justicedao/ipfs_state_laws huggingface dataset:
436-160-0430 Medical Bill Data Changes (1) Changes to medical bill information must be submitted according to the standards referenced in OAR 436-160-0004. (2) The Unique Bill ID will be used to match cancellations, corrections, and replacements to the original bill. Failure to match on this data element will result in a rejected transaction. (3) The insurer must correct and resubmit any transactions rejected for which law or rule requires filing, reporting, or notice to the director. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.264 History: Reverted to WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 Temporary suspended by WCD 7-2014(Temp), f. 7-10-14, cert. ef. 10-1-14 thru 12-27-14 WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 WCD 5-2014(Temp), f. 6-5-14, cert. ef. 7-1-14 thru 12-27-14 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 10-2007, f. 11-1-07, cert. ef. 1-1-08
436-160-0440 Monitoring and Auditing Insurers (1) The director may monitor and conduct periodic audits of medical bill data to ensure compliance with ORS chapter 656 and these rules. (2) All records maintained or required to be maintained must be disclosed upon request by the director. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.252, 656.254, 656.264, 656.455 & 656.726 History: Reverted to WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 Temporary suspended by WCD 7-2014(Temp), f. 7-10-14, cert. ef. 10-1-14 thru 12-27-14 WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 WCD 5-2014(Temp), f. 6-5-14, cert. ef. 7-1-14 thru 12-27-14 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-160-0445 Assessment of Civil Penalties (1) Under ORS 656.745, the director may assess a civil penalty against an insurer that fails to comply with ORS Chapter 656 or the director’s rules and orders. (2) The insurer is responsible for its own actions as well as the actions of others acting on the insurer’s behalf. If an insurer or someone acting on the insurer’s behalf violates any provisions of these rules, the director may impose a civil penalty against the insurer. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.254 & 656.745 History: Reverted to WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 Temporary suspended by WCD 7-2014(Temp), f. 7-10-14, cert. ef. 10-1-14 thru 12-27-14 WCD 6-2013, f. 10-10-13, cert. ef. 7-1-14 WCD 5-2014(Temp), f. 6-5-14, cert. ef. 7-1-14 thru 12-27-14 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0001 Authority, Applicability, Administration, and Purpose of these Rules (1) These rules are promulgated under the director's authority contained in ORS 656.726(4). (2)(a) These rules apply to workers’ compensation proof of coverage transactions filed with the director by electronic data interchange (EDI) on or after April 1, 2015. (b) For coverage effective before July 1, 2009, the insurer must contact the director if the insurer is unable to file proof of coverage by EDI. (3) The director’s purpose is to require workers’ compensation proof of coverage reporting by EDI. (4) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. (5) Orders issued by the division in carrying out the director's authority to enforce ORS chapter 656 are considered orders of the director. Statutory/Other Authority: ORS 84, 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.017, 656.407, 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0004 Adoption of Standards (1) The director adopts, by reference, IAIABC EDI Implementation Guide for Proof of Coverage, Release 2.1, dated July 1, 2010. (2) The form, format, and delivery of data elements reported and definitions will conform to these standards, unless otherwise provided in these rules. (3) A copy of the Release 2.1 guide is available for review during regular business hours at the Workers’ Compensation Division, Operations Section, 350 Winter Street NE, Salem OR 97301, 503-947-7742. IAIABC members may view a copy of the Release 2.1 guide, or non-members may purchase a copy, at the IAIABC website: http://www.iaiabc.org. Statutory/Other Authority: ORS 84, 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.017, 656.407, 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0030 Retention of Electronic Records Insurers and self-insured employers must retain workers' compensation records under OAR 436-050-0120 and OAR 436-050-0220. Records may be retained in electronic format if the records can be reproduced. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.455 & 731.475 History: WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0035 General Filing Information (1) Senders must follow United States Postal Service guidelines for reporting all addresses. (2) Transactions will be rejected if Mandatory or Mandatory/Conditional data elements are omitted or submitted in a form or format the division is unable to process. (3) Not Applicable data element(s) in a transaction will be ignored if the data element is either omitted or submitted in a form or format the division is unable to process. (4) Worker leasing company (also known in other jurisdictions as professional employer organization) policies will be accepted by EDI, subject to the same data and transaction editing standards as other policies. A policy filing for a worker leasing company does not eliminate the worker leasing company’s requirement to file worker leasing notices under OAR 436-180-0110. (5) Wrap-up policies will be accepted by EDI, subject to the same data and transaction editing standards as other policies. Wrap-up projects and any change of insurer mid-project must be approved by the Oregon Division of Financial Regulation. Statutory/Other Authority: ORS 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.419, 656.423 & 656.427 History: WCD 3-2025, minor correction filed 10/23/2025, effective 10/23/2025 WCD 13-2018, minor correction filed 08/09/2018, effective 08/09/2018 WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15
