A contested case hearing (CCH) is a recorded proceeding during which parties who disagree with an administrative decision of the Director of the Department of Consumer & Business Services can present evidence to challenge and overturn the decision. The data presented here are ordered by the calendar year the request to challenge the director’s decision was received. Some disputes may not be resolved until the following year(s).
Original orders in a dispute are written by the Dispute Resolution Section (Medical Review Unit, Appellate Review Unit, and the Rehabilitation Review Unit), the Compliance Section, and the Benefits Section. If that order is not agreeable to a party in the dispute, a director’s order is required. A party dissatisfied with the director’s order may appeal the order in a contested case hearing, where an administrative law judge (ALJ) from the Workers' Compensation Division will issue a ruling.
In 1997, there were 238 cases appealed to the CCH section. This was a decrease of 21 percent from 1996 which had 302 cases. In 1997, orders from the Medical Review Unit had the most appeals to CCH with 75, next were orders from Rehabilitation Review Unit with 63, and third was the Appellate Review Unit with 50. Also in 1997 there were 23 orders from the Benefits Section and 18 orders from the Compliance Section appealed to CCH. Figure 1 shows the percentage of orders from each unit or section that were appealed to CCH for 1995 through 1997.
The contested case hearing is concluded by the administrative law judge issuing one of six rulings on the director’s order: affirm the order, partially affirm the order, reverse the order, remand the order back to the section or unit of origin, reverse the order then remand, or the ALJ can dismiss the appeal (withdrawn appeals are also written as dismissals). The parties involved in the case can also mediate without a hearing in which case the ruling is written as a stipulation or settlement. When an ALJ makes a ruling it is issued as a proposed and final order.
In 1997, 19.3 percent of all cases brought
before CCH were affirmed, 1.7 percent were partially affirmed,
5.9 percent of the director’s orders were reversed, 9.7
percent were either remanded or
reversed and remanded, 56.3 percent were either dismissed or
withdrawn, and 4.6 percent were settled by stipulation. The remaining
orders (2.5 percent ) were deferred, abated or closed for other
reasons. Table 1 shows the jurisdictions of the original disputed
orders and the case dispositions from CCH for 1997. Table 2 compares
the percentage of cases within each disposition for the years
1995-1997.
There are a total of 36 issues subject to appeal, from the various sections and units. Of those 36 issues, vocational assistance, which is under the jurisdiction of Rehabilitation Review Unit, had the most orders appealed to CCH with 63. Of the vocational assistance cases, 11.1 percent resulted in a ruling to affirm the order of the director, 7.9 percent to reverse, 6.3 percent to remand, one case, or 1.6 percent, was settled by stipulation, and the remaining 73.0 percent were dismissed or withdrawn. The next issue with the most appeals, 31, was timeliness of reconsiderations, which is under the jurisdiction of the Appellate Review Unit. Of the 31 cases for timeliness of reconsiderations 19.4 percent affirmed the director’s order, 6.5 percent reversed, 19.4 percent either remanded or reversed then remanded, 54.8 percent dismissed or withdrawn, and the remaining cases were deferred or abated with no ruling. The third most frequently appealed issue was medical fees, which is under the jurisdiction of the Medical Review Unit. They had 23 orders appealed to CCH. Of these, 21.7 percent were affirmed, 8.7 percent were partially affirmed, 17.4 percent were settled by stipulation, 43.5 percent were dismissed or withdrawn, and 8.7 percent were deferred or abated. Table 3 shows the total orders appealed to CCH and the dispositions for 1997.
If a dispute still exists after the proposed and final order has been made, an exception to the ALJ’s ruling can be filed. With the exception filed and upon review by administration, a final order is issued by the director. If no exceptions are filed the ALJ’s ruling becomes a Final Order after 60 days. The Final Order is then appealable to the Oregon Court of Appeals and then to the Oregon Supreme Court for discretionary review.
The Oregon Court of Appeals, as of December 1998, has ruled on
five cases from 1997. Two cases involved orders from MRU, two
were orders from Rehabilitation Review Unit, and one was from
the Compliance Section. For all five cases the Court of Appeals
ruled to dismiss. There are also at this time nine cases pending.
Of the cases that are pending or active, four are cases that
originated from the Medical Review Unit and three are from the
Rehabilitation Review Unit. Figure 2 shows the Court of Appeals
decisions for cases in which the request for a contested case
hearing was first received in CY 1996. As of December 1998 there
were five cases from 1996 pending at the Oregon Court of Appeals.
The average length of time, between the initial request for an appeal to CCH to the ruling by an ALJ, for 1997, is 86 days. The maximum length was 352 days and the minimum was six days. The average length of time, between the initial request for an appeal to CCH to the date the case closed (all appeals completed), was 191 days. The maximum length was 621 days and the minimum was 33 days. The average length of time for only those 1997 cases that appealed all the way to the Oregon Court of Appeals, before closing, was 414 days. As of December 1998, nine cases that were initiated in 1997 were pending. Figure 3 shows the average processing time for a request to CCH for the years 1995-1997.
If you have questions about the information contained in this document please contact by e-mail or phone: David Burgess, Research Analyst, Research & Analysis Section, Information Management Division (503) 947-7364.
This document was originally published in May 1999.
Document URL: http://www.cbs.state.or.us/external/imd/rasums/3234r.html
[Printed form: 440-3234(05/99/IMD)]In compliance with the Americans with Disabilities Act (ADA), this publication is available in alternative formats by calling (503) 378-4100 (V/TTY).