justicedao/ipfs_state_laws huggingface dataset:
436-030-0066 Review of Prior Permanent Partial Disability Awards For claims having a date of injury prior to January 1, 2005, which involve unscheduled body parts, areas, or systems as defined by OAR 436-035-0005, and all claims with dates of injury on or after January 1, 2005, an award of permanent partial disability is subject to periodic examination and adjustment under ORS 656.268 and 656.325 and in accordance with the following conditions: (1) Requests for review and adjustment must be made in writing to the division. (2) The party requesting review of permanent disability must send a copy of the request to all involved parties at the time the request is made. The worker may submit any information in rebuttal. (3) All pertinent medical, vocational, and other applicable evidence must be submitted with the request, including sufficient information to determine the extent of permanent partial disability. The request must state the basis for the request and provide supporting evidence. If the director finds that the worker has failed to accept treatment as provided in this rule, the director will make any necessary adjustments allowed under OAR 436-035. (4) The basis for the request for adjustment in the permanent disability award must be asserted to be failure of the worker to make a reasonable effort to reduce the disability. Statutory/Other Authority: ORS 656.268, 656.726, OL Ch. 332 1995 & OL Ch. 313 1999 Statutes/Other Implemented: ORS 656.268, 656.726, OL Ch. 332 1995, OL Ch. 313 1999, 656.325 & 656.331 History: WCD 3-2020, amend filed 02/07/2020, effective 03/01/2020 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2004, f. 2-19-04 cert. ef. 2-29-04 WCD 9-2000, f. 11-13-00, cert. ef. 1-1-01 WCD 17-1997, f. 12-22-97, cert. ef. 1-15-98 WCD 8-1996, f. 2-14-96, cert. ef. 2-17-96 WCD 12-1994, f. 11-18-94, cert. ef. 1-1-95 WCD 31-1990, f. 12-10-90, cert. ef. 12-26-90 WCD 5-1990(Temp), f. 6-18-90, cert. ef. 7-1-90
436-030-0125 Reconsideration Form and Format A request for reconsideration may be in the form and format the director provides in Bulletin 227. A reconsideration request should include at least the following: (1) Worker’s name; (2) Date of injury; (3) Date of the closure being appealed; (4) Any specific issues regarding the Notice of Closure; (5) The name of the worker’s attorney, if any; (6) The name of the insurer’s attorney, if any; (7) If the request is made by a beneficiary of the worker or the worker’s estate, the identity and name of the requester, the name of the requester’s attorney, if any, and contact information; (8) Any special language needs; (9) Whether there is disagreement with the specific impairment findings used to determine permanent disability at the time of claim closure; (10) Any information and documentation deemed necessary to correct or clarify any part of the claim record believed to be erroneous; and (11) Any medical evidence that should have been but was not submitted at the time of the claim closure including clarification or correction of the medical record based on the examination(s) at, before, or pertaining to claim closure. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.268 History: WCD 3-2020, amend filed 02/07/2020, effective 03/01/2020 WCD 6-2015, f. 10-12-15, cert. ef. 11-17-15 WCD 4-2015(Temp), f. & cert. ef. 5-21-15 thru 11-16-15 WCD 2-2004, f. 2-19-04, cert. ef. 2-29-04 WCD 14-2003(Temp), f. 12-15-03, cert. ef. 1-1-04 thru 6-28-03 WCD 9-2000, f. 11-13-00, cert. ef. 1-1-01 WCD 17-1997, f. 12-22-97, cert. ef. 1-15-98 WCD 8-1996, f. 2-14-96, cert. ef. 2-17-96 WCD 12-1994, f. 11-18-94, cert. ef. 1-1-95
436-030-0175 Fees and Penalties within the Reconsideration Proceeding (1) An insurer failing to provide information or documentation as set forth in OAR 436-030-0135, 436-030-0145, 436-030-0155 and 436-030-0165 may be assessed civil penalties under OAR 436-030-0580. Failure to comply with the requirements set forth in OAR 436-030-0135, 436-030-0145, 436-030-0155, and 436-030-0165 may also be grounds for extending the reconsideration proceeding under ORS 656.268(6). (2) If upon reconsideration of a Notice of Closure there is an increase of 25 percent or more in the amount of permanent disability compensation from that awarded by the Notice of Closure, and the worker is