436-162-0038 Acknowledgement (1) The division will respond to submitted transmissions by providing either a Transaction Accepted (TA) or a Transaction Rejected (TR) acknowledgement. (2) Transaction rejected acknowledgements will be generated for transactions with errors, including but not limited to: (a) An omitted Mandatory data element; (b) An improperly populated data element field, e.g., numeric data element field is populated with alpha or alphanumeric data, or is not a valid value; (c) Transactions or electronic records within the transaction that require matching and cannot be matched to the division's database; (d) Illogical data in a Mandatory or Mandatory/Conditional field, e.g., policy expiration date is before policy effective date; (e) Duplicate transmission or duplicate transaction within the transmission; (f) Invalid triplicate code; or (g) Illogical event sequence relationship between transactions, e.g., endorsement transaction submitted before a policy transaction is submitted. (3) The insurer must correct and resubmit any transactions rejected for which a law or rule requires reporting to the director. (4) Transactions that are not rejected under section (2) of this rule will result in a Transaction Accepted acknowledgement. (5) An insurer’s obligation to file proof of coverage for the purposes of this rule is not satisfied unless the director acknowledges acceptance of the transaction. Statutory/Other Authority: ORS 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS, 656.419, 656.423 & 656.427 History: Renumbered from 436-162-0320, WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 Renumbered from 436-160-0320, WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11 WCD 4-2008, f. 9-17-08, cert. ef. 7-1-09 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 3-2003, f. 3-18-03, cert. ef. 4-1-03
436-162-0040 Recognized Filing Date (1) An electronic record is considered filed on the date it is delivered to the director only if the division issues a Transaction Accepted acknowledgment. (2) Rejected transactions are not considered filed and do not satisfy proof of coverage requirements until they are corrected, resubmitted, and accepted by the division. Statutory/Other Authority: ORS 656.264 & 656.726(4) Statutes/Other Implemented: ORS 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0310 Electronic Filing Requirements (1) Unless otherwise provided in these rules, insurers must transmit proof of coverage by EDI, and either use an approved vendor, or be approved as a sender. (2) Unless otherwise provided in these rules, the data elements have the meaning provided in the data dictionary of the IAIABC EDI Implementation Guide for Proof of Coverage, Release 2.1, dated July 1, 2010, referenced in OAR 436-162-0004(1). (3) Data elements are listed in Appendices A and B: (a) Appendix A shows all proof of coverage data elements accepted by EDI in Oregon, and whether the data element is Exclude (X), Expected (E), Fatal Technical (F), Fatal Technical/Conditional (FT), Mandatory (M), Mandatory/Conditional (MC), Not Applicable (NA), or Restricted (R), for each transaction type. (b) Appendix B lists Mandatory/Conditional data elements and the applicable conditions that make the data element mandatory. (4) Filing due dates are listed in Appendix C, the Event Table. (5) An insurer may file proof of coverage EDI by: (a) Transmitting an electronic record of the proof of coverage data elements identified as Mandatory or Mandatory/Conditional, including a correct FEIN, as defined in OAR 436-162-0005(10), for each legally distinct employer included in the establishing document transaction; and (b) Transmitting an establishing document transaction, coverage notice/binder, new/renew policy, rewrite/reissue policy, reinstatement, add location, add employer, or add jurisdiction. (6) If an employer elects to include any nonsubject worker(s) for coverage, or subsequently to exclude such workers from coverage, the insurer must submit a transaction with a reason code for including or excluding a corporate officer, partner, member, sole proprietor, or any other nonsubject worker as described in ORS 656.027. (7) Insurers may not: (a) Submit placeholder or invalid FEINs; or (b) Submit paper documents to the director without the director’s express permission. [ED. NOTE: Appendix referenced are available from the agency.] [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 Renumbered from 436-160-0310, WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 4-2008, f. 9-17-08, cert. ef. 7-1-09 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 3-2003, f. 3-18-03, cert. ef. 4-1-03
