Quick Reference Guide
Compensability Accident must be unintended, unanticipated, unforeseen, unplanned, and
Accident must be major cause of resulting injury.
Injuries in parking lot or common areas before clocking in or after clocking
out are not compensable.
Injuries on work break not compensable unless break is allowed by
CC Form 2 After a claim has been reported, a CC Form 2 must be filed within 10 days of
notice of injury which results in more than three days of lost time.
CC Form 2A If a claim or issue is disputed, a CC Form 2A must be filed within 15 days of
notice of the claim.
CC Form 2A Extension One extension may be granted by the Commission. It provides an additional
CC Form 3 Filed by the Claimant to initiate the claim.
EOA/Form 71 Must be filed within 10 days of notice of Form 3.
Discovery must be completed within 60 days.
Claimant has six months to file bona fide request for benefits or claim may be
Statute of Limitations One year from date of accident for denied claims.
If benefits paid, two years from date of accident or one year from date of last
payment of benefits.
Two years for cumulative trauma.
Must raise defense at first hearing.
TTD Three day waiting period.
104 week maximum.
52 weeks additional TTD if there is a consequential injury.
Soft tissues limits still apply.
Additional eight weeks for injection.
16 weeks if surgical recommendation.
Termination of TTD Automatic if
1.) No claim on file.
1.) Claimant released from treatment.
2.) Light duty.
Form 4 Must be filed any time benefits are initiated or terminated.
Medical Employer must provide treatment within five days of notice.
Employer may select the treating physician.
Claimant may request one change of physician.
Employer selects three options and Claimant must select one from the list
May terminate benefits if more than two missed appointments unless
Claimant provides a valid excuse.
PPD Must use 6 th Edition for injury to body as a whole.
Commission has indicated all injuries must be converted to body as a whole,
6 th Edition must be used.
PPD awards are held in reserve. Award is reduced by money earned in pre-
injury or equivalent job.
350 week maximum for body as a whole.
CMM Shall not be awarded unless recommended by treating physician or IME.
Voc Rehab Anyone entitled to PPD is eligible for voc rehab.
52 week maximum.
Must be requested within 60 days of PPD award.
Reopen May be reopened within six months of termination of compensation period
fixed in the original PPD award.
Workers’ Compensation Commission – Effective 02/01/14
The rights and remedies granted under the Administrative Workers’ Compensation Act
are exclusive for all injuries sustained by an employee as a result of injury, illness, or
death. 85A O.S. Section 5(A).
The exclusive remedy:
1. Shall not apply if an employer fails to secure payment of compensation due to
an employee under the Act. 85A O.S. Section 5(B)(1).
a. If the employer failed to secure payment of compensation, the employee
may maintain an action in District Court for damages on account of the
injury. The injured employee may maintain an action either before the
Commission or in the District Court, but not both. 85A O.S. Section 5(I).
2. Shall not apply if the injury was caused by an intentional tort committed by
the employer. 85A O.S. Section 5(B)(2).
3. The immunity from civil liability shall apply regardless of whether the injured
worker is denied compensation or deemed ineligible to receive compensation
under the Act. 85A O.S. Section 5(C).
4. The immunity created in this section does not apply against another employer
on the same job if the other employer does not stand in the position of an
intermediate or principle employer. 85A O.S. Section 5(E).
5. The immunity created under this section does not apply to an employer
standing in the position of a special master of a loaned servant as long as the
special master is not the immediate employer nor the intermediate or principle
employer. 85A O.S. Section 5(F).
a. The section is not to be construed to abrogate the loaned servant doctrine
in any respect other than that listed. 85A O.S. Section 5(G).
Law Governing Benefits
The law governing single event accidents will be the law in effect on the date of the
injury. For cumulative trauma injuries, the law in effect on the date of awareness will
apply. For death claims, the law in effect on the date of death will apply.
Compensable injury means damage or harm to the body or prosthetic appliance caused
solely as the result of either an accident, cumulative trauma, or occupational disease
arising out of the course and scope of employment. An accident means an event
involving factors external to the employee that was unintended, unanticipated,
unforeseen, unplanned, and unexpected, occurred at a specifically identifiable time and
place, occurred by chance and from unknown causes, and was independent of sickness,
mental incapacity, or bodily infirmity or any other cause. 85A O.S. Section 2(9)(A).
A compensable injury does not include:
1. An injury where the Claimant was an active participant to a fight.
2. An injury where the Claimant was an active participant to horseplay, unless the
Claimant is an innocent victim.
3. Injury that occurs with recreational or social activity.
4. Where the Claimant is intoxicated.
5. Injury resulting from aging, osteoarthritis, or degenerative process.
6. Any pre-existing condition except when the treating physician clearly confirms an
identifiable and significant aggravation. 85A O.S. Section 2(9)(B).
A compensable injury must be established by medical evidence supported by objective
findings. 85A O.S. Section 2(9)(B).
The course and scope of employment means the activity of any kind or character for
which the employee was hired that relates to and derives from the work, business, trade,
or profession of an employer and is performed by the employee in the furtherance of the
affairs or business of the employer. It includes activities conducted on the premises of an
employer or at other locations designated by employer. It does not include:
1. Transportation to and from his or her place of employment.
2. Dual missions.
3. Injury occurring in the parking lot or other common area adjacent to the place of
business before the employee clocks in or otherwise begins work or after the
employee clocks out or otherwise stops work.
4. Injury occurring while the employee is on a work break unless the injury occurs while
the employee is on a work break inside the employer’s facility and the work break is
authorized by the employee’s supervisor. 85A O.S. Section 2(13).
The compensable injury must be proven by preponderance of the evidence. 85A O.S.
Benefits shall not be payable for a condition which results from an intervening accident
which causes or prolongs disability, aggravation, or requires treatment. 85A O.S. Section
Any Claimant who suffers a compensable injury is entitled to receive compensation as
allowed by the Act. If there is no compensable injury, then the Claimant cannot receive
compensation under the Act. 85A O.S. Section 2(9)(G).
There is no liability for injuries caused by the willful intent of a Claimant to injure him or
herself. 85A O.S. Section 35(A)(2).
The Claimant is not entitled to medical benefits if the claim is determined to be not
compensable. 85A O.S. Section 52.
The Claimant is required to provide notice of the injury within 30 days. If the Claimant
fails to provide notice within that timeframe, then there exists a presumption that the
injury is not work-related. Notice must be given either orally or in writing to the
employer. 85A O.S. Section 68(A).
If an employer wishes to deny the employee’s right to compensation, then the employer
must file with the Commission a form notifying the commission that the right to
compensation is disputed listing the grounds for the dispute. This form must be filed
within 15 days of notice. 85A O.S. Section 86(A)(1).
1. Failure to file the form shall not preclude the employer’s ability to deny the claim or
to make additional defenses not initially included on the form. 85A O.S. Section
If the employer is not able to obtain sufficient medical information to allow a decision to
be made within 15 days of received notice, the employer may apply in writing for an
extension of time. The Commission may grant the extension in its discretion. The
employer must act in good faith and with due diligence to obtain the medical information
within the 15 day period. 85A O.S. Section 86(B).
1. The request for extension does not apply where the physician is an employee of, on
retainer with, or has a written contract to provide medical services for the employer.
Compensable Injury – Cumulative Trauma
Cumulative trauma means an injury to the employee that is caused by the combined
effect of repetitive physical activity extending over a period of time in the course and
scope of employment. It does not mean fatigue, soreness, or general aches and pains that
may have been caused, aggravated, exacerbated, or accelerated by the employee’s course
and scope of employment. Cumulative trauma shall have resulted directly and
independently of all other causes and the employee shall have completed at least 180
days of continuous employment. 85A O.S. Section 2(14).
The Claimant must give written notice of cumulative trauma to the employer within six
months of manifestation of symptoms. 85A O.S. Section 67(A)(2).
The notice of the claim must be given within 30 days from separation from employment
for cumulative trauma injuries. 85A O.S. Section 68(B).
When an employer has changed insurance carriers and there is a dispute as to liability
among the carriers and it is the only dispute of the claim, then the Commission will direct
both to pay on an equal basis. 85A O.S. Section 88(A).
1. Upon resolution of the issue, the prevailing party is entitled to reimbursement of all
money paid with interest from the date of payment pursuant to 12 O.S. 727.1 Section
Compensable Injury – Psychological Overlay
Psychological overlay is not compensable unless caused by physical injury. 85A O.S.
Psychological overlay can be compensable without a physical injury if the Claimant is a
victim of a violent crime. 85A O.S. Section 13.
The condition must be diagnosed by licensed psychiatrist or psychologist. 85A O.S.
Benefits are limited to 26 weeks of temporary total disability with one extension if the
need for the extension is proven by clear and convincing evidence. 85A O.S. Section 13.
If death results directly from the mental injury or illness within a one year period, then
compensation shall be paid consistent with other death claims. 85A O.S. Section 13.
Death directly or indirectly related to the mental illness or injury occurring one year or
more after the incident shall not be compensable. 85A O.S. Section 13.
Compensable Injury – Heart/Lung
Cardiovascular, coronary, pulmonary, respiratory, or cerebrovascular accident or
myocardial infarction causing injury, illness, or death is compensable only if, in relation
to other factors contributing to the physical harm, the course and scope of employment
was the major cause. 85A O.S. Section 14(A).
Such an injury shall not be deemed compensable unless it is shown that the exertion of
work necessary to precipitate the disability or death was “extraordinary and unusual” in
comparison to the employee’s usual work or that some unusual and unpredicted incident
occurred which is found to have been the major cause of the physical harm. 85A O.S.
Physical or mental stress shall not be considered. 85A O.S. Section 14(B)(2).
Compensable Injury – Occupational Disease
Occupational disease is compensable if the injury arises out of the work activities and
within the scope of employment if disability or death results from the disease. 85A O.S.
No compensation shall be payable if the Claimant falsely represented himself or herself
in writing as not having a prior disability, prior layoff, or prior compensation because of
the disease. 85A O.S. Section 65(B).
If an occupational disease is aggravated by other disease or infirmity which is not work-
related, then the compensation payable shall be reduced and limited to only the portion of
the compensation that would be payable if the occupational disease were the major cause
of the disability or death as the occupational disease, as a causative factor, bears to all the
causes of the disability or death. 85A O.S. Section 65(C)(1).
The reduction in compensation is effected by reducing the number of weekly or monthly
payments or the amounts of the payments. 85A O.S. Section 65(C)(2).
Occupational disease means any disease that results in disability or death and arises out
of and in the course of the occupation or employment of the employee or naturally
follows or unavoidably results from an injury as that term is defined in this Act. A causal
connection between the occupation or employment and the occupational disease shall be
established by a preponderance of the evidence. 85A O.S. Section 65(D)(1).
No compensation is payable for contagious or infectious disease unless contracted in the
course and scope of employment or connected with a hospital or sanatorium in which
persons with the disease are treated. 85A O.S. Section 65(D)(2).
No compensation for any ordinary disease of life to which the general public is exposed.
85A O.S. Section 65(D)(3).
The employer or insurance carrier last on the risk when last injuriously exposed is liable.
85A O.S. Section 65(E)(1).
Compensation shall be based on the average weekly wage of the employee when last
injuriously exposed. 85A O.S. Section 65(E)(2).
An employer is not liable for compensation for occupational disease unless:
1. The disease is due to the nature of employment in which hazards of the disease
actually exist and are characteristic thereof and peculiar to the employment and
actually incurred in the course and scope of employment.