found to be at least 20 percent permanently disabled, the insurer will be ordered to pay the worker a penalty equal to 25 percent of the increased amount of permanent disability compensation. Penalties will not be assessed if an increase in compensation results from one of the following: (a) An order issued by the director that addresses the extent of the worker’s permanent disability that is not based on the standards adopted under ORS 656.726(4)(f); (b) New information is obtained through a medical arbiter examination, for claims with medically stationary dates or statutory closure dates on or after June 7, 1995; or (c) Information that the insurer or self-insured employer demonstrates they could not reasonably have known at the time of claim closure. (3) For the purpose of section (2) of this rule, a worker who receives a total sum of 64 degrees of scheduled or unscheduled disability or a combination thereof, will be found to be at least 20 percent disabled. For example: A worker who receives 20 percent disability of a great toe (3.6 degrees) is not considered 20 percent permanently disabled because the great toe is only a portion of the whole person. A worker who is 100 percent permanently disabled is entitled to 320 degrees of disability. A worker who receives 64 degrees (20 percent of 320 degrees), whether scheduled, unscheduled or a combination thereof, will be considered the equivalent of at least 20 percent permanently disabled for the purposes of this rule. (4) Attorney fees under ORS 656.268(6)(c) are addressed in OAR 436-001-0432. Attorney fees under ORS 656.383(1) are addressed in OAR 436-001-0438. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.268, ORS 656.383 & ORS 656.745 History: WCD 6-2022, amend filed 07/05/2022, effective 09/01/2022 WCD 11-2007, f. 11-1-07, cert. ef. 1-2-08 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2004, f. 2-19-04 cert. ef. 2-29-04 WCD 9-2000, f. 11-13-00, cert. ef. 1-1-01 WCD 8-1999, f. & cert. ef. 4-28-99 WCD 2-1999(Temp), f. 1-14-99, cert. ef. 2-1-99 thru 7-30-99 WCD 17-1997, f. 12-22-97, cert. ef. 1-15-98 WCD 8-1996, f. 2-14-96, cert. ef. 2-17-96 WCD 11-1995(Temp), f. & cert. ef. 8-23-95 WCD 12-1994, f. 11-18-94, cert. ef. 1-1-95
436-030-0575 Audits (1) Notices of Closure and supporting documentation including, but not limited to, the Notice of Closure Worksheet (Form 2807) upon which the Notice of Closure is based, will be subject to periodic audit by the director. Supporting documentation and records must be maintained in accordance with OAR 436-050. (2) The insurer or self-insured employer is required to provide the director, within seven days of the director’s request, any data the director identifies as necessary to determine the impact of legislative changes on permanent partial disability awards. Statutory/Other Authority: ORS 656.268 & 656.726 Statutes/Other Implemented: ORS 656.268, 656.726 & 656.455 History: WCD 20-2024, minor correction filed 06/18/2024, effective 06/18/2024 WCD 3-2020, amend filed 02/07/2020, effective 03/01/2020 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 2-2004, f. 2-19-04 cert. ef. 2-29-04 WCD 9-2000, f. 11-13-00, cert. ef. 1-1-01 WCD 12-1994, f. 11-18-94, cert. ef. 1-1-95
436-030-0580 Penalties and Sanctions (1) Under ORS 656.745, the director or designee may assess a civil penalty against an employer or insurer who fails to comply with the statutes, rules, or orders of the director regarding reports or other requirements necessary to carry out the purposes of the Workers’ Compensation Law. (2) An insurer or health care provider failing to meet the requirements set forth in these rules may be assessed a civil penalty. (3) Under OAR 436-010-0340, the director may impose sanctions for any health care provider where the insurer can provide sufficient documentation to substantiate lack of cooperation. The medical service provider will be sent a warning letter about the reporting requirements and possible penalties. Failure by the health care provider to submit the requested information within the specified period may result in civil penalties. (4) Sufficient documentation to substantiate lack of cooperation by the health care provider includes: (a) Copies of letters to the health care provider; (b) Memos to the claim file of follow-up phone calls or the lack of response; (c) Letters