justicedao/ipfs_state_laws huggingface dataset:
436-045-0025 Dispositions (1) In order for a disposition of a claim by the parties to be considered for reimbursement eligibility under the Reopened Claims Program, it must be submitted to the director during the period of time in which the claim remains open under the Board’s Own Motion or voluntary claim reopening. (2) Dispositions submitted in accordance with (1) are not eligible to receive reimbursement from the Reopened Claims Program unless made with the prior written approval of the director. (3) Requests for written approval of proposed dispositions shall include: (a) A copy of the proposed disposition which specifies the amount of the proposed contribution to be made from the Reopened Claims Program; (b) A statement from the insurer indicating how the amount of the contribution was calculated; (c) Any other information as required by the director. (4) The director will not approve the disposition for reimbursement if the proposed contribution from the Program exceeds a reasonable projection of that claim’s future liability to the Program under that Board’s Own Motion reopening or voluntary claim reopening. Statutory/Other Authority: ORS 656.236, 656.289 & 656.625 Statutes/Other Implemented: ORS 656.236, 656.289 & 656.625 History: WCD 12-2001, f. 12-7-01, cert. ef. 1-1-02 WCD 13-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 9-1991, f. 12-13-91, cert. ef. 1-1-92 WCD 27-1990, f. 11-30-90, cert. ef. 12-26-90 WCD 7-1990(Temp), f. 6-18-90, cert. ef. 7-1-90
436-045-0030 Reimbursement (1) Reimbursement shall be made by Compliance quarterly after receipt and approval of documentation of compensation paid by the paying agent. (2) The director, by bulletin, shall prescribe the form and format for requesting reimbursement from the Program. Documentation to support the reimbursement request shall include but not be limited to: (a) Net temporary disability compensation paid, net permanent disability paid, and net medical compensation paid for dates of injury prior to January 1, 1966. For purposes of this section, “net” compensation paid means the total compensation paid less any recoveries, including but not limited to, third party recovery, Retroactive Program reimbursement, and Workers with Disabilities Program reimbursement. (b) Payment certification statement. (c) Any other information deemed necessary by the director. (3) Periodically Compliance shall audit the physical file of the paying agent to validate the amount reimbursed and to verify that the closing report is correct. Reimbursement shall not be approved if, upon such audit, it is found: (a) Payments were not authorized in the Board’s Own Motion order or voluntary claim reopening; or (b) Payments of temporary disability compensation were made for periods of time during which the worker did not qualify as a “worker” pursuant to ORS 656.005(28); or (c) Compensation has been paid as a result of untimely, inaccurate, or improper claims processing; or (d) The separate payments of compensation have not been documented, as required under generally accepted accounting procedures; or (e) Medical payments for claims with injury dates prior to January 1, 1966 are in excess of what should have been paid if paid in accordance with OAR 436-009-0030 and properly audited as required by OAR 436-009-0020; or (f) Permanent disability payments were made in claims reopened for other than a new medical or omitted condition. Statutory/Other Authority: ORS 656.625 Statutes/Other Implemented: ORS 656.625 History: WCD 11-2022, minor correction filed 11/29/2022, effective 11/29/2022 WCD 10-2007, f. 11-1-07, cert. ef. 1-1-08 WCD 12-2001, f. 12-7-01, cert. ef. 1-1-02 WCD 13-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 27-1990, f. 11-30-90, cert. ef. 12-26-90 WCD 8-1987, f. 12-18-87, ef. 1-1-88
436-050-0003 Purpose and Applicability (1) Purpose. These rules carry out the workers’ compensation law related to employers’ and insurers’ responsibilities to cover subject workers for compensable injuries and illnesses. (2) Applicability. (a) These rules apply to employers, self-insured employers, and insurers. (b) The requirements of OAR 436-050-0165, 436-050-0170, 436-050-0175, 436-050-0180, 436-050-0190, 436-050-0200, 436-050-0205, 436-050-0210 and 436-050-0220 apply to both self-insured employers and self-insured employer groups. References in those rules to “employer” include employer groups, and references to “self-insured employer” include self-insured employer