justicedao/ipfs_state_laws huggingface dataset:
436-055-0085 Training for Interactions with Independent Medical Examination Providers (1) Director approval of training curricula. Any training relating to interactions with independent medical examination (IME) providers must follow a curriculum that has been approved by the director. Curricula must include at least some of the following components: (a) Appropriate and ethical communication with IME providers; (b) Insurers’ rights and responsibilities; (c) Injured workers’ rights and responsibilities; (d) IME providers’ standards of conduct requirement; (e) IME complaint process and investigations by the Workers’ Compensation Division; or (f) The requirements of ORS 656.325 and OAR 436-010. (2) Request for approval. Any person may develop a training curriculum and request approval from the director under this section. (a) The request for approval must: (A) Be made in writing; (B) Describe how the training content relates to the components in section (1) of this rule; and (C) Specify the total number of training hours to be provided. (b) The director will approve or deny the request and notify the person of the decision within 30 days of receipt of the request. (A) If the request is approved, the curriculum will be valid until the content or number of hours of training change, at which time a new request for approval must be submitted. (B) If the request is denied, the director will notify the person of the reasons for denial. The person may resubmit the request when the reasons for denial have been addressed. (3) Registry of approved curricula. The director will maintain a registry of approved training curricula. 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 5-2006, f. 6-15-06, cert. ef. 7-1-06 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06
436-055-0110 Assessment of Civil Penalties (1) Penalties for failure to comply with statutes, rules, and orders. The director may assess a civil penalty under ORS 656.745(2) against an insurer that violates ORS chapter 656, OAR 436-055, or an order of the director. (2) Penalties for failure to comply with ORS 656.780. The director may assess a civil penalty against an insurer that fails to maintain or produce certification and training records as required by these rules, or that employs anyone other than an Oregon certified claims examiner to process claims. Statutory/Other Authority: ORS 656.726 & ORS 656.780 Statutes/Other Implemented: ORS 656.780 & 656.745 History: WCD 12-2019, amend filed 12/18/2019, effective 01/01/2020 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 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
436-060-0012 Notices and Correspondence Following the Death of a Worker (1) If a worker is deceased, regardless of the cause of death, an insurer must: (a) Address all future notices and correspondence to the estate of the worker or qualified beneficiaries; (b) Provide a written notice of acceptance or denial of a claim to the estate of the worker; and (c) Issue a Notice of Closure, when applicable, to the estate of the worker. The insurer must mail the worker’s copy of the Notice of Closure to the worker’s last known address. The insurer may mail copies of the Notice of Closure to any known or potential beneficiaries. (2) Other notices required under this chapter intended for the worker are not required when the worker is deceased. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.262, 656.264 & 656.268 History: WCD 7-2020, amend filed 03/13/2020, effective 04/01/2020 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10
436-060-0040 Payment of Permanent Partial Disability Compensation (1) General. A permanent partial disability award exceeding $6,000 may be paid monthly by the insurer. If it is paid monthly, it must be paid at 4.35 times the weekly temporary disability rate at the time of closure. A permanent partial disability award less than $6,000 must be paid under OAR 436-060-0060. (2) Reopened claims. If a claim is reopened as a result of a new medical condition, or an aggravation of the conditions resulting from the worker’s compensable injury: (a) Any permanent partial disability benefits due must continue; and (b) If any temporary disability benefits are due, permanent partial disability benefits must be paid concurrently. (3) Vocational training plans. If the worker begins an authorized training plan under OAR 436-120 after claim closure, the insurer must suspend the payment of any work disability award, but continue to pay any impairment award. The insurer must stop temporary disability compensation payments and resume any award payments suspended under ORS 656.268(10) upon the worker’s completion or ending of the training, unless the worker is not then medically stationary. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.726(4), 656.216, 656.268(10) & 656.704 History: WCD 7-2020, amend filed 03/13/2020, effective 04/01/2020 WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 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 11-2001, f. 11-30-01, cert. ef. 1-1-02 WCD 5-1996, f. 2-6-96, cert. ef. 2-12-96 WCD 7-1994, f. 8-11-94, cert. ef. 8-28-94 WCD 29-1990, f. 11-30-90, cert. ef. 12-26-90 WCD 9-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 6-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 4-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 8-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 8-1983, f. 12-29-83, cert. ef. 1-1-84, Renumbered from 436-054-0232 WCD 6-1981, f. 12-23-81, cert. ef. 1-1-82
436-060-0045 Payment of Compensation During Worker Incarceration (1) General. A worker is not eligible to receive temporary disability compensation for periods of time during which the worker is incarcerated for commission of a crime. All other compensation must be provided the worker as if the worker were not incarcerated, except as provided in OAR 436-120. For the purpose of this rule: (a) A worker is incarcerated for commission of a crime when: (A) In pretrial detention; or (B) Imprisoned following conviction for a crime; and (b) A worker is not incarcerated if the worker is on parole or work release status. (2) Initiation of payments after incarceration. Temporary disability compensation, if due and payable, must be paid the worker within 14 days of the date the insurer becomes aware the worker is no longer incarcerated. (3) Right to claim closure. A worker who is incarcerated has the same right to claim closure under ORS 656.268 as a worker who is not incarcerated. Any permanent disability awarded must be paid the same as if the worker were not incarcerated. Statutory/Other Authority: ORS 656.160, 656.704 & 656.726(4) Statutes/Other Implemented: ORS 656.160, 656.704 & 656.726(4) History: WCD 7-2020, amend filed 03/13/2020, effective 04/01/2020 WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 10-2002, f. 10-2-02 cert. ef. 11-1-02 WCD 1-1992, f. 1-3-92, cert. ef. 2-1-92 WCD 29-1990, f. 11-30-90, cert. ef. 12-26-90 WCD 19-1990(Temp), f. & cert. ef. 9-18-90 WCD 9-1990(Temp), f. 6-18-90, cert. ef. 7-1-90
436-060-0153 Electronic Payment of Compensation (1) General. Benefits may be paid through a direct deposit system, automated teller machine card or debit card, or other means of electronic transfer if the worker voluntarily consents. (a) Except as provided under (1)(c) of this rule, an insurer must obtain the worker’s consent before initiating electronic payments. The consent may be written or verbal. The insurer must provide the worker a written confirmation when consent is obtained verbally. (b) An employer making payments under OAR 436-060-0020(1) may assume the worker consents to having benefits paid through a direct deposit system if that is the method the employer usually uses to pay the worker’s wages. (c) A self-insured employer paying benefits may assume the worker consents to having benefits paid through a direct deposit system if that is the method the employer usually uses to pay the worker’s wages. (d) The worker may discontinue receiving electronic payments by notifying the insurer or employer in writing. (2) Cardholder agreement for ATM or debit cards. The worker must receive a copy of the cardholder agreement outlining the terms and conditions under which an automated teller machine card or debit card has been issued before or at the time the initial electronic payment is made. (3) Instrument of payment. The instrument of payment must be negotiable and payable to the worker for the full amount of the benefit paid, without cost to the worker. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.262(4) & ORS 84.013 History: WCD 13-2022, amend filed 12/19/2022, effective 01/01/2023 WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 5-2008, f. 12-15-08, cert. ef. 1-1-09
436-060-0160 Use of Sight Draft to Pay Compensation Prohibited Insurers may not use a sight draft to pay any benefits or payments due a worker or beneficiary under ORS chapter 656. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.726(4) History: WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 10-2002, f. 10-2-02, cert. ef. 11-1-02 WCD 6-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 8-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 8-1983, f. 12-29-83, cert. ef. 1-1-84, Renumbered from 436-054-0315 WCD 1-1980, f. & cert. ef. 1-11-80 WCD 6-1978, f. & cert. ef. 4-27-78 WCB 18-1975, f. 12-19-75, cert. ef. 1-1-76