2. Disablement or death occurs within three years in the case of silicosis or asbestosis or
one year in all other occupational disease cases.
3. Death follows continuous disease commencing within time period and results within
seven years. 85A O.S. Section 65(F)(1).
If exposure to x-rays, radioactive substances, or ionizing radiation then the limitations
expressed do not apply. 85A O.S. Section 65(F)(2).
Asbestosis means the characteristic fibrotic condition of the lungs caused by the
inhalation of asbestos dust. 85A O.S. Section 66(A)(1).
Silicosis means the characteristic fibrotic condition of the lungs caused by the inhalation
of silica dust. 85A O.S. Section 66(A)(2).
Silicosis and asbestosis are presumed not to be work-related unless during 10 years
before the date of disablement the Claimant is exposed to silica or asbestos for at least
five of those years, with two of those years being in Oklahoma. 85A O.S. Section 66(B).
Payment for uncomplicated silicosis or asbestosis shall be payable in accordance with
Sections 45 and 48. 85A O.S. Section 66(C).
Silicosis or asbestosis complicated with tuberculosis is payable as above if the silicosis
and asbestosis was an essential factor in the disease. 85A O.S. Section 66(D)(1).
If the disability or death from silicosis or asbestosis is complicated with any other
disease, then compensation shall be reduced and apportioned as with other occupational
diseases. 85A O.S. Section 66(D)(2).
If affected by silicosis or asbestosis but there is no disability that results, but it is unduly
hazardous for the Claimant to continue in the employment, then the Claimant shall be
entitled to compensation until they are able to obtain steady employment in a suitable
occupation. 85A O.S. Section 66(E)(1).
In such cases, vocational rehabilitation can be ordered. 85A O.S. Section 66(E)(2).
Written notice of the disease must be provided within six months of distinct
manifestation. 85A O.S. Section 67(A)(1).
Notice of the occupational disease must be given within 30 days of the employee’s
separation from employment or there will be a rebuttable presumption that the injury did
not arise out of and in the course of employment. 85A Section 68(B).
If the employee is temporarily unable to perform his or her job or alternative work, then
the Claimant shall be entitled to receive compensation equal to 70% of their average
weekly wage, not to exceed 70% of the State’s average weekly wage. 85A O.S. Section
Temporary total disability payments are limited to 104 weeks, but if a consequential
injury is found and additional time is needed to reach maximum medical improvement,
then it may continue for an additional 52 week period. 85A O.S. Section 45(A)(1).
There are no TTD payments for the initial three day waiting period. 85A O.S. Section
TTD may be terminated by giving notice to the Claimant if:
1. The Claimant is released from medical treatment on all body parts.
2. The Claimant misses three consecutive appointments without a valid excuse.
3. The Claimant fails to comply with orders for medical treatment.
4. The Claimant otherwise abandons medical treatment. 85A O.S. Section 45(A)(2).
The Claimant may seek to have TTD reinstated by filing within 10 days of termination.
The Claimant must prove a valid excuse for the failure to comply with medical treatment
or for the abandonment of treatment. 85A O.S. Section 45(A)(2).
An ALJ may appoint an independent medical examiner to determine if additional
treatment is necessary. 85A O.S. Section 45(A)(2).
In soft tissue cases, the Claimant is entitled to eight weeks for nonsurgical soft tissue
injuries. An additional eight week period may be provided for one or more injections.
An additional 16 weeks can be granted based upon a surgical recommendation. 85A O.S.
1. If no surgery is performed within 30 days of approval due to the Claimant acting in
bad faith, then the extension is terminated and the Claimant shall reimburse the
employer for any TTD paid over and above the eight weeks.
TTD is not allowed if a Claimant is currently drawing unemployment benefits. If TTD is
controverted and subsequently awarded and the injured worker drew unemployment
during the period of time for which TTD was sought, the worker is entitled to the
difference between the TTD rate and unemployment benefits, to the extent TTD exceeds
unemployment. 85A O. S. Section 49
Temporary Partial Disability
Temporary partial disability is paid based on 70% of the difference between the average
weekly wage before the injury and the average weekly wage while performing alternate
work. 85A O.S. Section 45(B)(1).
Temporary partial disability is not allowable if the average weekly wage for the alternate
work is greater than the TTD rate. 85A O.S. Section 45(B)(1).
There is a 52 week cap on temporary partial disability benefits. 85A O.S. Section
If the Claimant refuses the work offered by employer within the restrictions, then the
Claimant is not entitled to temporary total disability.
Employer shall promptly provide medical treatment as may be reasonable and necessary
in connection with the injury. An employer may select the treating physician. 85A O.S.
If the employer fails to provide treatment within five days of actual notice, then the
injured employee may select the physician to provide the medical treatment. 85A O.S.
No diagnostic tests may be repeated within six months without agreement of the parties
or based upon an order of the Court for good cause. 85A O.S. Section 50(C).
The Claimant must submit to evaluation at the request of the employer or the
Commission. Refusal to submit to the examination will result in the right to prosecution
being suspended and no compensation payable during the period of the refusal. 85A O.S.
Service of medical devices is ongoing, including battery replacement, medication refill
for the device, device repair, or device replacement. 85A O.S. Section 50(F).
The ODGs are the primary standard of reference for medical treatment. However, they
are no longer requirements. 85A O.S. Section 16(A).
Employer must pay 100% of the medical costs pursuant to the fee schedule with no
maximum dollar or duration limit. 85A O.S. Section 51.
The Claimant must submit to evaluation and treatment by another doctor designated or
approved by the Workers’ Compensation Commission as the Commission may require.
85A O.S. Section 53(A).
If the Claimant refuses to be evaluated by the designated doctor approved by the
Commission, then proceedings will be suspended and no compensation is payable for any
period during the period of refusal. 85A O.S. Section 53(B).
Failure of the Claimant to obey a judgment of the Commission for a period of one month
from the date of the judgment shall bar the right of the Claimant to further compensation
in respect to the injury. 85A O.S. Section 53(C).
If the Claimant unreasonably refuses surgery where two physicians have recommended
the surgery, then the Commission shall take the refusal into consideration in determining
compensation for permanent partial disability and permanent total disability.
The Commission may grant case management on the request of a party or if the
Commission determines that it is appropriate. There is a provision for the allowance of
one change of a case manager at the request of the parties. 85A O.S. Section 113.
The employer may submit bills to the Commission for review if the employer believes
the charges are unreasonable. This does not apply if there is another contract in existence
between the employer/insurance carrier and the medical provider. 85A O.S. Section
If a Claimant misses two or more treatment visits, then they are no longer entitled to
receive benefits under the act unless they can show that the absence was caused by
extraordinary circumstances beyond their control or they provide two hours notice and
have a valid excuse. 85A O.S. Section 57(A).
1. The lack of transportation is not a valid excuse or extraordinary circumstance. 85A
O.S. Section 57(B).
An employer shall furnish a prosthetic device as is necessary for the lifetime of the
Claimant. 85A O.S. Section 114.
Injury to a prosthetic device is an injury and the employer shall repair or replace the
prosthetic device. 85A O.S. Section 114.
An intervening injury to the area where the prosthetic device is located terminates the
employer’s ongoing obligation to pay for the repair and replacement of the prosthetic
device. 85A O.S. Section 114.
Change of Physician
If the employer has a CWMP, then the employer will choose the treating physician. The
Claimant may apply for dispute resolution through the CWMP for a change of physician.
85A O.S. Section 56(A).
If there is no CWMP in place, then the employer selects the treating physician and the
Claimant may apply for one change of physician. The employer will then provide three
options to the injured worker and the Claimant may select from the three choices. 85A
O.S. Section 56(B).
Medical – Continuing Medical Maintenance
Continuing medical maintenance means medical treatment that is reasonable and
necessary to maintain Claimant’s condition resulting from the compensable injury after
reaching maximum medical improvement. It shall not include diagnostic tests, surgery,
injections, counseling, physical therapy, or pain management devices or equipment. 85A
O.S. Section 2(12)
No continuing medical maintenance shall be provided unless recommended by the
treating physician. The employer is not responsible for continuing medical maintenance
outside of the parameters established by the Physician Advisory Committee or the ODGs.
Employer is not responsible for continuing medical maintenance not previously awarded
or approved in advance by the employer. 85A O.S. Section 50(D).
Prescription medication shall be prescribed as recommended by the ODGs. Claimant
must have preauthorization for drugs that are not preferred by the ODGs, exceed, or are
not addressed by the ODGs. 85A O.S. Section 16(B).
Medical – IME
The Commission will maintain a list of independent medical examiners. 85A O.S.
The ALJ may appoint an independent medical examiner to assist in determining any
issue. If surgery is recommended, the employer can request an IME and an IME shall be
appointed to determine if surgery is reasonable and necessary. 85A O.S. Section 112(B).
An IME shall be appointed within 10 days of petition for an IME filed by either party.
85A O.S. Section 112(C).
If the IME determines that more treatment is needed, then the employer will designate a
treating physician to provide the indicated treatment. 85A O.S. Section 112(F).
The IME is paid by the employer. 85A O.S. Section 112(G).
There will be a review process created by the Commission to oversee the quality of
performance and timeliness of reports from IMEs. 85A O.S. Section 112(H).
The ALJ or Commission must set out its reasons for deviating from the opinion of the
independent medical examiner. The opinion must be followed unless there is clear and
convincing evidence otherwise. 85A O.S. Section 112(I).
If there is an objection within 10 days of the report from the IME, then a deposition can
be taken and cross examination is allowed. The employer is responsible for the costs of
the deposition. 85A O.S. Section 112(J).
Permanent Partial Disability
Permanent partial disability means a permanent disability or loss of use after maximum
medical improvement has been reached which prevents the injured employee, who has
been released to return to work by the treating physician, from returning to his or her pre-
injury or equivalent job. 85A O.S. Section 2(34).
Permanent disability means the extent expressed as a percentage of the loss of a portion
of the total physiological capabilities of the human body as established by competent
medical evidence and based on the current edition of the American Medical Association
Guides to the Evaluation of Impairment. 85A O.S. Section 2(33).
Objective findings are those findings which cannot come under the voluntary control of
the patient. 85A O.S. Section 2(31)(A)(1).
When determining permanent disability, a physician, any other medical provider, an
Administrative Law Judge, the Commission, or the Courts shall not consider complaints
of pain. 85A. O.S. Section 2(31)(A)(2).
For the purpose of making permanent disability ratings to the spine, physicians shall use
criteria established by the most current edition of the AMA Guides. 85A O.S. Section
Objective evidence necessary to prove permanent disability in occupational hearing loss
cases may be established by medically recognized and accepted clinical diagnostic
methodologies. 85A O.S. Section 2(31)(A)(3)(A).
Any difference in the baseline hearing levels shall be confirmed by subsequent testing.
However, such tests shall be given within four weeks of the initial baseline hearing test
but not before five days after being adjusted for presbycusis. 85A O.S. Section
Pre-injury or equivalent job means the job the Claimant was working for the employer at
the time of the injury or any other employment offered by Claimant’s employer that pays
at least 100% of the employee’s average weekly wage. 85A O.S. Section 2(37).
Disability means incapacity because of compensable injury to earn in the same or any
other employment substantially the same amount of wages the employee was receiving at
the time of the compensable injury. 85A O.S. Section 2(16).
