Oregon Insurer’s Request for Director Approval of an Additional Independent Medical Examination (MEX) is a formal request for the approval of a medical examination of an insured individual by an independent medical examiner (IME). It is commonly used by insurers to ensure that the medical condition of an individual is accurately diagnosed and assessed in order to make an accurate decision regarding coverage or payment for a claim. There are two types of Oregon Insurer’s Request for Director Approval of an Additional Independent Medical Examination: the “InitiaMEXEX” and tFollowupllMMEXIMEIndexedexMEXMEXEX is the firsMEXEX request submitted to the Director by an insurer and is used to obtain an opinion from an independent medical examiner on the diagnosis and status of an individual’s medical condition. The Follow-UMEXEX is a second request submitted to the Director by an insurer in order to obtain an additional opinion from an independent medical examiner on the diagnosis and status of an individual’s medical condition. The request for Director Approval of an Additional Independent Medical Examination must include the insured individual’s name, date of birth, address, and contact information, as well as the name, address, and contact information of the independent medical examiner (IME) who will be performing the medical examination. The request must also include a description of the insured individual’s medical condition and a statement of the reason for requesting the additional MEX.
Oregon Insurer's Request for Director Approval of an Additional Independent Medical Examination
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Authorization to release medical records By signing this form, you authorize health care providers and other custodians of claim records to release relevant records to the workers' compensation insurer, self-insured employer, claim administrator, and the Oregon Department of Consumer and Business Services.
Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.
This bulletin provides updated benefit rates based on the Oregon state average weekly wage. This bulletin replaces Bulletin No. 111 dated . July 1, 2023, through June 30, 2024, the SAWW used to compute workers' compensation benefits is $1,295.86.
To browse FormTitleCategory801Report of Job Injury or IllnessFirst report of injury801sReporte de Lesion o Enfermedad en el TrabajoFirst report of injury
Fill out Form 801 ?Report of Job Injury or Illness? and turn it in to your employer. Your employer should send it to its workers' compensation insurance carrier within five days of your notice. Your employer should provide you this form.
The Form 43 is to be completed by the respondent (employer/workers' compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimant's claim to workers' compensation benefits.