436-060-0170 Recovery of Overpayment of Benefits (1) Benefits paid a worker. An insurer may recover overpayment of benefits paid to a worker as specified by ORS 656.268(12), (13), (14), and (16), unless authority is granted by an administrative law judge or the board. (2) Benefits due a worker. An insurer may recover an overpayment from any benefits currently due on any claim the worker has with that insurer. The insurer must explain in writing the reason, the amount, and the method of recovery to the worker and the worker’s attorney, if any, or to the worker’s beneficiaries. (3) Permanent partial disability offsets. When overpaid benefits are offset against monthly permanent partial disability award payments, the insurer must recover the benefits from the total amount of the award. The insurer must pay out the remainder of the award at 4.35 times the temporary total disability rate, or at least $108.75, starting with the first month’s payment. (4) Supplemental disability benefits. The director, through its assigned processing administrator described under OAR 436-060-0035(2)(d), may recover overpayments of supplemental disability benefits under the same conditions provided under ORS 656.268(12), (13), (14), and (16), or may require the insurer to do so. If the insurer recovers an overpayment on behalf of the assigned processing administrator, the insurer must reimburse the assigned processing administrator. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.268(12) (13),(14), & (16) History: WCD 14-2024, amend filed 06/07/2024, effective 07/01/2024 WCD 14-2022, amend filed 12/20/2022, effective 01/01/2024 WCD 7-2020, amend filed 03/13/2020, effective 04/01/2020 WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 10-2002, f. 10-2-02, cert. ef. 11-1-02 WCD 5-1996, f. 2-6-96, cert. ef. 2-12-96 WCD 29-1990, f. 11-30-90, cert. ef. 12-26-90 WCD 9-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 6-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 4-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 8-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-054-0320 WCD 3-1984, f. & cert. ef. 4-4-84 WCD 8-1983, f. 12-29-83, cert. ef. 1-1-84 WCD 6-1981, f. 12-23-81, cert. ef. 1-1-82 WCD 1-1980, f. & cert. ef. 1-11-80
436-060-0195 Miscellaneous Monetary Adjustments Among Insurers (1) General. The director may order monetary adjustments between insurers when a worker has a right to compensation, but there is a dispute between insurers that does not fall under the director’s authority in ORS 656.307 and OAR 436-060-0190. (a) When any litigation on the issues in question is final, insurers must make any necessary monetary adjustments between themselves, consistent with the determination of coverage for compensation paid to the worker, medical providers, and others for which they are responsible, within 30 days of receiving enough information to determine the benefits paid and the relationship to the conditions involved. (b) Any balance due after making such adjustments must be paid in a timely manner to the worker, medical providers and other parties under OAR 436-009 and 436-060-0150. (c) Any failure to obtain reimbursement from an insurer under this rule is not recoverable from the Consumer and Business Services Fund. (2) Obligation to process claims. The director may direct any necessary monetary adjustment between parties, but will not order an insurer to pay compensation above that required by law, as it relates to the insurer’s claim, except when an insurer unduly compensates a worker while having knowledge such compensation has already been paid by another insurer. However, each insurer has its own independent obligation to process its claim and pay compensation due until the claim is either accepted or denied. When notified by the director that a dispute over monetary adjustment exists the insurer must provide a written response to questions or issues raised, including supporting documentation, to the division, the other insurers involved and other interested parties within 21 days of the mailing date of the notification. (3) Failure to make adjustments. Failure to respond to the director’s inquiries or make monetary adjustments within 30 days of an order by the director will subject the insurer to civil penalties under OAR 436-060-0200. (4) Unnecessary costs. When the director determines improper or untimely claim processing by an insurer resulted in unnecessary costs, the director may deny monetary adjustment between the insurers. Statutory/Other Authority: ORS 656.704, ORS 656.726(4) & 656.745 Statutes/Other Implemented: ORS 656.704, ORS 656.726(4) & 656.745 History: WCD 2-2020, minor correction filed 01/29/2020, effective 01/29/2020 WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 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 10-2002, f. 10-2-02 cert. ef. 11-1-02 WCD 11-2001, f. 11-30-01, cert. ef. 1-1-02 WCD 7-1994, f. 8-11-94, cert. ef. 8-28-94 WCD 1-1992, f. 1-3-92, cert. ef. 2-1-92