436-162-0335 Testing Procedures and Transaction Accuracy Standards (1) An insurer that wants to self report proof of coverage must report through an approved vendor until the insurer completes all of the testing requirements in this rule and receives approval from the director to self report. (2) To obtain approval, each sender must successfully complete the Secure File Transfer Protocol (SFTP) test, demonstrate ability to successfully transmit coverage data in the format specified in OAR 436-162-0004(1), achieve ninety percent reporting accuracy, and retrieve and process automated EDI acknowledgements. (3) To begin the testing process for proof of coverage EDI, the sender must: (a) Contact the division’s EDI coordinator. Contact information is on the division’s webpage: http://wcd.oregon.gov/insurer/edi/Pages/proof-of-coverage.aspx; and (b) Complete and submit the proof of coverage EDI transmission profile (Form 440-4979), available from: http://wcd.oregon.gov/insurer/edi/Pages/proof-of-coverage.aspx. (4) A successful EDI test is determined by the following: (a) The resolution of any consistently recurring Fatal Technical errors identified by the division; (b) Transmissions are sent to the division without errors in the header or trailer record; (c) Transmissions are sent to the division without transaction level technical errors; and (d) The sender is able to retrieve and process the automated EDI acknowledgement transactions. (5) To move from testing to production: (a) The sender must submit a minimum of three transmissions containing at least three records for each Oregon valid triplicate code included in Appendix A. (b) Data transmitted during the proof of coverage EDI test must represent actual proof of coverage data, which will be discarded after the test. (c) The division will provide the sender with an acknowledgement file to account for the processing outcome of each transaction, i.e., accepted or rejected. The sender should reconcile or correct identified data errors in their source data system as necessary. (d) Ninety percent of transactions submitted during the testing phase must be accepted by the division. Additional proof of coverage EDI test transmission(s) may be required until a ninety percent accuracy rate is achieved. (6) The director will notify senders once they have successfully completed testing. (7) Once approved, the sender must maintain the accuracy as defined in sections (4) and (5)(d) of this rule. Failure to meet technical requirements may result in the revocation of EDI transmission approval. (8) The division will inform the sender and insurer (if different) if accuracy standards for technical requirements fall below standards prescribed in sections (2) and (5)(d) of this rule. Statutory/Other Authority: ORS 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.264, 656.419, 656.423 & 656.427 History: Renumbered from 436-162-0060, WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11
436-162-0340 Changes or Corrections (1) Changes or corrections to proof of coverage information must be submitted under the standards referenced in OAR 436-162-0004(1). (2) To report changes or corrections of an insured employer's name or address, or other data elements, the insurer must transmit the appropriate transaction to specify what data is being changed or corrected. (3) The insurer's policy number is used to assist in matching each transaction to the appropriate employer. When an insurer changes a policy number, the insurer must report that change prior to the next transaction submitted for that policy. Failure to report a change in the policy number will prevent future filings from being processed by the division's information processing system and the insurer will receive a Transaction Rejected acknowledgement. (4) To add or delete coverage for corporate officers, members of a limited liability company, partners, sole proprietors, or other nonsubject workers, the insurer must file the appropriate “include” or “exclude” endorsement transaction to the associated policy filing. Statutory/Other Authority: ORS 656.264, 656.419, 656.423, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656. 419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 Renumbered from 436-160-0340, WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 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 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 3-2003, f. 3-18-03, cert. ef. 4-1-03
436-162-0370 Proof of Coverage Terminations When the insurer cancels coverage before the expiration of the policy term, the insurer must: (1) Provide written notice to the employer under ORS 656.427(1) and (3); (2) Retain a record of the written notice sent to the employer under ORS 656.427, and proof of mailing of that notice, for inspection by the division; and (3) Provide notice to the director under ORS 656.427 by EDI. Statutory/Other Authority: : ORS 656.264, 656.427 & 656.726(4) Statutes/Other Implemented: ORS 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15 Renumbered from 436-160-0370, WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11 WCD 4-2008, f. 9-17-08, cert. ef. 7-1-09
436-162-0380 Cancellation of Coverage by the Employer When the employer cancels coverage before the expiration of the policy term, the insurer must: (1) Retain a record of the written or verbal notice provided by the employer to the insurer under ORS 656.423, including proof of date of receipt of that notice, for inspection by the division; and (2) Provide notice to the director under ORS 656.423 by EDI. Statutory/Other Authority: ORS 656.264, 656.423 & 656.726(4) Statutes/Other Implemented: ORS 656.423 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15