Permanent partial disability may not exceed a total of 100% to any body part or to the
body as a whole. 85A O.S. Section 45(C)(1).
An award for permanent disability must be supported by objective medical evidence.
85A O.S. Section 45(C)(1).
Body as a whole injuries are rated according to the current edition of the American
Medical Association Guides to the Evaluation of Permanent Impairment. 85A O.S.
The examining physician shall not deviate from the Guides unless specifically provided
for in the Guides. 85A O.S. Section 45(C)(3).
The award for permanent disability shall be paid at 70% of the average weekly wage with
a maximum of $323.00 per week. 85A O.S. Section 45(C)(4).
Injuries to the body as a whole shall total only 350 total weeks. 85A O.S. Section
Permanent partial disability payments shall be held in reserve by the employer. If the
Claimant returns to work in the pre-injury or equivalent job, then the award is reduced by
70% of the Claimant’s average weekly wage earned in that employment for each week
If employment is terminated for reason other than misconduct or if the injured worker is
not able to return to the pre-injury or equivalent job, then the remaining award is paid in a
lump sum. 85A O.S. Section 45(C)(5).
If an injured worker is fired for misconduct, then the employer shall have the burden to
prove the misconduct. 85A O.S. Section 45(C)(5).
If the Claimant refuses to return to work, then the award is deferred for each week the
Claimant refuses that return to work. 85A O.S. Section 45(C)(5).
All attorney fees shall be paid in full at the time of the deferral of the payment. 85A O.S.
The fact that an employee has suffered previous disability or received compensation shall
not preclude a later claim. 85A O.S. Section 45(C)(6).
If the prior condition is aggravated or accelerated by the new claim, then the Claimant is
only entitled to additional permanent disability caused by the new injury. No reduction
in benefits for temporary disability or medical treatment. 85A O.S. Section 45(C)(6).
1. The reduction in permanent disability is calculated first, by prior court order or
settlement which conclusively establishes the amount of permanent partial disability
determined to be pre-existing.
The reduction shall be calculated as follows:
1. If the pre-existing impairment is the result of an injury sustained while working for
the same employer against whom the workers’ compensation benefits are currently
being sought, then any award of compensation shall be reduced by the current dollar
value attributable under the Administrative Workers’ Compensation Act to the
percentage of permanent partial disability determined to be pre-existing. The current
dollar value shall be calculated by multiplying the percentage of pre-existing
disability by the compensation rate in effect on the date of the accident or injury
against which the reduction will be applied. 85A O.S. Section 45(C)(6)(B).
2. In all other cases, the employer against whom benefits are currently being sought
shall be entitled to a credit for the percentage of pre-existing permanent partial
disability. 85A O.S. Section 45(C)(6)(B).
There are no payments on any order until all prior orders have been completed. 85A O.S.
The injury to the body of a whole shall have a maximum of 350 weeks. Amputation or
complete loss of use of a scheduled member results in payment of compensation even if
the Claimant returns to work. 85A O.S. Section 45(C)(9).
A Claimant who is eligible for permanent disability under the subsection shall be entitled
to receive vocational rehabilitation services for a period not to exceed 52 weeks. 85A
O.S. Section 45(C)(10).
If a Claimant unreasonably refuses to submit to a surgical operation which has been
recommended by two qualified physicians, then the Commission shall take the refusal
into consideration when determining compensation for permanent partial or permanent
Weeks for each scheduled member:
1. Arms/legs equal 275.
2. Hands/feet equal 220.
3. Thumb equals 66.
4. First finger equals 39.
5. Second finger equals 33.
6. Third finger equals 22.
7. Fourth finger equals 17.
8. Big toe equals 33.
9. Other toes equal 11.
10. Eye equals 275.
11. One ear equals 110.
12. Both ears equal 330.
13. One testicle equals 53.
14. Both testicles equals 158. 85A O.S. Section 46(A).
Permanent partial disability shall be awarded for amputation or total loss of use whether
or not the Claimant returns to work in his pre-injury job. 85A O.S. Section 46(B).
Amputation of the first phalange of a digit shall equal 50%. 85A O.S. Section 46(D)(1).
Amputation of two phalanges of a digit shall be the same as amputation of the digit. 85A
A loss of 80% or more of the vision of an eye shall equal the loss of an eye. 85A O.S.
The use of corrective lenses may be taken into consideration in evaluating the extent of
vision loss. 85A O.S. Section 46(E)(2).
Any injury to two or more fingers shall be rated to the hand proportionately. 85A O.S.
Total loss of a scheduled member is the same as an amputation. 85A O.S. Section 46(G).
The sum of all permanent partial disability awards, not counting Multiple Injury Trust
Fund awards, may not exceed 350 weeks. 85A O.S. Section 46(H).
The Physician Advisory Committee may submit another method or system to evaluate
impairment aside from the Guides. It requires approval of the Legislature. 85A O.S.
When an award becomes final, the entire sum or unpaid portion thereof shall become a
final adjudicated obligation and payment may be enforced by the Claimant or his
beneficiaries. 85A O.S. Section 116(A).
1. Maximum amount allowable for disfigurement is $50,000.00. 85A O.S. Section
2. The Claimant must wait at least 12 months after an injury before being awarded
disfigurement. 85A O.S. Section 45(F)(2).
3. An injured employee shall not be entitled to compensation for permanent disability
and disfigurement to the same part of the body. 85A O.S. Section 45(F)(3).
1. In order to be compensable, a hernia must otherwise meet the definition of a
compensable injury and the following:
a. Sudden effort, severe strain, or application of force directly to the abdominal
b. Severe pain in hernial region.
c. Pain caused work to be substantially impacted.
d. Notice given within five days.
e. The physical distress required medical treatment. 85A O.S. Section 61(A).
2. If compensable, the Claimant is entitled to six weeks of temporary total disability
benefits. 85A O.S. Section 61(B)(1).
3. If a Claimant refuses to permit a hernia operation, he may get an additional 13 weeks
of TTD and medical treatment. 85A O.S. Section 61(B)(2).
4. If death occurs from a hernia within one year and the death was the direct and sole
result of the hernia or a radical operation of the hernia, then benefits are payable as
other death claims. 85A O.S. Section 61(C).
Permanent Total Disability
Injury resulting in permanent total disability will result in payment of 70% of the average
weekly wage not to exceed the State’s average weekly wage. 85A O.S. Section 45(D)(1).
Payment is made for 15 years and until the Claimant reaches the age of Social Security
Retirement. 85A O.S. Section 45(D)(1).
If die of unrelated causes, then benefits cease on the date of death. 85A O.S. Section
An award for permanent total disability may be revived for a one time lump sum payment
of 26 weeks, split among all those eligible to revive the claim. 85A O.S. Section
If the Commission awards permanent partial disability and permanent total disability,
then permanent partial disability shall be paid first and then permanent total disability
second. 85A O.S. Section 45(D)(1).
Permanent total disability may be awarded to an employee who has exhausted his
maximum temporary total disability even if the Claimant has not reached maximum
medical improvement. 85A O. S. Section 45(D)(1).
The Commission will review permanent total disability awards annually. 85A O.S.
The Claimant must file an affidavit stating that he is not working and not capable of a
return to work each year. 85A O.S. Section 45(D)(2).
A failure to file the affidavit will result in the suspension of benefits but may be
reinstated with a hearing before the Commission. 85A O.S. Section 45(D)(2).
When an award for permanent total disability becomes final, any accrued portion shall
operate as a final adjudicated obligation and payment may be enforced by the Claimant or
his beneficiaries. 85A O.S. Section 116(B).
The Workers’ Compensation Commission shall hire a vocational rehabilitation director to
oversee the vocational program. 85A O.S. Section 45(E)(1).
If the Claimant cannot return to work in his prior job or an equivalent due to permanent
restrictions as determined by the treating physician, then either party may request
vocational evaluation. 85A O.S. Section 45(E)(2).
An eval may be directed if the Claimant has not returned to work for at least a 90 day
period. 85A O.S. Section 45(E)(2).
The director then assigns the case to counselors for the coordination of the plan. 85A
O.S. Section 45(E)(2).
At the request of either party or if an ALJ orders it, an evaluation for vocational
rehabilitation will be completed. 85A O.S. Section 45(E)(4).
If the employee refuses or fails to complete in good faith the evaluation, then the cost of
the evaluation and services or training may be deducted from the award of benefits which
remains unpaid. 85A O.S. Section 45(E)(4).
Vocational rehabilitation may be ordered before maximum medical improvement is
reached if the treating physician believes the injury will prevent the employee from a
return to work. 85A O.S. Section 45(E)(5).
There is a 52 week limitation on vocational rehabilitation. The request for vocational
rehabilitation shall be filed within 60 days of receipt of the permanent restrictions that
prevent the return to work. 85A. O.S. Section 45(E)(6).
If the rehabilitation requires residence or travel, then the employer is responsible for
payment of board, lodging, travel, tuition, books, and equipment for training. 85A O.S.
If the vocational evaluation is for the purpose of evaluating whether the Claimant is
permanently and totally disabled, then the Claimant is entitled to weekly benefits at the
TTD rate. It is for a period not to exceed 52 weeks. The employer may deduct any
amount paid for tuition from compensation awarded to the employee. 85A. O.S. Section
Change of Condition
Except in the case of settlement, the Commission may review any compensation
judgment award or decision within six months of termination of the compensation period
affixed in the original compensation award on the grounds of a change in the physical
condition or proof of erroneous wage rate. 85A O.S. Section 80(A).
The Commission may terminate, continue, decrease, or increase future payments which
were previously awarded. 85A O.S. Section 80(A).
No review shall affect compensation paid under a prior order. 85A. O.S. Section 80(B).
The Commission may correct a clerical error within one year of the date of the order.
85A O.S. Section 80(C).
Aging and its effects on the injury cannot be considered in determining whether there has
been a change of condition. 85A O.S. Section 80(D).
Average Weekly Wage
The average weekly wage will be calculated by taking the gross earnings of the Claimant
divided by the number of full weeks of employment worked by the Claimant with a
maximum of the last 52 weeks prior to the injury. 85A O.S. Section 59(A)(1).
If working on a piece basis, then the total earnings are divided by the number of hours
worked and then multiplying the hourly wage by the number of hours in a full time work
week in the nature of employment in which the Claimant was working. 85A O.S. Section
Overtime earnings are added to regular wages and divided the overtime by the number of
weeks worked. 85A O.S. Section 59(B).
If exceptional circumstances, the Commission can use a method as it determines is fair
and just to all parties. 85A O.S. Section 59(C).
Benefits for a National Guard, volunteer firefighter, peace officer, or civil defense worker
are the wages in regular employment. 85A O.S. Section 59(D).
If death does not result within one year from the accident or within three years from the
period of payment of compensation, then there is a rebuttable presumption that the death
did not result from the injury. 85A O.S. Section 47(A).
A common law spouse shall not be entitled to benefits unless the alleged spouse obtains
an order from a Court with competent jurisdiction ruling that the common law marriage
existed. 85A O.S. Section 47(B).
Beneficiary/Amounts of payments:
1. If there is a surviving spouse, then a lump sum payment of $100,000.00 plus 70% of
the average weekly wage, with a maximum being the State’s average weekly wage,
for life. Upon remarriage a lump sum payment of two years shall be made to the
2. Children with a living spouse, $25,000.00 lump sum to each child and 15% of the
average weekly wage per week, up to the maximum of the State’s average weekly
3. If more than two children with a living spouse, a total lump sum of $50,000.00 will
be paid with a pro rata share to each child equally. 30% of the average weekly wage
will be paid per week on a per rata basis to each child.