groups. (c) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS chapter 656 History: WCD 7-2022, amend filed 11/07/2022, effective 01/01/2023 WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 7-2018, amend filed 06/07/2018, effective 07/01/2018 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 10-2015, f. 12-24-15, cert. ef. 1-1-16 WCD 13-2014, f. 11-26-14, cert. ef. 1-1-15 WCD 10-2014, f. 8-15-14, cert. ef. 9-15-14 WCD 8-2013, f. 11-12-13, cert. ef. 1-1-14 WCD 5-2013, f. 7-3-13, cert. ef. 7-22-13 WCD 1-2013(Temp), f. & cert. ef. 1-23-13 thru 7-21-13 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 4-2008, f. 9-17-08, cert. ef. 7-1-09 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2007, f. 11-1-07, cert. ef. 11-28-07 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 5-2005, f. 5-26-05, cert. ef. 6-1-05 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 10-2003, f. 8-29-03, cert. ef. 9-15-03 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 1-1998, f. 1-9-98, cert. ef. 1-23-98 WCD 9-1996, f. 3-11-96, cert. ef. 4-1-96 WCD 2-1994, f. 4-1-94, cert. ef. 5-1-94 WCD 3-1992, f. 1-10-92, cert. ef. 2-1-92 WCD 25-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 9-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 9-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 7-1983, f. 12-22-83, cert. ef. 12-27-83; Renumbered from 436-051-0003 WCD 10-1982, f. 9-30-82, cert. ef. 10-1-82 WCD 4-1982, f. 2-10-82, cert. ef. 2-15-82 WCD 3-1980, f. & cert. ef. 4-2-80
436-050-0025 Service of the Notice of Civil Penalty Orders When the director issues a civil penalty order, it will be served by certified mail, return receipt requested, or in any other manner provided by Oregon Rules of Civil Procedure (7)(D) available at: https://www.oregonlegislature.gov/bills_laws/Pages/orcp.aspx. Proof of service may include a hard copy signed receipt or electronic verification. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704, 656.726 & 656.740 History: WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08
436-050-0040 Responsibility for Providing Coverage When a Contract is Awarded (1) If a person, including a person that is a sole proprietorship, that is responsible to provide coverage for an individual performing labor under ORS 656.029, fails to comply with ORS 656.017, that person is considered a noncomplying employer. As used in this section, “sole proprietorship” means a business entity or individual who performs labor without the assistance of others. (2) As used in ORS 656.029, "the performance of labor where such labor is a normal and customary part or process of the person’s trade or business" includes the day-to-day activities or operations which are necessary to successfully carry out the business or trade. (3) A person contracting to pay remuneration for professional real estate activity as defined in ORS chapter 696, to a qualified real estate broker as defined in ORS 316.209, is not an employer of the qualified real estate broker, and is not required to provide coverage under ORS 656.017. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.029 & ORS 656.037 History: WCD 18-2021, amend filed 12/13/2021, effective 01/01/2022 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 9-1996, f. 3-11-96, cert. ef. 4-1-96 WCD 25-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 9-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 9-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86, Renumbered from 436-051-0052 WCD 7-1983, f. 12-22-83, cert. ef. 12-27-83 WCD 4-1982, f. 2-10-82, cert. ef. 2-15-82 WCD 3-1980, f. & cert. ef. 4-2-80
436-050-0045 Nonsubject Workers For the purposes of clarifying terms used in ORS 656.027: (1) “Casual” refers only to employments where the work in any 30-day period, without regard to the number of workers employed, involves a total labor cost lower than the dollar amount published in Bulletin 387. (2) “ Home health worker ” does not include a worker employed by a home health agency, as defined in ORS 443.014, or in-home care agency, as defined in OAR 333-536-0005 . (3) “ Person performing foster parent or adult foster care duties ” means: (a) A person performing foster parent duties, including, but not limited to: (A) Any person certified as a foster parent by the Oregon Department of Human Services under ORS chapter 418; or (B) Any person employed by a certified foster parent in the operation of a foster home as defined in ORS chapter 418; or (b) A person performing adult foster care duties, including, but not limited to: (A) Any person operating an adult foster home licensed under ORS 443.705 to 443.825; or (B) Any person employed by the operator to perform services that assist the residents of the adult foster home. (c) “ Adult foster home, ” as used in subsection (b), means any family home or facility, licensed under ORS 443.705 to 443.825, in which room, board, and 24-hour care services are provided, for compensation, to five or fewer adults who are not related to the operator by blood or marriage. (4) “ Private employment contract ” means a contract under which a worker is directly employed by the owner of the private home. As used in this section, “owner of the private home” means: (a) Any person who occupies and owns, leases, or rents the private home; (b) Any person related by blood, marriage, or Oregon registered domestic partnership to a person described under subsection (a); or (c) Any person who, by direction of a person described under subsection (a), or by order of a court, has become responsible for managing the household affairs of that person. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.027 History: WCD 18-2021, amend filed 12/13/2021, effective 01/01/2022 WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 20-2018, amend filed 11/15/2018, effective 01/01/2019 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 1-1998, f. 1-9-98, cert. ef. 1-23-98 WCD 3-1992, f. 1-10-92, cert. ef. 2-1-92 WCD 7-1991(Temp), f. 10-4-91, cert. ef. 10-7-91
436-050-0055 Extraterritorial Coverage (1) For the purposes of determining whether a worker is temporarily in or out of state under ORS 656.126, the director will use criteria including, but not limited to, the following: (a) The extent to which the worker’s work within the state is of a temporary duration; (b) The intent of the employer regarding the worker’s employment status; (c) The understanding of the worker regarding the employment status with the employer; (d) The permanent location of the employer and its permanent facilities; (e) The circumstances and directives surrounding the worker’s work assignment; (f) The state laws and regulations to which the employer is otherwise subject; (g) The residence of the worker; (h) The extent to which the employer’s work in the state is of a temporary duration, established by a beginning date and expected ending date of the employer’s work; and (i) Other information relevant to the determination. (2) Within 30 days after coverage of an Oregon employer is effective, the insurer providing the coverage must notify the employer in writing of the provisions of ORS 656.126 and this rule. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.126 History: WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 12-2001, f. 12-7-01, cert. ef. 1-1-02 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 1-1998, f. 1-9-98, cert. ef. 1-23-98 WCD 9-1996, f. 3-11-96, cert. ef. 4-1-96 WCD 25-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90
436-050-0195 Requirements for Changes in Self-Insured Employer Entity (1) Notification of deletion of entity or changes in entity, contact information, or ownership. If there is any change in the entity, changes in addresses, telephone numbers, and points of contact, or ownership of a self-insured employer, or if the self-insured employer wishes to delete an entity from the employer’s certification, the employer must notify the director in writing within 30 days after the change occurs. (2) Adding entities. If a self-insured employer wishes to add entities to the employer’s certification: (a) The self-insured employer must submit a completed Form 1865, “Endorsement to Include Legal Entity in Self-Insured Certification,” signed by an officer of the employer; (b) Each entity must enter into an agreement, signed by an officer of the entity, making the entity jointly and severally liable for the payment of any compensation and moneys due to the director by the self-insured employer or any other entity included in the employer’s certification; and (c) The director will determine, based on the information provided, the effect of the change on the deposit required and whether the entities can be combined for experience rating purposes. Statutory/Other Authority: ORS 656.407, ORS 656.430 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.407 & ORS 656.430 History: WCD 7-2022, amend filed 11/07/2022, effective 01/01/2023 WCD 7-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90