436-060-0400 Penalty and Attorney Fee for Untimely Payment of Disputed Claims Settlement (1) Right to request penalties and attorney fees. If the insurer fails to pay amounts due on a disputed claims settlement within five business days of receipt of notice from the worker that the payment is late, the worker or worker’s attorney may request penalties and attorney fees. (2) Requirements for requests. Requests for penalties and attorney fees under this rule must be in writing, state what payments were delayed or remain unpaid, and be mailed or delivered to the division within 180 days of the date of notice to the insurer. In order to be awarded an attorney fee the attorney must submit a signed, current retainer agreement. (3) Required response from the insurer. When notified by the director that a penalty or attorney fees have been requested under this rule, the insurer must respond in writing to the division. (a) The response must include any information or documentation requested by the director. (b) The response must be mailed or delivered to the division within 14 days of the date of the director’s inquiry letter; and (c) Copies of the response, including any attachments, must be sent simultaneously to the worker and the worker’s attorney, if any. (4) Failure to respond. If the insurer fails to meet the requirements of section (3) of this rule, the director may assess additional civil penalties under OAR 436-060-0200. (5) Penalty and fee amounts. The penalty and fee will be based on the amounts allocated to the worker and the attorney in the settlement agreement as prescribed in ORS 656.262(12)(b). Penalties will be issued in accordance with the matrix set forth in Appendix “C.” (6) Timely payment of penalties. Penalties and attorney fees ordered under this rule must be paid to the worker and attorney no later than the 30th day after the date of the order, unless the order is appealed. If the order is appealed and later upheld, the penalty and attorney fee will be due within 14 days of the date the order upholding the penalty becomes final. Failure to pay penalties and attorney fees in a timely manner may subject the insurer to civil penalties under OAR 436-060-0200. [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.262 History: WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10
436-060-0510 Reimbursement of Permanent Total Disability Benefits from the Workers’ Benefit Fund (1) General. The insurer may request reimbursement of permanent total disability benefits paid after the date of the notice of closure under ORS 656.206(6)(a). (2) Requirements for requests. Requests for reimbursement must be filed within one year of the mailing date of the final order upholding the notice of closure and include: (a) Sufficient information to identify the insurer and the injured worker; (b) The net dollar amount of permanent total disability benefits paid. “Net dollar amount” means the total compensation paid less any recoveries, including, but not limited to, third party recoveries or amounts reimbursable from the Retroactive Program or Reopened Claims Program; and (c) A statement certifying that payment has been made. (3) Moneys due under Retroactive or Reopened Claims Programs. If any of the moneys are due under the Retroactive Program or Reopened Claims Program, any reimbursement request must be submitted under OAR 436-075 or 436-045. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.206 & 656.605 History: WCD 6-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06
436-070-0003 Purpose and Applicability (1) Purpose. These rules prescribe the rate of the Workers’ Benefit Fund assessment under ORS 656.506 effective Jan. 1, 2026, the method and manner for calculating the assessment rate, and the method and manner in which employers are to pay the assessment. (2) Applicability. (a) These rules apply to all employers. (b) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.506 History: WCD 2-2025, amend filed 10/02/2025, effective 01/01/2026 WCD 3-2023, amend filed 10/13/2023, effective 01/01/2024 WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 8-2019, amend filed 10/01/2019, effective 01/01/2020 WCD 19-2018, amend filed 11/01/2018, effective 01/01/2019 WCD 3-2016, f. 11-8-16, cert. ef. 1-1-17 WCD 10-2012, f. 12-7-12, cert. ef. 4-1-13 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 2-1996, f. & cert. ef. 1-12-96 WCD 9-1994, f. 10-31-94, cert. ef. 1-1-95 WCD 3-1983, f. 6-30-83, cert. ef. 7-1-83, Renumbered from 436-055-0103