4. Children but no spouse, $25,000.00 lump sum and 50% of the average weekly wage
5. More than two children but no spouse, $25,000.00 lump sum and 100% of the injured
worker’s average weekly wage (to the max of the State’s average weekly wage) on a
pro rata basis to each child.
6. More than six kids, $150,000.00 lump sum with pro rata payments to each child and
100% of the average weekly wage on a pro rata basis to each child.
7. If there is no spouse or children, then each legal guardian, if financially dependent at
the time of death, will get 25% of the average weekly wage until either death of the
guardian, the guardian reaches Social Security eligibility, or five years, whichever
occurs first. 85A O.S. Section 47(C).
Up to $10,000.00 for funeral expenses will be paid. 85A O.S. Section 47(C)(5).
Benefits will be paid to a child until the child’s death, the child’s marriage, or until the
child reaches the age of 18. If the child reaches the age of 18 and is a full time student, is
physically or mentally incapable of self-support, then benefits are paid until the age of 23
unless the child is no longer in school or if the child becomes capable of self-support.
85A O. S. Section 47(D).
Beneficiary or guardian must file a proof of loss with the Commission. 85A O. S.
Dependency is determined as of the time of injury. 85A O.S. Section 47(F).
The employer shall begin payment within 15 days from the date of the Commissions
determination. 85A O.S. Section 47(F).
If a death occurs involving a minor who is not legally capable of working, then benefits
are doubled, unless the minor misrepresents his or her age in writing to employer. 85A
O. S. Section 48.
There is a one year statute of limitations from the date of injury. If there is no weekly
compensation or medical provided within that time period then the claim is barred. 85A
O.S. Section 69(A)(1).
For occupational diseases, the Claimant has two years from the date of last injurious
exposure. 85A O.S. Section 69(A)(2)(a).
For cases of silicosis and asbestosis, it must be filed within one year from the date of
disablement and disablement must occur within three years of the last exposure. 85A
O.S. Section 69(A)(2)(b).
Disease caused by exposure to x-rays, radioactive substances, and ionizing radiation must
be filed within two years of the date the condition was made known to the Claimant by
examination and diagnosis by a doctor. 85A O.S. Section 69(A)(2)(c).
Death claims must be filed within two years of the date of death. 85A O.S. Section
Once a claim has been filed, the Claimant must file a bona fide request for hearing within
six months or the claim may be dismissed. 85A O.S. Section 69(A)(4).
In cases in which compensation has been paid, a claim for additional compensation is
barred unless filed within one year from the date of the last payment of disability or two
years from the date of the injury, whichever is greater. 85A O.S. Section 69(B)(1).
The replacement of medicine, crutches, devices, prosthetics, or other such apparatus do
not have a statute of limitations. Replacement of such items does not constitute payment
of compensation so as to toll the statute of limitations. 85A O.S. Section 69(B)(2).
A claim for compensation must specifically state that it is a claim for compensation. Any
document which does not specifically request additional benefits is not considered a
claim for additional compensation. 85A O.S. 69(C).
If within six months of the filing of a claim for additional compensation no bona fide
request for a hearing has been made with respect to the claim, the claim shall be
dismissed without prejudice to refiling within the limitation periods previously put forth.
85A O.S. Section 69(D).
The failure to timely file is not a bar unless the employer raises the defense at the first
hearing. 85A O.S. Section 69(E).
If a failure to file is induced by fraud, then the Claimant will have one year from the time
of the discovery of the fraud to file a claim. 85A O.S. Section 69(F)(1).
For a minor child, the limitations apply from the date a guardian is appointed or within
one year from reaching the age of majority. 85A O.S. Section 69(F)(2).
For a mental incompetent, it is one year from the date of the appointment of a guardian.
85A O.S. Section 69(F)(2).
Latent injuries do not delay the limitation periods. 85A O.S. Section 69(G).
Savings clause – the Claimant may pay a filing fee and dismiss his or her claim without
prejudice and refile within one year of the order dismissing the claim. 85A O.S. Section
Policies or contracts of insurance must contain:
1. Provisions that identify the insured employer and identify each covered employee or
describe covered employees by class or type of labor performed and the estimated
number of employees of each such class or type. No single policy may be issued to
any group of employers who are unaffiliated with one another in terms of ownership,
control, or right to participate in the profits of the affiliated enterprises. 85A O.S.
2. Provisions that insolvency or bankruptcy of the employer or discharge shall not
relieve the carrier from payment of compensation. 85A O.S. Section 42(A)(2).
The agreement of the carrier that it shall promptly pay the person entitled to
compensation every installment of compensation that may be awarded or agreed upon
and that the obligation shall not be affected by any default of the employer or by any
default in the giving of any notice required by the policy or otherwise and the
agreement shall be construed to be a direct obligation by the carrier to the person
entitled to compensation and is enforceable in that person’s name. 85A O.S. Section
4. Any other provisions as the insurance department allows or requires to be included.
85A O.S. Section 42(A)(4).
All employers must secure compensation for injured workers. 85A O.S. Section
The primary obligation to pay compensation is on the employer. Obtaining insurance
does not relieve the employer of the obligation. 85A O.S. Section 35(B).
The employer must secure compensation by either:
2. Obtaining guarantee insurance.
3. Become an own risk employer.
4. Be part of a group self-insurance association. 85A O.S. Section 38.
For purposes of the Workers’ Compensation Act, the employer and insurance company
are treated as one. 85A O.S. Section 39.
Prime contractor is responsible for payment of compensation if a subcontractor fails to
secure compensation unless there is an intermediate employer who has coverage. 85A
O.S. Section 36(A).
The prime contractor may recover from the subcontractor the amount of compensation
paid. 85A O.S. Section 36(B)(1).
The claim for recovery shall constitute a lien against any money owed by the prime
contractor to the subcontractor. 85A O.S. Section 36(B)(2).
If the subcontractor does not cover a sole proprietor or partners, then the prime contractor
is not liable for any injury to those individuals. 85A O.S. Section 36(C).
The employer may cancel the policy of insurance with 30 days’ notice to the insurance
carrier. Notice may be less than 30 days if the employer obtains other coverage. 85A
O.S. Section 42(B)(1).
An insurance carrier may cancel the policy by:
1. Must state the hour and date that the cancellation is effective.
2. Must provide 30 days notice or 10 days after notice is mailed if the cancellation is for
nonpayment of a premium.
3. If the employer obtains other coverage, the effective date of the new policy shall be
the date of cancellation. 85A O. S. Section 42(B)(2).
A policy of insurance must insure all people and you may not split coverage. 85A O.S.
If a Claimant is covered by premiums paid by the employer, then the employer and
insurance company are estopped from denying that the Claimant was an employee. 85A
O.S. Section 117.
Failure to Secure Compensation
Failure of an employer to secure compensation constitutes a misdemeanor and is
punishable by a fine of up to $10,000.00. 85A O.S. Section 40(A)(1).
Commission shall serve upon employer notice of a proposed judgment and civil penalty
to be assessed if the Commission suspects the employer has failed to secure
compensation. 85A O.S. Section 40(B)(1).
The employer may contest the proposed judgment by filing a written request for hearing
within 20 days of being served with the notice. 85A O.S. Section 40(B)(2)(a).
No special form must be filed but the request for hearing must specify the grounds for
contesting the judgment. 85A O.S. Section 40(B)(2).
A judgment becomes final if the employer fails to timely contest the proposed judgment,
unless the failure is with good cause. 85A O.S. Section 40(B)(2)(c).
The burden is on the employer to prove that the judgment is incorrect. 85A O.S. Section
If the defense raised by the employer is that they had coverage for the period, then the
employer must say so in its request for hearing and must name the carrier. 85A O.S.
The Commission must then notify the carrier. 85A O.S. Section 40(B)(3)(b).
The carrier must promptly (at least five days before the hearing) reply by either affirming
coverage or affirmatively denying coverage. 85A O.S. Section 40(B)(3)(c).
The Commission may assess a penalty of up to $1,000.00 per day for which an employer
has failed to secure compensation. 85A O.S. Section 40(B)(5).
If the employer fails to secure compensation or pay any civil penalty under the Act, then
the Commission may request an injunction be entered to stop all employment related
activities until full payment has been made. 85A O.S. Section 40(B)(6).
Employer must send notice to the Commission within 10 days of first notice of injury or
death. 85A O.S. Section 63(A).
Other reports may be required but an employer may refuse if it deems the information
requested is privileged and confidential. 85A O.S. Section 63(B).
The report provided cannot be used as evidence in a hearing. 85A O.S. Section 63(C).
The mailing of any report in a stamped envelope that is properly addressed within the
time period prescribed shall be in compliance with this section. The Commission is also
directed to create a means of electronic delivery. 85A O.S. Section 63(D).
A $500.00 fine may be levied against any employer who after notice refuses to send any
report required. The Commission will notify the employer of a proposed judgment
finding the employer to be in violation of this provision. 85A O.S. Section 63(E).
An employer may contest the proposed judgment by filing written request for a hearing.
This must be done within 20 days. The dispute must specify the grounds for contesting
the judgment. 85A O.S. Section 63(F).
If an employer fails to pay any civil penalty assessed by the Commission, the
Commission may petition the District Court of the county where the employer’s principal
place of business is located for an order enjoining the employer from engaging in
business or employment activities until all reports are filed and penalties paid. 85A O.S.
The Commission is required to promulgate rules to establish a preliminary conference
designed to accomplish:
1. To allow the Claimant to confer with a legal advisor from the Commission. The
conference is to occur in the county where the accident happened unless agreed by the
2. To provide opportunity for settlement of some or all issues.
3. Facilitate resolution without the expense of litigation/attorney fees.
4. Authorize approval of settlements by legal advisor. The advisor approving the
settlement may not be the same legal advisor who conferred with the Claimant. 85A
O.S. Section 70.
If a claim is filed by the Claimant, the Commission will notify the employer of the claim
within 10 days of filing. 85A O.S. Section 71(A).
The Commission is to assign an ALJ to hold a hearing at the request of a party or on its
A request for hearing must set forth any issue of fact or law in controversy and the
specific contentions of the party applying for the hearing.
If the party is not represented, the ALJ shall define the issues to be heard.
10 days’ notice of the hearing must be given.
The decision of the ALJ will be sent to the parties. 85A O.S. Section 71(B).
At the hearing, the Claimant and employer may each submit evidence relating to the
claim. Evidence may be submitted by any person authorized in writing. That may
include medical reports. 85A O.S. Section 71(C)(1)(a).
The determination of existence or extent of impairment shall be supported by objective
and measurable physical findings. 85A O.S. Section 71(C)(1)(b).
The ALJ must look at the entire record and determine whether the issue has been proven
by a preponderance of the evidence. 85A O.S. Section 71(C)(2).
The Act must be strictly construed. 85A O.S. Section 71(C)(3).
The ALJ and Commission must weigh evidence impartially and without giving benefit of
the doubt to any party. 85A O.S. Section 71(C)(4).
A judgment of the Commission will be sent by registered mail to the parties. 85A O.S.
No compensation for disability is payable for any period beyond the Claimant’s death.
However, an award may be made after death for an unpaid period of disability preceding
the Claimant’s death. 85A O.S. Section 71(E).