436-162-0400 Monitoring and Auditing Insurers (1) The director may monitor and conduct periodic audits of proof of coverage reporting data to ensure compliance with ORS chapter 656 and these rules. If the director finds violations of the reporting requirements of these rules the director may issue civil penalties under OAR 436-162-0440 and ORS 656.745. (a) Proof of coverage must be reported timely. “Timely” means that an insurer reports data within the time allowed by these rules, including Appendix C, the Event Table. (b) Proof of coverage must be reported accurately. “Accurately” means that the reported coverage data accepted by the division conforms to the reporting requirements of these rules, including Appendices A, B, and C. (2) All records maintained or required to be maintained must be disclosed upon request by the director. Statutory/Other Authority: ORS 656.264, 656.726(4) & 656.745 Statutes/Other Implemented: ORS 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15
436-162-0440 Assessment of Civil Penalties (1) Under ORS 656.745, the director may assess a civil penalty against an insurer that fails to comply with ORS chapter 656 or the director’s rules and orders. (2) The insurer is responsible for its own actions as well as the actions of others acting on the insurer’s behalf. If an insurer or someone acting on the insurer’s behalf violates any provisions of these rules, the director may impose a civil penalty against the insurer. Statutory/Other Authority: ORS 656.264, 656.726(4) & 656.745 Statutes/Other Implemented: ORS 656.419, 656.423 & 656.427 History: WCD 12-2014, f. 11-13-14, cert. ef. 4-1-15
436-170-0002 Purpose of Rule The Landscape Contractors Board, Department of Revenue, Department of Consumer and Business Services, Employment Department, and Construction Contractors Board must adopt rules together to carry out ORS 670.600. 670.600 defines “independent contractor” for purposes of the programs administered by these agencies. This rule is intended to ensure that all five agencies apply and interpret 670.600 in a consistent manner; to clarify the meaning of terms used in 670.600; and, to the extent possible, to enable interested persons to understand how all five agencies will apply 670.600. Statutory/Other Authority: ORS 656.726(4) & 670.605 Statutes/Other Implemented: ORS 316.162 & 670.600 History: WCD 1-2007, f. 1-30-07, cert. ef. 2-1-07
436-170-0100 Statutory Context (1) ORS 670.600 generally establishes three requirements for “independent contractors.” One requirement is that an “independent contractor” must be engaged in an “independently established business.” Another requirement is related to licenses and certificates that are required for an “independent contractor” to provide services. A third requirement is that an “independent contractor” must be “free from direction and control over the means and manner” of providing services to others. (2) The specific focus of this rule is the “direction and control” requirement. See ORS 670.600 for the requirements of the “independently established business” test and for licensing and certification requirements. Statutory/Other Authority: ORS 656.726(4) & 670.605 Statutes/Other Implemented: ORS 316.162 & 670.600 History: WCD 1-2007, f. 1-30-07, cert. ef. 2-1-07
436-170-0200 Direction and Control Test (1) ORS 670.600 states that an "independent contractor" must be "free from direction and control over the means and manner" of providing services to others. The agencies that have adopted this rule will use the following definitions in their interpretation and application of the “direction and control” test: (a) “Means” are resources used or needed in performing services. To be free from direction and control over the means of providing services an independent contractor must determine which resources to use in order to perform the work, and how to use those resources. Depending upon the nature of the business, examples of the "means" used in performing services include such things as tools or equipment, labor, devices, plans, materials, licenses, property, work location, and assets, among other things. (b) “Manner” is the method by which services are performed. To be free from direction and control over the manner of providing services an independent contractor must determine how to perform the work. Depending upon the nature of the business, examples of the "manner" by which services are performed include such things as work schedules, and work processes and procedures, among other things. (c) “Free from direction and control” means that the independent contractor is free from the right of another person to control the means or manner by which the independent contractor provides services. If the person for whom services are provided has the right to control the means or manner of providing the services, it does not matter whether that person actually exercises the right of control. (2) Right to specify results to be achieved. Specifying the final desired results of the contractor’s services does not constitute direction and control over the means or manner of providing those services. Statutory/Other Authority: ORS 656.726(4) & 670.605 Statutes/Other Implemented: ORS 316.162 & 670.600 History: WCD 1-2007, f. 1-30-07, cert. ef. 2-1-07