Minick: OK Workers’ Comp Option Revisions Adopted

Oklahoma Workers’ Comp Option Revisions Adopted
By Bill Minick, PartnerSource president

The Oklahoma Legislature has unanimously approved changes to the Employee Injury Benefit Act (aka, the “Oklahoma Option”).  The new law confirms that timeframes for filing injury benefit claims and seeking first medical treatment remain subject to the terms of the benefit plan.  Most Oklahoma Option benefit plans require immediate injury reporting and medical care, subject to “good cause” exceptions.  Among other advantages, this leads to faster medical care, better medical outcomes, and safer workplaces for co-workers.

If an employee’s claim for injury benefits is denied for any reason, the plan must provide and communicate a clear process for appeal.  Appeals inside the benefit plan are reviewed at a higher level under either Oklahoma law or the same federal law that applies to employer-sponsored group health and retirement plans.  Following that internal appeal, employees can decide to further appeal any claim denial within one year to the Oklahoma Workers’ Compensation Commission or federal district court.

The new law adjusts that external claim appeals process to be more in favor of injured workers.  Review at the Oklahoma Workers’ Compensation Commission will first be handled by an Administrative Law Judge.  If that judge upholds the claim denial, the employee can further appeal to all Commissioners at the Workers’ Compensation Commission, and even take the claim to the Oklahoma Supreme Court.  This ALJ process and changes to the standards of review and development of Commission records were made in direct response to concerns expressed in a 2013 decision by the Oklahoma Supreme Court.

Lastly, the new law confirms the confidentiality of private-employer financial information submitted to the Oklahoma Insurance Department when seeking approval as a qualified employer.  The Department uses that information to confirm the employer has the insurance coverage or other financial means to pay all injury benefits.

The full text of the approved bill can be found here. Governor Fallin signed SB 767 into law on Friday, June 4.