance eligibility or the quality of assistance must seek a review from the director.
Reimbursement for Temporary Total Disability Paymentssubscribe to see similar legal issues
Application: The court determined that an insurer is not entitled to reimbursement for TTD payments made during a vocational rehabilitation program if the program was not authorized by the Department.
Reasoning: The Department maintained that the lack of authorization for the program precluded reimbursement.