justicedao/ipfs_state_laws huggingface dataset:
438-012-0032 Consent to Designation of Paying Agent (1) Except as provided in section (2) of this rule, when the Workers’ Compensation Division notifies the Board that it is prepared to issue an order designating a paying agent under ORS 656.307 and OAR 436-060-0180 if the Board consents to the order where one or more insurers involved in the proceeding is subject to ORS 656.278, the Board shall notify the Benefits Section within ten days whether it consents to the order. (2) If the Board is unable to determine from the available evidence whether the claimant would be entitled to Own Motion relief if the Own Motion insurer was determined to be the responsible insurer, the Board may require the parties to state their positions in writing and submit any supporting evidence to the Board within ten days. The time for the Board's response to the Workers’ Compensation Division is suspended during this process. Statutory/Other Authority: ORS 654.025(2) & 656.726(4) Statutes/Other Implemented: ORS 656.278(1) & 656.307 History: WCB 1-2004, f. 6-23-04 cert. ef. 9-1-04 WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96
438-012-0036 Permanent Disability Compensation (1) Where a new medical condition or an omitted medical condition claim has been determined to be compensable as defined under OAR 438-012-0001(4) and the claim was initiated after the aggravation rights under ORS 656.273 expired, the insurer may provide any permanent disability benefits to which the claimant is entitled under application of the Standards adopted by the Director under 656.726 when the insurer closes the claim pursuant to OAR 438-012-0055. (2) Pursuant to ORS 656.278(2)(d), an insurer may include permanent disability benefits for additional impairment to an injured body part that has previously been the basis of a permanent partial disability award, but only to the extent that the permanent partial disability rating exceeds the permanent partial disability rated by the prior award or awards. (3) Permanent disability pursuant to section (1) of this rule must be paid no later than the 30th day after: (a) The date of an Own Motion notice of claim closure; (b) The date of any litigation order which orders payment of permanent total disability. Permanent total benefits accruing from the date of the order must begin no later than the 30th day after the date of the order; (c) The date any litigation order authorizing permanent disability becomes final; or (d) The date a claim disposition is disapproved by the Board or Administrative Law Judge, if permanent disability benefits are otherwise due. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.278(1), 656.278(2) & 656.726(5) History: WCB 1-2013, f. 2-11-13, cert. ef. 4-1-13 WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06 WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02
438-012-0037 Payment of Medical Benefits Except as otherwise provided in OAR 438-012-0020(7), for every condition resulting from a compensable injury occurring before January 1, 1966, the Own Motion insurer may pay for reasonable and necessary medical services when: (1) Undertaken for curative purposes; (2) Provided to a claimant who has been determined to have permanent total disability; (3) Provided in the form of prescription medications; (4) Necessary to administer prescription medication or to monitor administration of prescription medication; (5) Provided in the form of prosthetic devices, braces and supports; (6) Necessary to maintain and monitor the status, replacement or repair of a prosthetic device, brace or support; (7) Necessary to diagnose the claimant's condition; (8) Necessary to enable the claimant to continue current employment; (9) Provided in the form of life-preserving modalities similar to insulin therapy, dialysis and transfusions; or (10) The Board determines that special circumstances justify the provision of further medical services. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.278(1)(c), 656.278(2)(c) & 656.726(5) History: WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06 WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02 WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95 WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90 WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90
438-012-0040 Action by Board after Insurer Recommendation Except as provided in OAR 438-012-0050, within a reasonable time after receipt of the insurer’s recommendation and supporting evidence and any additional evidence and argument from the claimant the Board may: (1) Issue its order based upon the evidence and argument submitted by the parties; (2) Request additional evidence from one or more of the parties; or (3) Refer the matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions. Statutory/Other Authority: ORS 654.025(2) & 656.726(4) Statutes/Other Implemented: ORS 656.278(1) & 656.726(4) History: WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95 WCB 5-1987, f. 12-18-87, cert. ef. 1-1-88