from the health care provider indicating a lack of cooperation; or (d) Medical reports received by the insurer, after adequate instruction by the insurer or the director, which do not supply the requested information or which supply information that is not consistent with the Disability Rating Standards in OAR 436-035. Statutory/Other Authority: ORS 656.268 & 656.726 Statutes/Other Implemented: ORS 656.268, 656.726 & 656.745 History: WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2004, f. 2-19-04 cert. ef. 2-29-04 WCD 9-2000, f. 11-13-00, cert. ef. 1-1-01 WCD 17-1997, f. 12-22-97, cert. ef. 1-15-98 WCD 8-1996, f. 2-14-96, cert.ef. 2-17-96 WCD 12-1994, f. 11-18-94, cert. ef. 1-1-95 WCD 5-1992, f. 1-17-92, cert. ef. 2-20-92 WCD 31-1990, f. 12-10-90, cert. ef. 12-26-90 WCD 13-1987, f. 12-17-87, ef. 1-1-88
436-035-0001 Authority for Rules These rules are promulgated under the Director’s authority contained in ORS 656.726(4). Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 2-2003, f. 1-15-03 cert. ef. 2-1-03 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88
436-035-0002 Purpose of Rules These rules establish standards for rating permanent disability under the Workers’ Compensation Act. These standards are written to reflect the criteria for rating outlined in ORS chapter 656 and assign values for disabilities that are applied consistently at all levels of the workers’ compensation award and appeal process. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.012, 656.210, 656.212, 656.214, 656.222, 656.225, 656.245, 656.262, 656.267, 656.268, 656. 273, 656.726 & 656.790 History: WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 2-2010, f. 5-5-10, cert. ef. 6-1-10 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 6-1992, f. 2-14-92, cert. ef. 3-13-92 WCD 2-1991, f. 3-26-91, cert. ef. 4-1-91 WCD 18-1990 (Temp), f. 9-14-90, cert. ef. 10-1-90 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88
436-035-0003 Applicability of Rules (1) These rules apply to the rating of permanent disability under ORS chapter 656 and to all claims closed on or after the effective date of these rules for workers medically stationary on or after June 7, 1995. (2) The rules adopted by WCD Administrative Order 93-056 apply to the rating of permanent disability for workers medically stationary on or after July 1, 1990 but before June 7, 1995, except as otherwise provided in 1995 Oregon Laws, chapter 332. (3) The rules adopted by WCD Administrative Order 6-1988 apply to the rating of permanent disability for workers medically stationary before July 1, 1990, except as otherwise provided in 1995 Oregon Laws, chapter 332. (4) For the purpose of reconsideration of claim closure under ORS 656.268, the rules in effect on the date of issuance of the appealed notice of closure apply to the rating of permanent disability for workers medically stationary after July 1, 1990, except as otherwise provided in 1995 Oregon Laws, chapter 332. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268, 656.273 & 656.726 History: WCD 2-2017(Temp), f. 4-10-17, cert. ef. 4-11-17 thru 10-7-17 WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 2-2010, f. 5-5-10, cert. ef. 6-1-10 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2003, f. 1-15-03 cert. ef. 2-1-03 WCD 6-1998, f. 5-13-98, cert. ef. 7-1-98 WCD 1-1997, f. 1-9-97, cert. ef. 2-15-97 WCD 19-1996(Temp), f. & cert. ef. 8-19-96 WCD 3-1996, f. 1-29-96, cert. ef. 2-17-96 WCD 13-1995(Temp), f. & cert. ef. 9-21-95 Reverted to WCD 15-1992, f. 11-20-92, cert. ef. 11-27-92 WCD 3-1993(Temp), f. & cert. ef. 6-17-93 WCD 15-1992, f. 11-20-92, cert. ef. 11-27-92 WCD 10-1992(Temp), f. & cert. ef. 6-1-92 WCD 6-1992, f. 2-14-92, cert. ef. 3-13-92 WCD 6-1991(Temp), f. 9-13-91, cert. ef. 10-1-91 WCD 2-1991, f. 3-26-91, cert. ef. 4-1-91 WCD 20-1990(Temp), f. & cert. ef. 11-20-90 WCD 18-1990(Temp), f. 9-14-90, cert. ef. 10-1-90 Reverted to WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89 WCD 1-1989(Temp), f. & cert. ef. 1-24-89 WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88