436-050-0205 Notice of Self-Insurer’s Personal Elections When a self-insured employer elects to provide coverage for a nonsubject worker under ORS 656.039, the employer must notify the director in writing of the election and of any cancellation of the election within 30 days of the effective date. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.039 History: WCD 7-2022, amend filed 11/07/2022, effective 01/01/2023 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90
436-050-0300 Self-Insured Employer Group, Common Claims Fund (1) Except for qualified self-insured employer groups approved by the director as exempt from security deposit requirements under OAR 436-050-0185, a self-insured employer group must establish and maintain, under the direction and control of the board of trustees and administrator, a common claims fund for the sole purpose of ensuring the availability of funds to make certain the prompt payment of all compensation and all other payments that may become due from such self-insured employer group under the workers’ compensation law. This requirement does not apply in any year in which the director applies an incurred but not reported (IBNR) factor of greater than zero percent in the determination of the self-insured employer group’s security deposit under OAR 436-050-0180. (2) The common claims fund must be maintained in an account held by an Oregon state chartered or a federally chartered bank. Government subdivisions certified as a self-insured employer group may also maintain the common claims fund in a "Local Government Investment Pool" account held by the Office of the State Treasurer. (3) Except as provided in section (6) of this rule, the balance of the common claims fund must be maintained in an amount at least equal to 30 percent of the average of the group’s paid losses for the previous four years. The full sum of the required common claims fund balance must be maintained at all times. (4) The director may require the self-insured group to increase the amount maintained in the common claims fund. (5) By March 1 of each year, a self-insured employer group must provide the director with adequate documentation to validate the balance in the common claims fund or notice that the amount calculated under section (3) or (6) of this rule must be included in the determination of the self-insured employer group’s security deposit under OAR 436-050-0180. The director may require a self-insured employer group to provide documentation of the common claims fund balance more frequently. (6) For governmental subdivisions certified as a self-insured employer group, the balance of the common claims fund must be maintained in an amount at least equal to 60 percent of the average of the group’s yearly paid losses for the previous four years. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.430 History: WCD 18-2021, amend filed 12/13/2021, effective 01/01/2022 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 10-2014, f. 8-15-14, cert. ef. 9-15-14 WCD 5-2013, f. 7-3-13, cert. ef. 7-22-13 WCD 1-2013(Temp), f. & cert. ef. 1-23-13 thru 7-21-13 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 9-1987, f. 12-18-87, ef. 1-1-88 WCD 9-1985, f. 12-12-85, ef. 1-1-86 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86, Renumbered from 436-051-0420 WCD 7-1983, f. 12-22-83, cert. ef. 12-27-83 WCD 4-1982, f. 2-10-82, cert. ef. 2-15-82
436-050-0340 Group Self-Insurance Revocation (1) The director may revoke the certification of a self-insured employer group after giving 10 days written notice if: (a) The employer group does not comply with ORS 656.430(7) or (8), OAR 436-050-0170 to 436-050-0190, 436-050-0260, or 436-050-0290; (b) There are fewer than five employers within a group; (c) The net worth of the group falls below that required by OAR 436-050-0260(3); (d) The employer group defaults in payment of compensation or other payments due the director; (e) The employer group commits any violation for which a civil penalty could be assessed under ORS 656.745; or (f) The employer group or any member of the group submits any false or misleading information. (2) Notice of revocation will be given as provided in ORS 656.440, except that the director may revoke the certification of a self-insured employer group after giving 30 days written notice as provided in ORS 656.430(9). Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.430, ORS 656.434 & ORS 656.440 History: WCD 7-2022, amend filed 11/07/2022, effective 01/01/2023 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 10-2014, f. 8-15-14, cert. ef. 9-15-14 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 9-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 9-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86, Renumbered from 436-051-0440 WCD 7-1983, f. 12-22-83, cert. ef. 12-27-83 WCD 4-1982, f. 2-10-82, cert. ef. 2-15-82