The ALJ and Commission are not bound by the technical or statutory rules of evidence.
The ALJ and Commission may make such investigation or conduct hearing to best
ascertain the rights of the party. 85A O.S. Section 72(A)(1).
Statements of the deceased regarding the injury may be sufficient if corroborated by other
evidence. 85A O.S. Section 72(A)(2).
The ALJ or the Commission shall look at the entire record to determine if the claim has
been established by a preponderance of the evidence. 85A O.S. Section 72(A)(3).
ALJs must make sufficient on the record findings of fact and conclusions of law. 85A
O.S. Section 72(A)(4).
Procedures: Public Hearings
All hearings will be open to the public and stenographically reported. 85A O.S. Section
The Commission shall provide for the preparation of a record for all hearings and other
proceeding. 85A O.S. Section 72(B)(1)(b).
The Commission shall not be required to stenographically report or prepare a record of
the joint petition. The ALJ or legal advisor shall record the hearing at no cost to the
parties. 85A O.S. Section 72(B)(2).
Procedures: Introduction of Evidence
All oral and documentary evidence must be presented at the initial hearing on a
controverted claim. Oral evidence shall be stenographically reported. Further hearings
for presentation of evidence may be granted at the discretion of the hearing officer. The
request must show the substance of the evidence sought to be added at a later date. 85A
O.S. Section 72(C)(1).
Any party proposing to introduce medical reports must provide the report seven days
prior to the hearing to the party and the Commission. If the report is not available, then a
written statement of the substance of the testimony of the medical provider sought to be
submitted must be provided seven days before the hearing. 85A O.S. Section
If the opposing party desires to cross examine the medical provider, then the presenting
party must make every opportunity to have the doctor present for the hearing. 85A O.S.
Failure to comply with the provisions of this subsection may result in the preclusion of
the report from evidence except in the discretion of the hearing officer. 85A O.S. Section
The parties may waive the time periods. 85A O.S. Section 72(C)(4).
All expert medical reports must satisfy the requirements of the Federal Rules of Evidence
Section 702. 85A O.S. Section 72(D).
The Commission shall have the power to preserve and enforce order, issue subpoenas,
administer oaths, compel attendance and testimony of witnesses, and require production
of documentary evidence. 85A O.S. Section 73(A).
Any person or party who disobeys, resists a lawful order or process, obstructs a hearing,
neglects to produce records after an order to do so, or refuses to appear after subpoena, or
refuses to take the oath may be found to be in contempt of the Commission and may be
subject to a fine not to exceed $10,000.00. 85A O.S. Section 73(B).
There is a rebuttable presumption that the Commission has jurisdiction, that notice was
sufficient, and that injury was not of the willful intention of the Claimant. 85A O.S.
The Commission may cause the deposition of witnesses to be taken. 85A O.S. Section
Any witness who appears at the direction of a subpoena shall be entitled to the same fee
as a witness in a district court action. 85A O.S. Section 76.
The Commission may employ lawyers to appear on its behalf if the Commission is
named as a party or is otherwise interested in a court proceeding. 85A O.S. Section 77.
All filings must be signed by an attorney or a party. 85A O.S Section 83(A)(1).
The signature of the party must certify that the pleading has been read, that it is being
filed in good faith, and is not being brought for an improper purpose such as harassment
or unnecessary delay. 85A O.S. Section 83(A)(2).
If the pleading is not signed then the request for hearing is stricken. 85A O.S. Section
If the pleading is signed in violation of the Act, then the person signing is subject to
sanctions, including a reasonable attorney fee. 85A O.S. Section 83(A)(4).
Sanctions may be levied against any party or attorney who, without good cause, fails to
appear for a hearing, deposition, or other matter, or who frivolously joins another party,
including a reasonable attorney fee. 85A O.S. Section 83(B).
The Commission may require any employer to make a deposit or bond with the
Commission to secure prompt and convenient payment of compensation. 85A O.S.
Compensation shall bear interest pursuant to 12 O.S. Section 727.1 from the day the
award is made by the ALJ on all accrued and unpaid compensation. 85A O.S. Section
Procedures: Notification to the Commission
Upon making the first payment or on extension of any payment of compensation, the
employer is required to notify the Commission of that fact on a form. 85A O.S. Section
Within 30 days of the final payment of compensation, the employer shall notify the
Commission of final payment and the total amount paid. 85A O.S. Section 92(B)(1).
A $100.00 penalty for failure to file the notice within 30 days may be assessed. There is
no penalty without prior notice. 85A O.S. Section 92(B)(2).
The Commission may, on its own or upon application of a party, investigate the claim,
require medical examination, hold hearings, take action deemed necessary to protect the
rights of the party when:
1. Payments are being made without an award,
2. The claim is controverted,
3. Payments of compensation are suspended,
4. If the employer seeks to suspend payments. 85A O.S. Section 93.
Any claim begins by the filing of the employee’s First Notice of Claim for
Compensation. 85A O.S. Section 111(A).
If the employer controverts any issue related to the employee’s First Notice, then the
employer must file a Notice of Contested Issues. 85A O.S. Section 111(B).
Any party may request a pre-hearing on any issue. The matter will then be set within
seven days. If compensability of the claim is contested, then the employer must complete
discovery within 60 days of the filing of the request for benefits. 85A O.S. Section
A fee of $140.00 is due against whom the award becomes final. 85A O.S. Section
The fee for a motion to reopen is $130.00. 85A O.S. Section 118(B).
The persons requesting or receiving copies of documents on file with the Commission
shall pay a fee of $1.00 for each page copied. 85A O.S. Section 119(A).
Parties may file a joint petition for settlement with the Commission. After the joint
petition has been filed, the Commission shall order that all claims have been settled. 85A
O.S. Section 87.
If the parties reach an agreement to settle any issue of the claim, the employer and
employee shall sign the joint petition. 85A O.S. Section 115(A).
If not all of the issues to a claim are settled, then the joint petition will be noted as such
and an appendix will be attached. 85A O.S. Section 115(B).
In the absence of fraud, the joint petition shall be deemed a final adjudication of all rights
pursuant to the Act. An official record shall be made by an official commission reporter
of the testimony taken to effect the joint petition. 85A O.S. Section 115(C).
A good faith effort to notify the employer of possible settlement shall be made by any
insurance carrier, CompSource, or group self-insured plan. Written comments or
objections to settlements may be filed with the Commission. Notice shall be made to all
policy holders of the right to a good faith effort by their insurer to notify them of any
proposed settlement if the policy holder so chooses. 85A O.S. Section 115(D).
Any party may appeal a decision of the ALJ to the Workers’ Compensation
Commissioners. After hearing arguments, the Commissioners may reverse or modify if
the decision is against the clear weight of evidence or is contrary to law. 85A O.S.
The hearing is to be recorded by a reporter if requested by a party. 85A O.S. Section
If the Commission elects to reverse the decision of the ALJ, then the Commission must
make specific findings relating to the reversal. 85A O.S. Section 78(A).
The fee for an appeal to the Commission is $175.00. 85A O.S. Section 78(B).
Any party may appeal a decision to the Supreme Court within 20 days from the date of
the decision. 85A O.S. Section 78(C).
A judgment, decision, or award is stayed during the appeal. 85A O.S. Section 78(C).
The Supreme Court may modify, reverse, remand, or set aside the decision only if:
1. It violates provisions of the Constitution.
2. It is in excess of the statutory authority or jurisdiction of the Commission.
3. A decision is made on unlawful procedures.
4. It is affected by other error of law.
5. It is clearly erroneous in view of reliable, material, probative, and substantial
6. It is arbitrary or capricious.
7. Is procured by fraud.
8. Missing findings of fact on issues essential to the decision. 85A O.S. Section 78(C).
The appealing party must file a transcript of the record of proceedings within 45 days of
the appeal being filed. 85A O.S. Section 78(C).
In addition to fees paid to the Supreme Court for the appeal, an additional $100.00 fee
must be paid to the Commission for the cost of preparing the record. 85A O.S. Section
Alternative Dispute Resolution
The Workers’ Compensation Act has placed an emphasis on alternative dispute
resolution. The Commission is required to develop an alternative dispute resolution
program that allows the injured employee an opportunity to obtain benefits at a request or
informal procedure. The idea is to make the programs available and affordable to injured
workers who are unrepresented. 85A O.S. Section 110(A).
Participation in the alternative dispute resolution program is not required to commence a
claim. Further, a request for the alternative dispute resolution does not invoke the
jurisdiction of the Commission. 85A O.S. Section 110(B).
Mediation is voluntary and nonbinding. A Claimant may mediate or proceed directly to
the filing of the claim. 85A O.S. Section 110(C).
A Commission mediator appointed by the Commission shall conduct informal mediation
between the parties when there is a claim for a closed period of lost time where the
injured worker has already returned to work, for cases involving medical benefits only,
for reimbursement of travel expenses and medical treatment, in cases in which the
employee is not represented by an attorney, or if there is no record of insurance coverage.
85A O.S. Section 110(D).
If a request for an administrative hearing is made on an issue not specifically listed
above, then the Commission shall have a hearing within 15 days. At that time, the ALJ
will accept a waiver of mediation or appoint a mediator. 85A O.S. Section 110(E).
Mediation is confidential and no part of the proceeding is a part of the public record. If
an agreement is not reached, the results and statements made are not admissible in any
proceeding. 85A O.S. Section 110(F).
The Commission is to certify mediators. Both attorney and non-attorneys who have
worked in workers’ compensation for at least five years may serve as mediators. 85A
O.S. Section 110(G).
Once appointed, the certified mediators will stay on the list for five years. They must
undergo six hours of continuing education every two years. 85A O.S. Section 110(H).
Mediators are paid by the employer. A rate is to be set by the Commission. 85A O.S.
The Claimant shall be in attendance unless all parties agree. All parties must have
someone present for the mediation who has full settlement authority. 85A O.S Section
An injured worker may participate without the necessity of an attorney. 85A O.S.
Claims made for attorney fees are not valid unless approved by the Workers’
Compensation Commission. 85A O.S. Section 82(A)(1)(a).
A Claimant attorney is entitled to recover an attorney fee of up to 10% of any temporary
total disability or temporary partial disability benefits or 20% of any permanent partial
disability benefits. If the employer makes a written offer to settle PPD, PTD, or death
benefits, and that offer is rejected, the employee’s attorney may not recover in excess of
30% of the difference between the amount of the award and the settlement offer. 85A
O.S. Section 82(A)(1)(b).
No attorney fees are allowed in non-controverted cases. 85A O.S. Section
No attorney fees on any medical benefits. 85A O.S. Section 82(A)(1)(b)(2).
In the event an employee requests a change of physician which is controverted by the
employer, the attorney is entitled to a fee of $200.00. There is nothing in the Act to
indicate by whom that fee is to be paid. 85A O.S. Section 82(A)(1)(b)(3).
An attorney fee may include up to 10% of the value of vocational rehabilitation services.
85A O.S. Section 82(A)(1)(b)(4). Again, there is nothing within the law to indicate by
whom that attorney fee is to be paid.
A controverted claim means a contested hearing over the issues of compensability, TTD,
temporary partial disability, permanent partial disability, permanent total disability, or
death benefits. Medical benefits are not specifically listed in this section in defining what
is a controverted claim. 85A O.S. Section 82(A)(1)(C).
Payments are to be made to the Claimant by check, electronic funds, transfer, debit card,
or by state warrant. 85A O.S. Section 84(A).
