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Post-closure treatment

After an injured worker is declared medically stationary, the attending physician may prescribe curative care or palliative care, or the claim may qualify for a reopening under aggravation. Additionally, the worker may qualify for prescription medical and office visits to monitor, administer, or renew prescriptions; or provide services to diagnose the worker's condition.


Palliative care
Definition | Medical services provided to reduce or temporarily moderate the intensity of an otherwise stable condition to enable the worker to continue working (This does not reopen the claim.)

Requirements | According to Oregon administrative rules, a palliative care request, prepared by the attending physician, must:

  • Describe objective findings
  • Include the ICD diagnosis code of the condition to be treated
  • Detail the treatment plan, including:
    • The name of the rendering provider
    • Specific treatment modalities
    • Frequency and duration (not to exceed 180 days)
    • An explanation of how the care is related to the compensable condition
    • A description of how the care will enable the worker to continue in the workforce, and the adverse effect if the request is not approved

The request must be submitted to the insurer, in writing, by the attending physician. Treatment can begin once the request is submitted.


Curative care
Definition | Care provided to an injured worker to stabilize a temporary and acute waxing and waning of symptoms of the worker's condition (This does not reopen the claim.)

Requirements | According to Oregon administrative rules, a curative care request must include a treatment plan that describes:

  • Objectives of the treatment
  • Specific modalities
  • Frequency and duration

The request must be submitted to the insurer, in writing, by the attending physician. Treatment can begin once the request is submitted.


Aggravation
Definition | An "aggravation" is a worsening of the already accepted condition or conditions, which is supported by medical evidence and objective findings. (This reopens the claim.)

Requirements | A claim for aggravation may be made by filing form 827 anytime in a claim that has been previously closed. The aggravation must be filed by the attending physician. It cannot be filed by a Type B provider as an aggravation is beyond the "initial" claim.

The attending physician must include medical evidence supported by objective findings of an actual worsening of the accepted claim. Temporary waxing and waning of symptoms is not considered an aggravation; however, the worker may qualify for a brief period of additional curative treatment.

From saif.com

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