Administrative Law Judge Oklahoma Workers’ Compensation Commission LEGISLATIVE UPDATE Tara Inhofe Administrative Law Judge Oklahoma Workers’ Compensation Commission

TITLE 85A- RELEVANT PROVISIONS 85A-2- DEFINITIONS. COMPENSABLE INJURY COURSE AND SCOPE OF EMPLOYMENT CUMULATIVE TRAUMA PERMANENT DISABILITY PERMANENT PARTIAL DISABILITY PRE-INJURY OR EQUIVALENT JOB

85A-7 - DISCRIMINATION OR RETALIATION PROVIDES EXCLUSIVE REMEDY FOR EMPLOYMENT RELATED RETALIATORY DISCHARGE CASES. LIMITS DAMAGES TO BACK PAY UP TO $100,000.00 LESS INTERIM EARNINGS OR AMOUNTS EARNABLE WITH REASONABLE DILIGENCE. ---------------------------------------------------------------------------------------------------------------------- 85A-13 - MENTAL INJURIES HAS TO BE CAUSED BY A PHYSICAL INJURY UNLESS THE CLAIMANT WAS A VICTIM OF A CRIME OF VIOLENCE. MUST BE DIAGNOSED BY A LICENSED PSYCHIATRIST OR PSYCHOLOGIST AND MEET THE CRITERIA OF THE MOST CURRENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS. LIMIT OF 26 WEEKS OF TTD UNLESS GOOD CAUSE SHOWN TO EXTEND TO 52 WEEKS.

85A-14 - HEART INJURIES REQUIRES THAT THE EXERTION OF THE WORK NECESSARY TO CAUSE THE HEART INJURY WAS EXTRAORDINARY AND UNUSUAL IN COMPARISON TO THE CLAIMANT’S USUAL WORK.

85A- FAILURE TO SECURE INSURANCE COVERAGE PROVIDES CIVIL AND CRIMINAL PENALTIES FOR NON- COMPLIANCE WITH INSURANCE COMPENSATION. HEARINGS WILL BE CONDUCTED BY COMMISSION ALJ’S.

85A-45 AND 46 TTD, TPD, PPD, PTD (SECTION 45) - AMONGST OTHER THINGS PROVIDES FOR A DEFERRAL OF PPD BENEFITS IF THE CLAIMANT RETURNS TO HIS PRE-INJURY OR EQUIVALENT JOB. IF CLAIMANT IS NOT OFFERED THEIR JOB BACK, THEN THEY MAY BE ENTITLED TO A LUMP SUM PAYMENT IF THEY HAVEN’T REFUSED AN OFFER TO RETURN TO THEIR PRE-INJURY OR EQUIVALENT JOB OR ENGAGED IN MISCONDUCT. VOCATIONAL REHABILITATION - HAS TO BE FILED WITHIN 60 DAYS OF THE DATE OF RECEIVING PERMANENT RESTRICTIONS. TRAINING DOES NOT LAST MORE THAN 52 WEEKS. DISFIGUREMENT - CAN BE UP TO $50,000.00. AN AWARD CAN NOT BE MADE UNTIL TWELVE MONTHS AFTER THE INJURY. THE LAW FOR A SINGLE EVENT INJURY IS THE DATE OF THE ACCIDENT. THE LAW FOR A CUMULATIVE TRAUMA OR OCCUPATIONAL DISEASE IS THE DATE OF AWARENESS. THE LAW FOR DEATH BENEFITS IS THE DATE OF DEATH

SECTION 46 PROVIDES THE SCHEDULE FOR AMPUTATIONS AND LOSS OF USE FOR THE SCHEDULED MEMBERS. THE SIXTH EDITION OF THE AMA GUIDES WILL BE USED FOR EVALUATIONS OF ALL BODY PARTS, INCLUDING SCHEDULED MEMBERS.

85A-50 - MEDICAL TREATMENT IF THE EMPLOYER DOES NOT PROVIDE THE CLAIMANT WITH TREATMENT WITHIN FIVE DAYS OF ACTUAL KNOWLEDGE OF THE ACCIDENT, THEN THE INJURED EMPLOYEE MAY SELECT THE PHYSICIAN. 85A-57- FAILURE TO APPEAR FOR SCHEDULED APPOINTMENTS IF THE CLAIMANT MISSES TWO OR MORE APPOINTMENTS FOR TREATMENT, THEN BENEFITS CEASE.

85A-62 - NONSURGICAL SOFT TISSUE STILL FOLLOWS THE SAME FORMAT OF THE OLD SOFT TISSUE STATUTE. 85A-69 - STATUTE OF LIMITATIONS FOR CLAIMS IN WHICH NO BENEFITS HAVE BEEN PAID, THERE IS A ONE YEAR STATUTE OF LIMITATIONS FOR SINGLE EVENT INJURIES. IF BENEFITS HAVE BEEN PAID THE STATUTE IS ONE YEAR FROM THE LAST PAYMENT OF DISABILITY COMPENSATION OR TWO YEARS FROM THE DATE OF INJURY, WHICHEVER IS LONGER. THERE IS A TWO YEAR STATUTE FOR DEATH BENEFITS. THIS SECTION ALSO PROVIDES FOR THE DISMISSAL OF THE CLAIM IF NO ACTIVITY HAS TAKEN PLACE.