436-035-0006 Determination of Benefits for Disability Caused by the Compensable Injury (1) In initial injury claims. In an initial injury claim, permanent disability caused by the compensable injury includes disability caused by: (a) An accepted condition; or (b) A direct medical sequela of an accepted condition. (2) In new or omitted condition claims. In a new or omitted condition claim, permanent disability caused by the compensable injury includes disability caused by: (a) An accepted new or omitted condition; or (b) A direct medical sequela of an accepted new or omitted condition. (3) In aggravation claims. In an aggravation claim, permanent disability caused by the compensable injury includes disability caused by: (a) An accepted worsened condition; or (b) A direct medical sequela of an accepted worsened condition. (4) In occupational disease claims. In an occupational disease claim, permanent disability caused by the compensable injury includes disability caused by: (a) An accepted occupational disease; or (b) A direct medical sequela of an accepted occupational disease. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.225, 656.268, 656.726 & 656.802 History: WCD 3-2017, f. 9-7-17, cert. ef. 10-8-17 WCD 2-2017(Temp), f. 4-10-17, cert. ef. 4-11-17 thru 10-7-17 WCD 1-2015, f. 1-29-15, cert. ef. 3-1-15
436-035-0014 Worsened Pre-existing Conditions If a worsened pre-existing condition is compensable under ORS 656.225, a worker is eligible for an award for permanent disability caused by the worsened pre-existing condition. Example: (No apportionment) Compensable injury (remains major contributing cause): Herniated disk L5-S1/diskectomy. Pre-existing condition: arthritis (spine). Closing exam ROM = 10% (under these rules). Surgery (lumbar diskectomy) = 9%. Combine: 10% and 9% which equals 18% low back impairment due to this compensable injury. The worker is released to regular work. (Social-vocational factoring equals zero.) Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.726, ORS 656.005, ORS 656.214, ORS 656.225 & ORS 656.268 History: WCD 8-2022, amend filed 11/08/2022, effective 12/04/2022 WCD 3-2022, temporary amend filed 06/07/2022, effective 06/07/2022 through 12/03/2022 WCD 3-2020, amend filed 02/07/2020, effective 03/01/2020 WCD 7-2019, temporary amend filed 08/30/2019, effective 09/03/2019 through 02/29/2020 WCD 1-2015, f. 1-29-15, cert. ef. 3-1-15 WCD 2-2010, f. 5-5-10, cert. ef. 6-1-10 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05
436-035-0016 Reopened Claim for Aggravation/Worsening (1) Worsened conditions. When an aggravation claim is closed, the extent of permanent disability caused by any worsened condition accepted under the aggravation claim is compared to the extent of disability that existed at the time of the last award or arrangement of compensation. (2) Conditions not actually worsened. Permanent disability caused by conditions not actually worsened continues to be the same as that established at the last arrangement of compensation. (3) Redetermination of permanent disability. Except as provided by ORS 656.325 and 656.268(10), where a redetermination of permanent disability under ORS 656.273 results in an award that is less than the total of the worker’s prior arrangements of compensation in the claim, the award is not reduced. Statutory/Other Authority: ORS 656.726 & 656.273 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 1-2015, f. 1-29-15, cert. ef. 3-1-15 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05
436-035-0017 Authorized Training Program (ATP) (1) When a worker ceases to be enrolled and actively engaged in training under ORS 656.268(10) and there is no accepted aggravation in the current open period, one of the following applies: (a) When the date of injury is prior to January 1, 2005, the worker is entitled to have the amount of unscheduled permanent disability for a compensable condition re-evaluated under these rules. The re-evaluation includes impairment, which may increase, decrease, or affirm the worker’s permanent disability award; or (b) When the date of injury is on or after January 1, 2005, the worker’s work disability is re-evaluated under these rules. Impairment is not re-evaluated. The re-evaluation of the work disability may increase, decrease, or affirm the worker’s permanent disability award. (2) When a worker ceases to be enrolled and actively engaged in training under ORS 656.268(10) and there is an accepted aggravation in the same open period, permanent partial disability is redetermined under OAR 436-035-0016. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05