If the Claimant is mentally incompetent, the Commission may direct payment to be made
to a legally appointed guardian. 85A O.S. Section 84(B).
A “clean claim” for services rendered under the Act are payable within 30 days of receipt
of the bill unless a dispute as to compensability or the amount owed is raised by the
employer. A clean claim means any claim with no defect or impropriety including a lack
of required substantiating documentation or particular circumstance requiring special
treatment that impedes prompt payment. 85A O.S. Section 85.
If an employer has made advance payments for compensation, then the employer is
entitled to be reimbursed out of any unpaid installment or installments of compensation
due. 85A O.S. Section 89.
If a Claimant receives full wages during their disability, then the Claimant is not entitled
to compensation during the period. 85A O.S. Section 89.
Any wages paid by the employer above the maximum TTD award shall be deducted from
the permanent partial disability award. 85A O.S. Section 89.
Benefits payable to a Claimant are reduced dollar for dollar for benefits previously
received, including from group health care service plans, group disability, group loss of
income policy, group accident, health, or accident and health, self-insured employee
health and welfare benefit plan, or group hospital or medical service contract. This does
not apply if the group policy for disability is paid by the Claimant personally. 85A O.S.
Mileage is to be paid up to a maximum of 600 miles with the first 20 miles being
Third Party Claims
Nothing about the filing of a workers’ compensation claim shall have any bearing on the
right of the Claimant to make a claim against a third party for the injury. 85A O.S.
The employer must be given notice and opportunity to join the action. 85A O.S. Section
If the employer joins in the action against the third party, then the employer shall be
entitled to a first lien of 2/3 of the net proceeds recovered after the payment of reasonable
costs of collection. 85A O.S. Section 43(A)(1)(c).
The filing of a claim by an employee against a third party shall not affect the rights of the
employee to recover compensation under the Workers’ Compensation Act, but any
amount recovered by the Claimant from a third party shall be applied as follows:
1. Reasonable fees and costs of collection shall be deducted. 85A O.S. 43(A)(2)(a).
2. Employer or carrier shall receive 2/3 of the remainder of the recovery or the amount
of its workers’ compensation lien (whichever is less). 85A O.S. 43(A)(2)(b).
3. The remainder of the recovery is paid to the Claimant. 85A O.S. 43(A)(2)(c).
An employer may maintain its own action for subrogation. An employer must notify the
Claimant in writing that the Claimant may have their own attorney represent them. 85A
After notice and opportunity have been given for the Claimant to be represented in the
action, liability of the third party to the Claimant, as well as the employer and insurance
carrier, shall be determined. 85A O.S. Section 43(B)(2).
If the employer recovers against the third party, the employee is entitled to the excess of
an amount paid by the employer after deducting reasonable costs of collection. 85A O.S.
An employer or carrier liable under the Workers’ Compensation Act shall be entitled to
maintain a third party action against the employer’s uninsured motorist coverage or under
insured motorist coverage. 85A O.S. 43(B)(4).
Workers’ Compensation Retaliation
An employer may not retaliate against an employee if the employer has filed a claim
under the Act, retained a lawyer, asked for a hearing under the Act, or testified at any
proceeding under the Act. 85A O.S. Section 7(A).
The Commission is granted jurisdiction to hear and decide any claim made for retaliatory
discharge for violation of claims based on Section 7(A). 85A O.S. Section 7(B).
The Commission may award back pay of up to $100,000.00. 85A O.S. Section 7(C).
Interim earnings or amounts earnable with reasonable diligence by the person
discriminated against shall reduce the back pay otherwise allowable. 85A O.S. Section
The prevailing party shall be entitled to recover costs and a reasonable attorney fee. 85A
O.S. Section 7(D).
A Claimant who is temporarily totally disabled may not be discharged for the sole reason
of being absent. 85A O.S. Section 7(E).
An employer shall not be required to rehire or retain an employee who is physically
unable to return to regular duties or whose position is no longer available. 85A O.S.
The Act creates a felony for fraud for any person who makes a false statement, willfully
omits, or conceals material or information to:
1. Obtain any benefit or payment.
2. Increasing any claim for benefit or payment.
3. To obtain coverage. 85A O.S. Section 6(A)(1)(a).
A material false statement or representation includes the attempt to obtain treatment or
compensation for body parts that were not injured in the course and scope of
employment. 85A O.S. Section 6(A)(1)(b).
The Commission has a duty to refer any claim believed to be fraud to the prosecuting
attorney. 85A O.S. Section 6(C).
The Act creates a Workers’ Compensation Fraud Investigation Unit funded by the
Commission established under the office of the Attorney General. 85A O.S. Section
Every employer or carrier with reason to suspect violation of the fraud statute shall report
the violation to the Unit. 85A O.S. Section 6(D)(6).
No carrier or employer who makes a report shall be liable to the employee unless the
carrier or employer knowingly and intentionally included false information in the report.
85A O.S. Section 6(D)(6)(b).
Any carrier or employer who willfully and knowingly fails to report a violation shall be
guilty of a misdemeanor. 85A O.S. Section 6(D)(6)(c).
All benefits and proceedings are stayed after the employee is charged until the final
disposition of the case. 85A O.S. Section 6(J).
Child Support Liens
Benefits under the Workers’ Compensation Act are not subject to any lien other than a
child support lien. 85A O.S. Section 10(A).
Child support liens filed in accordance with 43 O.S. Section 135 shall be paid without
order of the Commission. 85A O.S. Section 10(B).
All income/wage assignments issued pursuant to 12 O.S. Section 1170 or 56 O.S. Section
237.7 shall be paid without order of the Commission. 85A O.S. Section 10(C).
Workers’ Compensation Commission Rules
If a controversy exists over the applicability of any rule, any person may petition the
Commission for a declaratory ruling. 810:1-1- 5.
All cases where the Claimant misses three days from work, the employer shall send a
report to the Commission and the insurance company within 10 days. 810:2-1- 4.
Persons who may appear:
1. Attorneys licensed to practice in the State of Oklahoma.
2. A corporation, LLC, insurance carrier, own risk employer, or self-insurance group
may appear either by attorney or with a designated rep who has full settlement
3. Any non-lawyer rep must submit their credentials ahead of time and be approved by
4. Claimants may appear pro-se at any time. 810:2-1- 9.
An Entry of Appearance shall be filed by any attorney. The Entry of Appearance must
have attached with it a written authorization signed by the client and the attorney,
identifying the attorney as the representative. 810:2-1- 10(b)(1).
Any Entry of Appearance must be filed within 10 days of receipt of the CC-Form- 3.
No ex parte communications with the Commission appointed professionals or an ALJ.
This includes an IME, vocational rehabilitation counselor, case manager, etc.. 810:2-1-
The time computation:
1. If less than 11 days, then you count only business days. If 11 or more days, then you
count all days. If the last day is not a business day, then you must file on the next
business day. 810:2-1- 13.
All contested issues will be set before an ALJ. 810:2-5- 50(a).
The Commission En Banc will hear appeals from the ALJ, an appeal from an adverse
determination from an opt out plan, and appeals for the Court of Existing Claims. 810:2-
An ALJ will be assigned to each claim. A hearing will be scheduled upon the request of
any party or at the Commission’s discretion. 810:2-5- 51(a).
All parties are entitled to at least 10 days’ notice of a hearing. Hearings will be scheduled
in Oklahoma City or in Tulsa. Objection to the venue must be filed within seven days of
receipt of the first hearing notice. 810:2-5- 51(b).
A request to disqualify an ALJ must be made in writing and the application must list the
reasons for the request. The ALJ may either withdraw or send the file for reassignment.
If the ALJ refuses, then the party may appeal the decision as any other appeal would be
heard. If the ALJ does withdraw, there is no appeal for the other party. 810:2-5- 52.
All hearings will be conducted by an ALJ without a jury. 810:2-5- 53(a).
The powers of the ALJ include to refer the case to mediation, administer oaths, regulate
the course of the hearing, permit discovery pursuant to 2-5- 31, accept written
stipulations, rule on the admissibility of evidence, determine admissibility, materiality,
and weight and credibility of evidence, hold settlement conferences, dispose of
procedural requests, issue orders, and grant additional hearings pursuant to 85A O.S.
Section 72(C), and take other action as allowed by law. 810:2-5- 53(b).
The ALJ may allow or require written argument or legal authority. 810:2-5- 53(d).
The record will be closed by the ALJ once all of the parties have had a right to be heard.
The Claimant must submit to a medical evaluation at the request of the employer. If the
Claimant refuses, then the employer may file a CC-Form- 13 requesting suspension of the
claim. 810:2-5- 45(a).
Mileage is allowed up to 600 miles. The request shall be reduced by 40 miles according
to the Court Rule. $15.00 per meal is allowed for every four hours of travel status. (This
has since been changed to 20 miles in keeping with the statute).
Attorney fee disputes:
1. An attorney is entitled to a fee if any portion of the claim is controverted. 810:2-5-
2. The ALJ will decide a dispute among two or more attorneys. 810:2-5- 47(b).
3. Attorneys may resolve any fee dispute by agreement. 810:2-5- 47(c).
1. The parties to a case may settle any or all issues. An approval of the Commission, an
ALJ, or the counselor is required. 810:2-5- 95(a).
2. A settlement is completed by the filing of a CC-Joint Petition Settlement. 810:2-5-
3. A settlement agreement is not binding unless approved by the Commission. The Joint
Petition Settlement shall be approved unless it is 1.) unfair, unconscionable, or
improper, 2.) there is intentional misrepresentation of a material fact, or 3.) agreement
not supported by competent evidence if it is for permanent partial disability. 810:2-5-
There will be no Joint Petition by Interrogatories unless the Claimant is in the military
service, is outside of the State of Oklahoma, is a nonresident of Oklahoma, or in
“extreme” circumstances. 810:2-5- 95(g).
Settlement does not extinguish the rights of the medical provider to seek payment of
medical services provided. 810:2-5- 95(j).
If a claim is on file, a medical provider must notify the Commission of treatment within
seven days or it waives its right to future notification, unless the provider is actually
known by employer or listed by the Claimant. 810:2-5- 95(k).
If medical treatment is settled, then the Claimant must give the employer all names of
doctors that have treated the Claimant. The employer must then send notice to all
medical providers listed. This is accomplished via the CC-Form- JPS. 810:2-5- 95(l).
Any injury occurring on or after February 1, 2014, must be filed with the Commission.
Single event accident or cumulative trauma claims are filed on a CC-Form- 3. Death
claims are filed on a CC-Form- 3A. Occupational disease cases are filed on the CC-
Form-3B. Claims to initiate a dispute regarding medical fees will be filed on an MFDR-
Form-19. 810:2-5- 2.
Death claims must be filed by the personal representative of the estate if probate has
begun. If no probate has begun, then by the spouse. If there is no spouse, then by the
next of kin. 810:2-5- 4.
All persons who may assert a claim in the death action must be named in the claim filing.
If there are unknown beneficiaries or beneficiaries whose whereabouts are unknown, then
Notice by Publication must be made. 810:2-5- 5(c).
Any party may request a pre-hearing conference on any issue. 810:2-5- 30(a).
Pre-hearing is an informal hearing to resolve the case, present discovery requests, and
identify legal issues. 810:2-5- 30(b).
The ALJ may order a pre-hearing conference at any time. 810:2-5- 30(e).
Sanctions for seeking a conference in an effort to delay, harass, or increase costs may be
made. 810:2-5- 39(f).