436-070-0005 Definitions Unless a term is defined elsewhere in these rules, the definitions of ORS chapter 656 are incorporated by reference and made a part of these rules. For the purpose of these rules, unless the context requires otherwise: (1) "Assessments" means the funds due from employees and employers under ORS 656.506. (2) “Board” means the Workers’ Compensation Board and includes its Hearings Division. (3) “Division” means the Workers’ Compensation Division of the Department of Consumer and Business Services. (4) "Employee" means an Oregon subject worker as defined in ORS 656.005 and any otherwise nonsubject worker for whom coverage is elected under ORS 656.039. (5) “Employer” means a subject employer as defined in ORS 656.005, including an employer that elects coverage for an otherwise nonsubject worker under ORS 656.039. (6) "Fund" means the Workers’ Benefit Fund as created in ORS 656.506. (7) "Fund balance" means the balance of the fund after revenue and investment income has been added and expenditures have been subtracted. Statutory/Other Authority: ORS 656.506 Statutes/Other Implemented: ORS 656.506 History: WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 2-1996, f. & cert. ef. 1-12-96 WCD 3-1983, f. 6-30-83, cert. ef. 7-1-83, Renumbered from 436-055-0105
436-070-0008 Administrative Review (1) Request for hearing on proposed sanctions or civil penalties. Any employer that disagrees with a proposed order, or proposed assessment of civil penalty, of the director under ORS 656.745, may request a hearing by the board. To request a hearing, the employer must: (a) Mail or deliver a written request to the division within 60 days of the mailing date of the proposed order or assessment; and (b) Specify, in the request, the reasons why the employer disagrees with the proposed order or assessment. (2) Requests for hearings on other actions, including estimation actions and orders. Any employer that disagrees with an action or order of the director under these rules, other than as described in section (1), may request a hearing by filing a request for hearing under OAR 436-001-0019 within 30 days of the mailing date of the order or notice of action. OAR 436-001 applies to the hearing. Statutory/Other Authority: ORS 656.735 & ORS 656.740 Statutes/Other Implemented: ORS 656.735, ORS 656.740 & ORS 656.704 History: WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 2-1996, f. & cert. ef. 1-12-96 WCD 9-1994, f. 10-31-94, cert. ef. 1-1-95
436-070-0010 Assessment Rate: Method and Manner of Determining (1) The assessment owed by an employer under this rule division and ORS 656.506 must be calculated using the method in OAR 436-070-0020 and based on a rate of 1.8 cents per hour. (2) Factors considered by the director in developing the rate include, but are not limited to: (a) The estimated annual fund expenditures and revenues; (b) The fund balance requirements; (c) The estimated annual hours worked per employee; (d) The estimated number of employees covered by workers’ compensation insurance; and (e) Other records relating to fund expenditures and revenues. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.506 History: WCD 2-2025, amend filed 10/02/2025, effective 01/01/2026 WCD 3-2023, amend filed 10/13/2023, effective 01/01/2024 WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 8-2019, amend filed 10/01/2019, effective 01/01/2020 WCD 17-2018, amend filed 09/28/2018, effective 01/01/2019 WCD 3-2016, f. 11-8-16, cert. ef. 1-1-17 WCD 10-2012, f. 12-7-12, cert. ef. 4-1-13 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 2-1996, f. & cert. ef. 1-12-96 WCD 9-1994, f. 10-31-94, cert. ef. 1-1-95 WCD 3-1983, f. 6-30-83, cert. ef. 7-1-83, Renumbered from 436-055-0120
436-070-0040 Monitoring/Auditing (1) Employers must maintain payroll and employment records that reflect the total hours worked by all employees for the current calendar year plus three prior calendar years. (2) Under ORS 656.726, the director may inspect the books, records and payrolls of employers pertinent to the administration of these rules. Employers must provide the director with all pertinent books, records and payrolls upon request. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.506 History: WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 9-1994, f. 10-31-94, cert. ef. 1-1-95 WCD 3-1983, f. 6-30-83, cert. ef. 7-1-83, Renumbered from 436-055-0135