436-035-0018 Death (1) If a closing report has been completed. If the worker dies due to causes unrelated to the compensable injury and a closing report has been completed, the worker’s permanent disability must be determined based on the closing report. (2) If a closing report has not been completed. If the worker dies due to causes unrelated to the compensable injury and a closing report has not been completed, findings of impairment and permanent work restrictions must be estimated. (a) The estimate must qualify as either a statement of no permanent disability under OAR 436-030-0020(2)(a) or a closing report under OAR 436-030-0020(2)(b). (b) If the worker was medically stationary at the time of death, the following applies: (A) Findings of impairment and permanent work restrictions are determined based on an estimate of the permanent disability that existed at the time the worker was medically stationary; and (B) The worker’s residual functional capacity is determined based on an estimate of the worker’s ability to perform work-related activities at the time the worker was medically stationary. (c) If the worker was not medically stationary at the time of death, the following applies: (A) Findings of impairment and permanent work restrictions are determined based on an estimate of the permanent disability that would have existed at the time the worker would have likely become medically stationary; and (B) The worker’s residual functional capacity is determined based on an estimate of the worker’s ability to perform work-related activities at the time the worker would have likely become medically stationary. (3) In claims where, at the time of death, there is a compensable condition that is medically stationary and a compensable condition that is not medically stationary, the conditions are rated under sections (1) and (2) of this rule, respectively. The adaptability factor is determined by comparing the adaptability values from sections (1) and (2) of this rule, and using the higher of the values for adaptability. (4) If the worker dies due to causes related to the compensable injury, death benefits are due under ORS 656.204 and 656.208. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 1-2015, f. 1-29-15, cert. ef. 3-1-15 WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05
436-035-0019 Chronic Condition (1) For the purpose of this rule, “significantly limited in the repetitive use” means the worker is unable to repetitively use a body part identified in subsections (a) through (j) of this section for more than two-thirds of a period of time. A worker is entitled to a 5% chronic condition impairment value for each applicable body part, when a preponderance of medical opinion establishes that, due to a chronic and permanent medical condition, the worker is significantly limited in the repetitive use of one or more of the following body parts: (a) Lower leg (below knee/foot/ankle); (b) Upper leg (knee and above); (c) Forearm (below elbow/hand/wrist); (d) Arm (elbow and above); (e) Cervical; (f) Thoracic spine; (g) Shoulder; (h) Low back; (i) Hip; or (j) Chest. (2) Chronic condition impairments are to be combined with other impairment values, not added. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.726, 656.005, 656.214 & 656.268 History: WCD 3-2020, amend filed 02/07/2020, effective 03/01/2020 WCD 2-2010, f. 5-5-10, cert. ef. 6-1-10 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05
436-035-0020 Parts of the Upper Extremities (1) The arm begins with the head of the humerus. It includes the elbow joint. (2) The forearm begins distal to the elbow joint and includes the wrist (carpal bones). (3) The hand begins at the joints between the carpals and metacarpals. It extends to the joints between the metacarpals and the phalanges. (4) The thumb and fingers begin at the joints between the metacarpal bones and the phalanges. They extend to the tips of the thumb and fingers, respectively. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-1991, f. 3-26-91, cert. ef. 4-1-91 WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89, Renumbered from 436-030-0130 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88 WCD 13-1987, f. 12-18-87, ef. 1-1-88 WCD 5-1981, f. 12-30-81, ef. 1-1-82, Renumbered from 436-065-0006 WCD 4-1980, f. 3-20-80, ef. 4-1-80