436-050-0500 Assessment of Civil Penalties The director may assess a civil penalty under ORS 656.745(2) against an employer or insurer that violates ORS chapter 656, OAR 436-050, or an order of the director. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.745(2) History: WCD 18-2021, adopt filed 12/13/2021, effective 01/01/2022
436-055-0003 Applicability and Purpose (1) Applicability. These rules apply to the certification of all workers’ compensation claims examiners on or after the effective date of these rules. (2) Purpose. The purpose of these rules is to establish standards for the certification of workers’ compensation claims examiners under ORS chapter 656. (3) Director’s discretion. The director may waive any procedural rule as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.726 & 656.780 Statutes/Other Implemented: ORS 656.780 History: WCD 2-2016, f. 11-8-16, cert. ef. 1-1-17 WCD 15-1999, f. 12-21-99, cert. ef. 1-1-00 WCD 5-1994, f. 7-14-94, cert. ef. 9-1-94 WCD 28-1990, f. 11-30-90, cert. ef. 1-1-91
436-055-0005 Definitions Except where the context requires otherwise, the definitions under ORS 656.005 and the following apply to OAR 436-055-0008 to 436-055-0110: (1) “Claims examiner” means anyone who has primary responsibility for decision making or benefit determination in a claim. (2) “Director” means the director of the Department of Consumer and Business Services or the director’s designee. (3) “Hearings Division” means the Hearings Division of the Workers’ Compensation Board. (4) “Insurer” means the State Accident Insurance Fund Corporation; an insurer authorized under ORS chapter 731 to transact workers’ compensation insurance in this state ; an assigned claims agent selected by the director under ORS 656.054; an employer certified under ORS 656.430 that meets the qualifications of a self-insured employer under ORS 656.407; or a service company that processes claims for an insurer or self-insured employer under the conditions prescribed in ORS 731.475(3) and ORS 656.455(1). (5) “Party” means a claimant for compensation, the employer of the worker at the time of injury, the insurer of the employer, or the insurer’s service company, if any. (6) “Process claims” means the determination of compensability and management of workers’ compensation claims. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.780 History: WCD 2-2016, f. 11-8-16, cert. ef. 1-1-17 WCD 15-1999, f. 12-21-99, cert. ef. 1-1-00 WCD 5-1994, f. 7-14-94, cert. ef. 9-1-94 WCD 28-1990, f. 11-30-90, cert. ef. 1-1-91
436-055-0008 Administrative Review and Contested Cases (1) Requests for hearings on sanctions and civil penalties. Any party that disagrees with a proposed order, or proposed assessment of civil penalty issued by the director under these rules, may request a hearing by the Hearings Division under ORS 656.740. To request a hearing, the party must: (a) Mail or deliver a written request to the Workers' Compensation Division within 60 days of the mailing date of the proposed order or assessment; and (b) Specify, in the request, the reasons why the party disagrees with the proposed order or assessment. (2) Requests for administrative review. Any party that disagrees with an action taken under these rules may request an administrative review of the action by the director. To request administrative review, the party must: (a) Mail or deliver a written request for review to the Workers' Compensation Division within 90 days of the action; and (b) Specify, in the request, the reasons why the party disagrees with the action. (3) Requests for hearing on any other action or order of the director. Any party that disagrees with an action or order of the director, except as described in section (1) of this rule, may request a hearing by filing a hearing request as provided in OAR 436-001-0019 within 60 days of the mailing date of the order or notice of action. OAR 436-001 applies to the hearing. Statutory/Other Authority: ORS 656.704; 656.726; 656.745 Statutes/Other Implemented: ORS 656.704 & 656.740 History: WCD 2-2016, f. 11-8-16, cert. ef. 1-1-17 WCD 5-2006, f. 6-15-06, cert. ef. 7-1-06 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 15-1999, f. 12-21-99, cert. ef. 1-1-00 WCD 28-1990, f. 11-30-90, cert. ef. 1-1-91