Discovery is governed by the Commission Rules. 810:2-5- 31(a).
The ALJ may permit or perform discovery taking into account the needs of the parties
and desirability of making the proceeding fair, expeditious, and cost effective. 810:2-5-
The ALJ may order a party to comply and issue subpoenas for the production of
witnesses and documents. 810:2-5- 31(b).
An ALJ may issue a protective order to prevent the disclosure of privileged information.
The completion of a medical evaluation must be done within 60 days of the date of the
filing of a contested claim. 810:2-5- 31(e).
The employer must respond by the filing of a CC-Form- 10 or a CC-Form- 10M. 810:2-5-
A general denial or failure to timely file is taken as admitting the allegation, except
jurisdictional defenses and the extent of disability. 810:2-5- 15(b).
Affirmative defenses shall be asserted on the CC-Form- 10. 810:2-5- 15(c).
Any party may request a hearing by filing a CC-Form- 9. Must specify any issues of fact
or law in controversy and contentions of a party applying for the hearing. 810:2-5- 16(a).
If a party files for permanent partial disability or permanent total disability, then they
must deliver a medical report to the opposing party with that request. 810:2-5- 16(b).
Objection to the termination of TTD and request for TTD or medical shall be set on a
pre-hearing conference for expedited hearing. The parties must advise as to the number
of witnesses anticipated at that time. 810:2-5- 16(c).
In all cases, the employer must file a CC-Form- 10 no later than 30 days after the filing of
a CC-Form- 9. It may be amended not later than 20 days before the hearing. 810:2-5-
The names of all witnesses and experts must be listed. 810:2-5- 16(f).
The parties must exchange all documentary evidence, exhibits, and complete witness lists
no later than 20 days before the hearing. 810:2-5- 16(g).
An expert medical report must be provided at least seven days prior to the date of the
hearing. If no report is available, then a written report naming the expert and providing
an anticipated substance of the report must be given. 810:2-5- 16(h).
The parties may waive any of the time periods provided for in this Act. 810:2-5- 16(i).
If there is no waiver, the evidence may be excluded. 810:2-5- 16(j).
A Claimant may join a party by filing an amended CC-Form- 3. 810:2-5- 17(a)(1).
The employer may join a party by filing a CC-Form- 13. Must send full notice to all of
the parties. The Commission will either grant or deny the request at its discretion. 810:2-
Sanctions may be provided for the frivolous attempt to join another party. 810:2-5-
At the discretion of the ALJ, the claims may be consolidated to the lowest claim number.
If the two claims filed are the identical action, then they shall be consolidated to the
lowest claim number. 810:2-5- 17(b)(2).
Any request for a consolidation will lead to a pre-hearing conference being filed. 810:2-
Continuances will be granted for good cause shown. 810:2-5- 18(a).
No continuance of an appeal will be granted without approval of the Commission chair
prior to the appeal date. On the date of the appeal hearing, a continuance may be granted
only by a majority vote of the Commission En Banc. 810:2-5- 18(b).
Section 810:2-5- 19 governs the process dealing with Pauper’s Affidavits.
All hearings are open to the public. Hearings may be held in any city of the State of
Oklahoma. Hearings before the ALJ shall be held in Oklahoma City or Tulsa. 810:2-5-
Hearings shall begin at the designated time. 810:2-5- 48(b).
Attorneys will be held to the standards of conduct governed by the Supreme Court. All
parties, witnesses, etc. must maintain the decorum and are subject to sanctions of the
Commission. 810:2-5- 48(c).
An audio recording of all hearings will be made. A copy is provided to any party upon
request at no charge and a transcript of the proceedings made by a Court reporter at the
request and expense of the person ordering it. 810:2-5- 48(d).
Rules of Evidence
The Commission is not bound by the technical or statutory rules of evidence/procedure.
All parties may present evidence and argument. Argument may be restricted to the
presentation in written form. The parties are entitled to cross examine any witnesses who
testify live. The Claimants are entitled to submit rebuttal evidence. The Commission
may exclude any irrelevant, immaterial, or repetitious evidence. 810:2-5- 49(b).
The ALJ may take notice of any law, facts that are judicially cognizable, and generally
recognized facts within the Commission’s specialized knowledge; with the notice to the
parties. 810:2-5- 49(c).
1. A document on file with the Commission requires no authentication. A public record
certified by the record keeper requires no authentication. A copy of the original may
be submitted to the Commission at the time of the hearing.
2. The document may not be added unless allowed by the ALJ or Commission.
3. Additional copies may be required to provide to the other parties.
4. If only a portion of the document is to be submitted, then it is the responsibility of the
offering party to extract and identify the portion of the document to be offered.
5. The Commission may permit a party to offer a document as part of the record within
specific designated time period after conclusion of the hearing. 810:2-5- 49(d).
Witnesses who appear shall be placed under oath either if testifying live or at the
deposition. 810:2-5- 49(e).
An affidavit may be offered in lieu of direct examination. 810:2-5- 49(f).
Expert testimony will be by written report, by deposition, or live at the hearing. Written
medical evidence must be within a reasonable degree of medical certainty and must
contain objective findings. 810:2-5- 49(g).
A vocational rehab specialist may testify by report, by deposition, or live at the hearing.
All exhibits must be identified by the case style and assigned file number before being
submitted. 810:2-5- 49(i).
Ratings for injuries to the body as a whole must be based upon the latest edition of the
AMA Guides. 810:2-5- 46(a).
In cases where a Claimant alleges a change of condition, they must have medical
evidence that is based upon the AMA Guides. 810:2-5- 46(b).
In the event of a hearing loss, the AMA Guides or an alternative method must be used.
Hearing loss may be established by tests that measure air, bone, conduction, thresholds,
and speech discrimination ability. Baseline levels must be confirmed by subsequent
testing given within four weeks of the initial test. 810:2-5- 46(c).
Evaluation of impairment to the eye may be based upon visual acuity for distance and
nearsightedness, visual fields and ocular motility with the absence of diplopia.
Corrective lenses may be considered. 810:2-5- 46(d).
The ALJ must issue written findings of fact and conclusions of law within 30 days from
the date of a hearing. 810:2-5- 54.
In order to appeal a decision to the Workers’ Compensation Commission En Banc, an
appeal must be filed within 10 days. Must file an original and two copies and the
Request for Review shall be in writing, the order must be attached, and it must clearly
and concisely rebut each issue and state the relief sought. Allegations that are not timely
filed are waived. General allegations of error are not sufficient. 810:2-5- 66(a).
Timeliness of an appeal is governed by 810:2-1- 13.
Oral argument on appeals is granted only at the discretion of the Commission. If
argument is allowed, it is limited to 10 minutes unless relief is granted by the
Commission at its discretion. Any party failing to appear when called for oral argument
waives their right to argue the case and the matter is submitted without their argument.
In all appeals, the parties must submit written arguments, including a Statement of the
Facts and Legal Authority for the position. It shall be no more than five pages in length,
double spaced, in at least 10 point font. No appendix is necessary. Appellant must file
the brief within 20 days after filing. The opposing party then then has 10 days to
respond. 810:2-5- 66(d).
The Commission may modify, reverse and issue a new order, reverse and remand, or
affirm the decision. The Commission may reverse only if the order is against the clear
weight of the evidence or contrary to law. An order reversing the decision of an ALJ
must contain specific findings of fact. A Court reporter is provided only if requested by a
party. The ALJ retains jurisdiction over all other matters unrelated to the appeal. 810:2-
An appeal to the Supreme Court shall be filed within 20 days from the date of the order.
Appeals from the Court of Existing Claims go to the Commission, not the Court En Banc.
They are only reviewed for procedural deficiencies and then sent to the Supreme Court.
810:2-5- 67. (There is great question as to whether this is allowed by law and the issue
has already been appealed to the Supreme Court).
A final judgment of the Commission that has not been complied with may be enforced
pursuant to 85A O.S. Section 79.
A claim may be dismissed for untimely prosecution if there is no bona fide request within
six months of the filing of a claim. 810:2-5- 85(b)(1).
A claim for additional compensation may be dismissed without prejudice within the
limits allowed by 85A O.S. Section 69(B) if no bona fide request for hearing has been
made within six months after the filing of the claim. 810:2-5- 85(b)(2).
A Claimant may voluntarily dismiss his or her claim with or without prejudice subject to
the ability to refile as allowed by 85A O.S. Section 108.
A cause filed for contempt for disobedience to or violation of a law, rule, order, or
judgment shall be commenced by the filing of a complaint. 810:2-5- 75(a).
The complaint shall state 1.) the name of the person/company against whom the
complaint is made, 2.) each law, rule, or order of which violation is charged, and 3.) in
general terms, the acts or omissions constituting the violation. 810:2-5- 75(b).
When the complaint is made, the Commission shall prepare a citation which shall state
1.) name of the complainant and the date the complaint was filed, 2.) a brief description
of the nature of the complaint, 3.) shall give reference to a company and copy of the
complaint, and 4.) a date upon which the complaint is set for hearing. At least 10 days’
notice must be given. 810:2-5- 75(c).
If a party fails to respond to the complaint on or before the date set for the hearing or if a
party fails to appear at the time of the hearing, then the Commission will immediately
proceed to hear the complaint. The Commission may impose a fine if warranted by the
evidence. 810:2-5- 75(f).
At the hearing, the Commission shall first hear all objections and defenses other than to
the merits of the complaint and shall enter an appropriate order. Amendments may be
allowed upon terms that are “just.” After all preliminary issues are resolved, the
Commission shall hear the merits of the complaint and shall impose a fine or dismiss the
complaint. 810:2-5- 75(h).
All claims or any issue may be mediated by agreement of the parties or by order of the
ALJ. 810:2-3- 4.
Mediation conferences may be used by agreement of the parties or by order of the ALJ
with the agreement of the parties. 810:2-3- 5(c).
Mediation conferences are voluntary, informal, nonbinding, and strictly confidential.
Attendance is required. An employer representative must have full settlement authority
in order to appear. Failure to appear may result in sanctions. 810:2-3- 5(d).
A mediation conference may be held in the county of the injury or another place by
agreement of the parties. 810:2-3- 5(e).
A mediation conference may be concluded at any time. At the conclusion, the mediator
will prepare a report of the mediation that goes in the case file. 810:2-3- 5(f).
Mediation without a Commission order is strictly voluntary. The parties may agree to
mediate by a certified mediator, to a mediation conference, to a Commission mediator, or
to a mediation independent of the Commission. 810:2-3- 7.
The Commission mediation may be obtained by request. The Commission will contact
the other party to see if there is an agreement. Must respond within 15 days or the failure
to respond will be deemed as a refusal to mediate.
If the parties agree, then each party must enter into a consent to mediate. The mediator
will be selected by the parties, or if the parties cannot agree, then a counselor will appoint
the certified mediator. 810:2-3- 7.
The Commission may order mediation under 85A O.S. Section 22(C)(9) and 85A O. S.
Section 110(E) with the assent of the parties. 810:2-3- 8.
The mediator 1.) must be impartial, 2.) may not impose settlement, 3.) may direct
questions to the parties, 4.) may obtain expert advice with the agreement of the parties,
5.) may caucus individually with each party, and 6.) shall send a report to the
Commission. 810:2-3- 9.
The mediation shall not be recorded or transcribed. All notes are collected by the
mediator at the end of the mediation session and held until completion and then
destroyed. 810:2-3- 10(a).