85A-72 - CONDUCT OF HEARING ADMINISTRATIVE HEARINGS DO NOT HAVE TO BE CONDUCTED WITH THE TECHNICAL OR STATUTORY RULES OF EVIDENCE OR PROCEDURE. THE STATUTE PROVIDES THAT THE HEARINGS ARE TO BE STENOGRAPHICALLY RECORDED. MEDICAL REPORTS ARE TO BE PROVIDED 7 DAYS BEFORE THE HEARING. RULE 810:10-5-49 ALSO DISCUSSES THE EVIDENTIARY STANDARD OF THE HEARINGS AS WELL AS THE PRESENTATION OF EVIDENCE. THE CONDUCT OF THE HEARINGS AS WELL AS THE POWERS OF THE ALJS IS CONTAINED IN RULE 810:10-5-53.

85A-78 - APPEALS PROCESS EITHER PARTY CAN APPEAL A DECISION BY THE ALJ BY FILING AN APPEAL WITHIN 10 DAYS TO THE COMMISSION. AFTER THE COMMISSION ISSUES AN ORDER, EITHER SIDE HAS 20 DAYS TO FILE AN APPEAL TO THE SUPREME COURT. THERE IS NO DIRECT APPEAL TO THE SUPREME COURT. RULE 810:10-5-66 DISCUSSES THE PROCEDURE FOR APPEALS IN MORE DETAIL

85A-80 - REVIEW OF COMPENSATION JUDGMENTS THE CLAIM CAN BE REVIEWED FOR A SIX MONTH PERIOD AFTER THE AWARD FOR A CHANGE OF CONDITION OR PROOF OF ERRONEOUS WAGE RATE. ANY CLERICAL ERRORS CAN BE CORRECTED WITHIN ONE YEAR FROM THE DATE OF THE ORDER.

85A - 82 - ATTORNEY FEES ATTORNEY FEES ARE AWARDED FOR “CONTROVERTED CLAIMS” - 10% FOR TTD AND 20% FOR PPD. ALL ATTORNEY FEES HAVE TO BE APPROVED BY THE COMMISSION. THIS DOES NOT APPEAR TO BE APPLICABLE TO DEFENSE COUNSEL.

85A-109/ 85A-110 - COUNSELOR OR OMBUDSMEN/ ALTERNATIVE DISPUTE RESOLUTION PROGRAM A SPECIAL EFFORT IS BEING MADE TO HAVE COUNSELORS OR OMBUDSMEN ASSIST INJURED WORKERS WITHOUT THE NECESSITY OF LEGAL REPRESENTATION. THIS INVOLVES EDUCATIONAL PROGRAMS FOR WORKERS AND EMPLOYERS. IN THAT VEIN, AN EFFORT IS BEING MADE TO USE MEDIATION IN CASES WHERE THERE IS A CLOSED PERIOD OF LOST TIME AND HAS RETURNED TO WORK; FOR MEDICAL BENEFITS ONLY; TRAVEL EXPENSES AND MEDICAL TREATMENT; IN CASES WHERE THE EMPLOYEE IS NOT REPRESENTED BY AN ATTORNEY AND WHERE THERE IS NO RECORD OF INSURANCE COVERAGE.

85A-111- COMMENCEMENT OF BENEFIT CLAIM - PHC DISCUSSES THE FILING OF THE CLAIM AND THE METHOD BY WHICH THE EMPLOYER CAN CONTROVERT ANY ISSUES IN THE CLAIM. MANDATES THAT DISCOVERY BE COMPLETED WITHIN 60 DAYS OF THE FILING OF A REQUEST FOR BENEFITS. RULE 810:10-1-4 PROVIDES THAT THE EMPLOYER FILE A REPORT WITH THE COMMISSION WITHIN 10 DAYS OF THE ACCIDENT OR KNOWLEDGE OF THE ACCIDENT. RULES 810:10-5-1 THROUGH 810:10-5-4 CONCERN THE PROCEDURE TO COMMENCE REGULAR CLAIMS AS WELL AS MITF AND DEATH CLAIMS.

85A-112 - INDEPENDENT MEDICAL EXAMINERS AN IME MAY BE APPOINTED ON ANY ISSUE BY THE ALJ. IF SURGERY IS RECOMMENDED BY THE TREATING PHYSICIAN, THEN AN IME IS MANDATORY IF REQUESTED BY THE EMPLOYER, 85A-113 CASE MANAGERS A CASE MANAGER MAY BE APPOINTED BY THE ALJ OR AT THE REQUEST OF EITHER PARTY. CASE MANAGERS MUST MEET THE CRITERIA IN THE DEFINITIONAL SECTION. THE COMMISSION WILL HAVE A LIST OF CASE MANAGERS TO SELECT FROM.

UPDATES: COMMON QUESTIONS Discovery Medical Reports Use of the AMA Guides Form A’s UPDATES: Court Reporters Deferral Issue Clean-up Bill Rule Changes.