438-012-0050 Board Will Act Unless Claimant Has Not Exhausted Other Available Remedies (1) The Board will act promptly upon a request for relief under the provisions of ORS 656.278 and these rules unless: (a) The claimant has available administrative remedies under the provisions of ORS 656.273; (b) The claimant's condition is the subject of a contested case under ORS 656.283 through 656.298, 656.307 or 656.308, or an arbitration or mediation proceeding under 656.307; or (c) The claimant's request for payment of temporary disability compensation is based on surgery or hospitalization or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the claimant to return to work that is the subject of either a managed care dispute resolution review process or a Director's medical review under ORS 656.245, 656.260 or 656.327. (2) The Board may postpone its review of the merits of the claimant's request for relief if the available remedies set forth in section (1) of this rule could affect the Board's authority to award compensation under the provisions of ORS 656.278. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.278(1) & 656.726(5) History: WCB 1-2013, f. 2-11-13, cert. ef. 4-1-13 WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06 WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03 WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02 WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95 WCB 5-1987, f. 12-18-87, cert. ef. 1-1-88
438-012-0055 Closure of Claims Reopened Under ORS 656.278 When a claim has been voluntarily reopened or ordered reopened by the Board and the medical reports indicate to the insurer that the claimant's condition has become medically stationary, the claim shall be closed by the insurer without the issuance of a Board order. In all such cases the insurer shall issue a Notice of Closure (Form 2066) to the claimant with copies to the claimant's attorney, if any, and the Workers' Compensation Division. The notice shall be on the form prescribed by the Director and shall inform the claimant of the amount and duration of temporary disability compensation, the amount of any permanent disability award determined under ORS 656.278(1)(b) and (2)(d), and the medically stationary date, and shall include the following notice in prominent or bold face type: "IF YOU THINK THIS CLAIM CLOSURE IS WRONG, YOU MAY ASK THE WORKERS' COMPENSATION BOARD TO REVIEW IT AND DECIDE WHETHER YOU ARE ENTITLED TO MORE COMPENSATION. IF YOU DO NOT ASK FOR REVIEW WITHIN 60 DAYS OF THE DATE OF THIS NOTICE YOU WILL LOSE ANY RIGHT YOU MAY HAVE TO CONTEST THIS NOTICE UNLESS YOU CAN SHOW GOOD CAUSE FOR DELAY BEYOND 60 DAYS. AFTER 180 DAYS ALL RIGHTS WILL BE LOST. YOU MAY ASK FOR A REVIEW BY WRITING TO THE BOARD AT 2601 25TH STREET SE, SUITE 150, SALEM, OREGON 97302-1280. YOU MAY HAVE AN ATTORNEY OF YOUR CHOICE, WHOSE FEE WILL BE LIMITED TO A PERCENTAGE OF ANY MORE COMPENSATION YOU MAY BE AWARDED." Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.278(1), (2), (6) & 656.726(5) History: WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06 WCB 1-2004, f. 6-23-04, cert. ef. 9-1-04 WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02 WCB 1-1999, f. 8-24-99, cert. ef. 11-1-99 WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95 WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90 WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90 WCB 2-1989, f. 3-3-89, cert. ef. 4-1-89 WCB 3-1988(Temp), f. 10-20-88, cert. ef. 11-1-88 WCB 5-1987, f. 12-18-87, cert. ef. 1-1-88
438-012-0061 Board Review of Voluntary Reopening of an Own Motion Claim (1) If a dispute arises out of a voluntary reopening of a claim under ORS 656.278(5), a party may file a written request for Board review, with copies to the other party. (2) Within 14 days after notification from the Board that a review has been requested, the insurer shall submit to the Board and to the claimant or the claimant’s attorney, if any, legible copies of all evidence which pertains to the claimant’s compensable condition at the time of the voluntary reopening. The insurer may also submit written arguments at this time, with copies to the claimant or the claimant’s attorney, if any. (3) The claimant may submit additional evidence and written argument to the Board, with copies to the insurer or its attorney, if any. To be considered, such evidence and argument must be submitted within 21 days from the date the insurer mails the evidence and argument pursuant to section (2) of this rule. (4) The Board may refer a matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions. (5) The Board shall issue its order within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.278(1), 656.278(5) & 656.726(5) History: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03 WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02
438-012-0062 Referral of Request for Enforcement of Board's Own Motion Order to Hearings Division (1) The Board may refer a request to enforce an Own Motion order to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions. (2) The Board shall issue its order within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division. Statutory/Other Authority: ORS 654.025(2) & 656.726(5) Statutes/Other Implemented: 656.278(1) & 656.726(5) History: WCB 1-2013, f. 2-11-13, cert. ef. 4-1-13 WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03
438-012-0065 Reconsideration of Own Motion Orders (1) All final orders issued by the Board under the provisions of ORS 656.278 shall set forth the parties, the request for relief, the Board’s decision and shall advise all parties of appeal rights. (2) A motion for reconsideration of a final order issued by the Board under the provisions of ORS 656.278 shall be filed within 30 days after the date of mailing of the order, or within 60 days after the mailing date if the party requesting reconsideration establishes good cause for the failure to file the request within 30 days after the mailing date. (3) Notwithstanding section (2) of this rule, in extraordinary circumstances the Board may, on its own motion, reconsider any prior Board order. Statutory/Other Authority: ORS 654.025(2) & 656.726(4) Statutes/Other Implemented: ORS 656.278(1), 656.278(3) & 656.726(4) History: WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95 WCB 2-1990, f. 1-24-90, cert. ef. 2-28-90 WCB 2-1989, f. 3-3-89, cert. ef. 4-1-89 WCB 5-1987, f. 12-18-87, cert. ef. 1-1-88