The parties and one representative may attend the mediation. The Claimant must attend
the mediation unless agreed by the parties. Nonparties are not allowed to participate.
No statement made or evidence learned during the mediation is admissible unless it is
otherwise discoverable and learned of through the normal discovery process. 810:2-3-
A mediator cannot be forced to testify. 810:2-3- 10(d).
Mediation may be concluded by any party at any time. 810:2-3- 11.
A mediator may charge a fee not to exceed $100.00 per hour with a total fee not to
exceed $800.00 total even if it requires more than one day of mediation. At least $200.00
may be received prior to the mediation beginning. The mediator is also entitled to
mileage and lodging as allowed by law if the mediation is for an out of town mediation.
Nothing contained in 810:2-3- 12(a) prohibits a flat fee being charged pursuant to the
limits listed above. 810:2-3- 12(b).
1. The Commission shall maintain a counselor program to assist claimants, employers,
and individuals claiming death benefits under the Act. 810:2-3- 3(a).
2. The division counsel shall 1.) meet with and provide information to claimants, 2.)
investigate complaints, 3.) communicate with employers and doctors on behalf of the
Claimant, 4.) conduct seminars for medical providers, insurance adjusters, employee
and employer groups, 5.) develop information and materials for claimants, employers,
and medical providers. 810:2-3- 3(b).
The Claimant will be notified by the Commission of the availability of the counselors.
Counselors are directed to assist unrepresented claimants to protect their rights and to
facilitate the informal dispute resolution and settlement through mediation conferences.
Counselors are authorized to advise Claimants and to approve JP settlements which result
from the preliminary conference. 810:2-3- 5(b).
Employer has an obligation to provide the Claimant with reasonable and necessary
medical treatment and to pay TTD if the Claimant is unable to perform work for more
than three calendar days. 810:2-1- 5(a).
The first installment is due on the 15 th day after the employer has notice of the injury. All
TTD accrued at that time shall be paid to the Claimant and weekly installment payments
shall be made thereafter. If the employer controverts the right to TTD, they must file a
form controverting TTD within 15 days after notice of the injury. An employer may
request an extension. They must send a copy of the controversion to the Claimant. The
Claimant may request a hearing. 810:2-1- 5(b).
Termination of TTD
An employer may terminate TTD at any time if no claim has been filed. If a claim for
compensation has been filed, an order of the Commission must be obtained unless:
1. The Claimant returns to work full time.
2. Employer provides notice to the Claimant and the Claimant is released by all treating
doctors for all body parts, if Claimant misses three consecutive doctor’s
appointments, the Claimant fails to comply with medical orders, or if the Claimant
abandons medical treatment.
3. Incarceration for conviction.
4. The Claimant files a permanent partial disability rating.
5. The parties agree in writing.
6. The Claimant dies.
7. The soft tissue limitations pursuant to 85A O.S. Section 62. 810:2-1- 6(a).
In all other cases, an order of the Commission is necessary. A request for hearing on the
motion to terminate shall be filed by filing the CC-Form- 13. 810:2-1- 6(b).
If TTD is terminated improperly, then TTD must be reinstated before a hearing to
terminate TTD will be conducted. 810:2-1- 6(c).
The Claimant must object within 10 days of the filing of the Form 13. If objection is
made, then an expedited hearing will be granted.
A doctor may prescribe over-the- counter medications. The doctor must put the strength
and quantity needed and the doctor shall prescribe over-the- counter medication instead of
prescription medication when clinically appropriate. 810:3-5- 1(b).
A doctor shall prescribe generics when available and clinically appropriate. 810:3-5- 1(c).
Doctors must use medications from the formulary adopted by the Commission. 810:3-5-
Employer may request a statement of medical necessity from a doctor. 810:3-5- 1(e).
If the employer denies a prescription as not reasonable and necessary, then a copy of the
EOB must be sent to the Claimant and to the doctor. 810:3-5- 1(f).
Billing and reimbursement are governed by the fee schedule and 85A O.S. Section 50.
Closed formulary is defined as all available FDA approved prescription and
nonprescription drugs prescribed and dispensed for outpatient use excluding:
1. Drugs identified with status “N” in the current edition of the ODGs;
2. Any compound drug;
3. Any investigational/experimental drug that is not yet broadly accepted;
4. Drugs not preferred, which exceed, or are not addressed by the ODGs. 810:3-1- 2.
The closed formulary shall apply to all injuries on or after February 1, 2014. 810:3-5-
Preauthorization is required for all excluded drugs. 810:3-5- 3(b).
Preauthorization must include the drug regimen plan of care and the anticipated dosage.
If there is no response to the request for preauthorization within 72 hours, then it is
deemed approved. 810:3-5- 3(c).
810:3-5-3(d) governs preauthorization for intrathecal drugs.
The prescribing of drugs shall be in accordance with the treatment guidelines established
in 810:3-7- 1.
Prescription and nonprescription drugs included in the closed formulary may be
prescribed without preauthorization. 810:3-5- 3(e).
Medical treatment shall be provided using the ODGs as the primary standard of reference
for determining frequency and extent of services. 810:3-7- 1(a).
Treatment provided by a CWMP shall be in accordance with the plans treatment
guidelines. The plans treatment guidelines shall be consistent with the ODG. 810:3-7-
The OTGs adopted in 2012 do not apply for injuries after February 1, 2014. They are
superseded by PAC guidelines adopted pursuant to 85A O.S. Section 17(B). The PAC
guidelines will be adopted for treatment not addressed by the ODGs and for prescriptions
in schedule two not addressed by the ODGs. 810:3-7- 1(c).
Independent medical examiners must disclose any financial interest in health care
facilities. 810:3-9- 2(c).
The IME selected shall be certified by a recognized specialty board in the area/areas
appropriate to treatment of the condition under review. 810:3-9- 4(a).
An IME may be appointed on any issue. This includes a need for additional treatment if
the Claimant has been released on all body parts. If surgery is requested, the employer
may request an IME. The IME must be qualified to perform surgery on the
recommended part of the body. 810:3-9- 4(c).
An IME opinion is binding unless clear and convincing evidence exists to the contrary.
Diagnostic tests may not be repeated any sooner than once every six months. 810:3-9-
The IME may charge up to $300.00 per hour for the review of medical records,
performance of any examinations, and the preparation of a written report. The maximum
allowable reimbursement is $1,600.00 per case. 810:3-9- 5(a)(2).
IMEs may charge $400.00 per hour for depositions. If cancelled within three business
days, then the doctor may charge a $400.00 cancellation fee. 810:3-9- 5(a)(3).
The payment of an IME is due upon submission of the report. 810:3-9- 5(a)(4).
A $200.00 no-show fee to be paid by the employer if the Claimant fails to appear. The
Claimant will reimburse the employer unless the Claimant has good cause for not
appearing for the evaluation. 810:3-9- 5(a)(5).
Failure to timely pay an IME may result in a fine for contempt. 810:3-9- 5(b).
The Commission may grant case management on the request of a party or when it deems
case management necessary. 810:3-11- 4(a).
If parties cannot agree on a case manager, then the case manager will be selected by the
Commission. 810:3-11- 4(b).
A case manager may not have a financial interest in the Claimant’s award or in the
employer’s business or may not regularly serve as a case manager for the employer.
Case managers will be selected at a pre-hearing conference. 810:3-11- 4(d).
The parties must send all relevant information and medical records within 10 days.
If the records are unattainable, then a letter must be sent to the case manager stating such.
Payment must be made for all reasonable and customary charges of the case manager.
Employer is subject to sanctions if not paid in a timely fashion. 810:3-11- 4(h).
Change of Treating Physician
The Claimant may seek one change of physician. If the Claimant requests it, the
Commission must grant it. The employer will then provide a list of three options and the
Claimant must select from those three options. The doctors must be qualified to treat the
injured body part. 810:3-13- 2.
Medical Fee Dispute Resolution
Payment for medical expenses incurred are due within 45 days of receipt of the bill by the
employer. Late payment (absent good cause) may subject the employer to a penalty of up
to 25% of the amount due that remains unpaid. Further, a $5,000.00 penalty per
occurrence may be awarded by the Commission if the Commission finds a pattern of the
employer willfully and knowingly delaying payments for medical treatment. 810:3-15-
Medical care provided pursuant to the ODGs is presumed reasonable and necessary.
Denial of medical treatment provided pursuant to the ODGs must be supported by clear
and convincing medical evidence. A medical provider whose services exceed the ODGs
must support their deviation from the ODG by clear and convincing medical evidence
made in writing. 810:3-15- 2(b).
A provider may initiate a claim for a medical fee dispute resolution by filing a form
MFDR-Form- 19. It must be filed within one year from the date that services were
rendered. That time period cannot be waived or tolled. 810:3-15- 3(b)(1).
Once the claim has been filed, the medical provider may request a hearing pursuant to
810:2-5- 16. 810:3-15- 3(b)(2).
MFDR-Form- 19 must contain relevant information to the claim plus a statement as to the
status of the claim and a position statement of the disputed issues. 810:3-15- 3(b)(3).
The provider must send the employer:
1. A paper copy of all medical bills related to the dispute.
2. A paper copy of all EOB’s.
3. A copy of all applicable medical records.
4. Any other document the medical provider deems appropriate. 810:3-15- 3(b)(4).
An employer’s response must be made by filing an MFDR-Form- 10M within 30 days of
the Form 9 being filed the provider. The response must provide any missing information.
It must also provide a position statement of disputed issues including
1. Employer’s reasoning for why the fees are disputed and should not be paid.
2. How the law, rules, or fee schedule impacts the disputed fees, including reference to
the specific general instruction, ground rule, or other provision of the fee schedule.
3. Discussion of how the documents support the employer’s position. 810:3-15- 3(b)(5).
Additional information sent to the provider and not the Court. That includes:
1. A paper copy of all initial and appeal EOB’s sent to the provider or a statement that
the employer did not receive the bills.
2. A paper copy of all medical bills if different from that originally submitted to the
insurance company for reimbursement.
3. A copy of pertinent medical records not provided by the provider. 810:3-15- 3(b)(5).
Highlights of bills may be submitted by each party. The fee schedule sets the maximum
allowable fee and does not prohibit a party arguing for a lesser amount to be owed.
The Commission may refer disputes involving conflicting interpretations of the
Oklahoma Fee Schedule to the Health Services Division. A dispute involving denial of
compensability of the claim, length of treatment, necessity of treatment, an authorized
physician, or other grounds, shall not be referred. 810:3-15- 3(b)(6)(B).
The matter will be initially set on an administrative docket to determine the payment
status. If the matter cannot be resolved, then it will be assigned to the ALJ’s hearing
docket. 810:3-15- 3(b)(7).
Appearances are governed by Section 810:2-1- 9. 810:3-15- 3(b)(8).
Disputes not covered by these rules, including medical necessity/appropriateness, the
Claimant’s request for a reimbursement or refund, and the employer’s request for a
determination of reasonableness of charges, will be addressed by filing a request for
hearing as provided in 810:2-5- 16, by mediation, or by agreement of the parties. 810:3-
If vocational services are not offered by the employer, the Commission may refer the
Claimant to a vocational evaluator. 810:4-1- 3(a).
If the parties dispute the report or cannot agree on a plan, the matter may be resolved
through mediation or shall proceed to a contested case hearing. The ALJ may order
services recommended or other services deemed appropriate. 810:4-1- 3(b).