438-012-0110 Penalty for Unreasonable Failure to Comply or Untimely Compliance with Board Own Motion Rules (1) Failure to comply with the Board’s Own Motion rules by the insurer, if found unreasonable or unjustified, may result in the imposition of penalties and attorney fees pursuant to ORS 656.262(11) and OAR 438-015-0110, exclusion of evidence, and/or referral for a fact-finding hearing. (2) Failure to comply with the Board’s Own Motion rules by the claimant, if found unreasonable or unjustified, may result in the exclusion of evidence, referral for a fact-finding hearing, and/or dismissal of the request for benefits. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.267(1)(3), 656.278(1)(b) & 656.726(5) History: WCB 1-2004, f. 6-23-04 cert. ef. 9-1-04
438-013-0005 Expedited Claims Service Established Pursuant to the mandate of 1987 Oregon Laws, Chapter 884, Section 18, there is established within the Hearings Division the Expedited Claims Service. The purpose of the Expedited Claims Service is to provide for prompt, informal dispute resolution and to insure fair and just treatment of workers in all proceedings. Statutory/Other Authority: ORS 656.291 Statutes/Other Implemented: ORS 656.291 History: WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0010 Referral of Request for Hearing to Expedited Claim Service (1) A request for hearing shall be referred to the Expedited Claims Service if: (a) The request does not involve the compensability of or responsibility for a claim, and the total amount in controversy, exclusive of penalties and/or related attorney fees, is $1,000 or less; (b) The only issue in the case is entitlement to penalties and/or related attorney fees; or (c) The request is for an expedited hearing to appeal a denial under ORS 656.262(15) for a worker’s failure to cooperate in a claim investigation. (2) If an Administrative Law Judge finds at the hearing or at any time prior to the hearing that the case should not have been referred to the Expedited Claims Service, the Administrative Law Judge shall refer the case for decision under the ordinary hearing process. With the consent of the Administrative Law Judge, the parties may agree on the oral record to proceed with the hearing as referred to the ordinary hearing process without further delay. Such an agreement to proceed is a waiver of any claim of defect as to notice of hearing or issues. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.291(2) History: WCB 3-2001, f. 11-14-01, cert. ef. 1-1-02 WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0015 Determination of Amount in Controversy For the purpose of referral to the Expedited Claims Service, the total amount in controversy shall be presumed to be $1,000 or less if the party requesting the hearing so states on a form prescribed by the Board or in the request for hearing. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(4) Statutes/Other Implemented: ORS 656.291(3) History: WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0020 Representation of Parties in Expedited Claims (1) A claimant need not be represented by any other person in proceedings before the Expedited Claims Service. (2) A claimant may be represented by an attorney or by an individual who is not an attorney in proceedings before the Expedited Claims Service. (3) Notwithstanding OAR 438-006-0100, an insurer, self-insured employer or claim processing agent for an insurer or self-insured employer may be represented by an authorized claims representative at any proceeding under the Expedited Claims Service. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(4) Statutes/Other Implemented: ORS 656.291(5) History: WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0025 Notice of Hearing Date The Hearings Division shall distribute a notice of hearing date to all parties and to all other individuals who represent the parties. The hearing shall be scheduled for a date that is not less than 15 days from the distribution of the notice of hearing nor more than 30 days from the date of receipt of the request for hearing by the Hearings Division. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(5) Statutes/Other Implemented: ORS 656.291 History: WCB 2-2014, f. 12-10-14, cert. ef. 1-1-15 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0030 Hearings in Expedited Claims; Informal Dispute Resolution (1) OAR 438-007-0018 does not apply to the Expedited Claim Service. The insurer’s representative shall bring all medical and vocational reports, records of compensation paid, and all other documents pertaining to the claim to the hearing. The Administrative Law Judge shall, before convening the hearing, determine whether the case may be resolved informally or decided on agreed facts. (2) If the case can be decided on agreed facts, the agreement of the facts shall be stated on the oral record. No testimony shall be taken and the record shall be closed upon oral argument, if any, on behalf of the parties. (3) If the case cannot be decided on agreed facts, the Administrative Law Judge shall so state on the oral record of the hearing or in the order. The Administrative Law Judge shall admit into evidence those documents furnished by the insurer that are relevant to a determination of the dispute, along with any other relevant documents offered by the claimant. (4) It is the intent of the Board in adopting these rules that all cases under the Expedited Claim Service be heard and decided quickly and fairly. Administrative Law Judges shall take an active role in the hearing. (5) Unless more time is allowed in advance after a showing of good cause, no hearing under the expedited Claims Service shall be scheduled to exceed one hour in duration. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(4) Statutes/Other Implemented: ORS 656.291(4)(6) History: WCB 11-1990, f. 12-13-90, cert. ef 12-31-90 Reverted to WCB 5-1987, f. 12-18-87, ef. 1-1-88 WCB 3-1990(Temp), f. & cert. ef. 3-1-90 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0035 Postponements and Continuances (1) A hearing under the Expedited Claims Service shall not be postponed except upon a showing of extraordinary circumstances beyond the control of the party requesting the postponement. “Extraordinary circumstances” shall be as defined in OAR 438-006-0081 except that unavailability of an individual who represents an insurer shall not be a reason to postpone a hearing under any circumstances and unavailability of an individual who represents a claimant shall not be a reason to postpone a hearing under the Expedited Claims Service unless the Administrative Law Judge finds that the claimant is physically or mentally incapable of representing themself at the hearing. (2) A hearing under the Expedited Claims Service may be continued for further proceedings only if the Administrative Law Judge finds and states on the oral record that a continuance is required to achieve substantial justice. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(4) Statutes/Other Implemented: ORS 656.291(3)(b) & 656.291(4) History: WCB 16-2022, minor correction filed 03/15/2022, effective 03/15/2022 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-013-0040 Order of Administrative Law Judge; Review (1) The Administrative Law Judge shall issue an order deciding the case not later than ten days after the closing of the record. The order may adopt by reference findings and conclusions stated on the oral record. (2) The Administrative Law Judge’s order shall include a notice of rights of review by the Workers’ Compensation Board under the provisions of ORS 656.295. Statutory/Other Authority: ORS 656.307, 656.388, 656.593 & 656.726(4) Statutes/Other Implemented: ORS 656.291(3)(b) & 656.291(4) History: WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-015-0003 Authority for Adoption These rules are adopted pursuant to ORS 656.236, 656.388, and 656.593, under the general rulemaking authority of the Board pursuant to 656.726(5). Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.236(4), 656.388(3), 656.593(1)(a) & 656.726(4) History: WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90 Reverted to WCB 2-1989, f. 3-3-89, ef. 4-1-89 Suspended by WCB 7-1990(Temp), f. 6-14-90, cert. ef. 7-1-90 WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 5-1987, f. 12-18-87, ef. 1-1-88
438-015-0005 Definitions In addition to the definitions set forth in OAR 438-005-0040: (1) “Approved fee” means an attorney fee paid out of a claimant’s compensation. (2) “Assessed fee” means an attorney fee paid to a claimant’s attorney by an insurer or self-insured employer in addition to compensation paid to a claimant. (3) “Attorney” means a member of the Oregon State Bar. (4) “Attorney fee” means payment for legal services performed on behalf and at the request of a claimant under ORS Chapter 656. (5)“Client paid fee” means an attorney fee paid by an insurer or self-insured employer to its attorney. (6) “Compensation” means all benefits, including medical services, provided for a compensable injury to a subject worker or the beneficiaries of a subject worker pursuant to ORS Chapter 656. (7) “Cost bill” means an itemized statement from the claimant of the amount of expenses and costs for records, expert opinions, and witness fees incurred as a result of the litigation involving a claim denial under ORS 656.386(1). (8) “Denied claim” means a claim for compensation which an insurer or self-insured employer refuses to pay on the express ground that the injury or condition for which compensation is claimed is not compensable or otherwise does not give rise to an entitlement to any compensation or a claim under ORS 656.386(1)(b)(B), (C) or (D) to which the insurer or self-insured employer does not timely respond. (9) “Expenses and costs” reimbursable under ORS 656.386(2) mean reasonable expenses and costs incurred by the claimant for things and services reasonably necessary to pursue a matter, but do not include attorney fees. Examples of expenses and costs referred to include, but are not limited to, costs of records, expert witness opinions, witness fees and mileage paid to execute a subpoena and costs associated with travel. Statutory/Other Authority: ORS 656.726(5) Statutes/Other Implemented: ORS 656.308, 656.382, 656.386, 656.388 & 656.726(5) History: WCB 1-2020, amend filed 03/06/2020, effective 06/01/2020 WCB 2-2016, f. 10-13-16, cert. ef. 11-1-16 WCB 2-2012, f. 11-13-12, cert. ef. 1-1-13 WCB 2-2007, f. 12-11-07, cert. ef. 1-1-08 WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96 WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90 Reverted to WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 7-1990(Temp), f. 6-14-90, cert. ef. 7-1-90 WCB 2-1989, f. 3-3-89, ef. 4-1-89 WCB 5-1987, f. 12-18-87, ef. 1-1-88