justicedao/ipfs_state_laws huggingface dataset:
436-120-0177 Selection of Category of Vocational Assistance (1) The insurer must select one of the following categories of vocational assistance before referring a worker to a counselor: (a) Direct employment services, if the worker has the necessary transferable skills to obtain suitable new employment. (b) Training, if the worker needs training in order to return to employment that pays a wage significantly closer to 100 percent of the adjusted weekly wage. “Significantly closer” may vary depending on several factors, including, but not limited to: the worker’s wage at injury, adaptability, skills, geographic location, limitations, and the potential for the worker’s income to increase with time as the result of training. (c) Limited training, if the worker is not authorized to work in the United States and needs training in order to return to employment that pays a wage significantly closer to 100 percent of the adjusted weekly wage. “Significantly closer” may vary depending on several factors, including, but not limited to: the worker’s wage at injury, adaptability, skills, geographic location, limitations, and the potential for the worker’s income to increase with time as the result of training. (2) The insurer must notify the worker of the category selection and the reason for the selection in the NOTICE OF ELIGIBILITY FOR VOCATIONAL ASSISTANCE issued under OAR 436-120-0115(9). (3) The insurer must reconsider the category of vocational assistance within 30 days of the insurer's knowledge of a change in circumstances including, but not limited to: (a) A change in the worker’s permanent limitations; (b) A change in the labor market; or (c) The category of vocational assistance proves to be inappropriate. (4) The insurer must notify the worker within five days if the reconsideration under section (3) results in a change in the vocational assistance category. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340(7) History: WCD 15-2024, amend filed 06/07/2024, effective 07/01/2024 Renumbered from 436-120-0400, WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00 WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0083 & 436-120-0085 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88
436-120-0185 Choosing a Counselor (1) Choosing a counselor. (a) The insurer and worker must agree on a counselor within 14 days of the worker being determined eligible for vocational assistance. (b) When the parties agree on a counselor, the insurer must mail the worker a NOTICE OF SELECTION OF VOCATIONAL COUNSELOR. (c) If the parties do not agree on a counselor, the insurer must notify the division within five days, and the director will select a counselor. (2) Changing counselors. (a) If the worker or insurer requests a change in counselor, the insurer and worker must agree on a new counselor within 14 days of the request. (b) If the parties do not agree on a new counselor, the insurer must refer the matter to the division within five days. (c) Any time there is a change in counselor, the insurer must mail the worker a NOTICE OF CHANGE OF VOCATIONAL COUNSELOR. (3) Providing documents to selected counselor. The insurer must provide the vocational counselor selected under (1) or (2) of this rule all relevant vocational and medical information within 14 days of mailing the notice under (1)(b) or (2)(c) of this rule. Statutory/Other Authority: ORS 656.340 & 656.726(4) Statutes/Other Implemented: ORS 656.340 History: WCD 15-2024, amend filed 06/07/2024, effective 07/01/2024 WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10, Renumbered from 436-120-0320 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 3-2004, f. 3-5-04, cert. ef. 4-1-04 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0330 & 436-120-0370 WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0035 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88, Renumbered from 436-120-0060 WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0111 WCD 5-1983, f. 12-14-83, cert. ef. 1-1-84 WCD 2-1983, f. & cert. ef. 6-30-83 WCD 11-1982(Temp), f. 12-29-82, cert. ef. 1-1-83
436-120-0187 Optional Services (1) Optional services are services provided to: (a) A worker who is not eligible for vocational assistance; or (b) A worker who is eligible for vocational assistance, in excess of the services described in these rules. (2) Optional services are provided at the discretion of the insurer. (3) The insurer may not use optional services to circumvent the intent of these rules. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340(7) History: Renumbered from 436-120-0455, WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 Renumbered from 436-120-0910, WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95
436-120-0410 Determining a Vocational Goal A counselor must determine a suitable vocational goal for the worker using one or more of the following: (1) Vocational testing. Vocational testing must be administered by an individual certified to administer the test. (2) Job analysis. A job analysis is a detailed description of the physical and other demands of a job based on direct observation of the job. (3) On-the-job evaluation. An on-the-job evaluation must evaluate a worker's work traits, aptitudes, limitations, potentials, and habits in an actual job environment. (a) The counselor must perform a job analysis to determine if the job is within the worker’s capacities. The insurer must submit the job analysis to the attending physician if there is any question about the appropriateness of the job. (b) The evaluation should normally be no less than 20 hours in a period of seven consecutive days and should normally last no longer than 30 days. (c) The evaluation does not establish any employer-employee relationship. (d) A written report must evaluate the worker’s performance in the areas originally identified for assessment. (4) Labor market search. (a) A labor market search is obtained from direct contact with employers, other actual labor market information, or from other surveys completed within 90 days of the report date. (b) A labor market search is needed when standard labor market reference materials do not have adequate information upon which to base a decision, or there are questions about a worker’s specific limitations, training, and skills that must be addressed with employers to determine if a reasonable labor market exists. (c) The person providing the information must have hiring responsibility or direct knowledge of the job’s requirements and the job must exist at the firm contacted. (d) The labor market search report must include, but is not limited to: (A) Date of contact; (B) Firm name, address, and telephone number; (C) Name and title of person contacted; (D) Qualifications of persons recently hired; (E) Physical requirements; (F) Wages paid; (G) Condition of hire (full-time, part-time, seasonal, temporary); (H) Date and number of last hire(s); and (I) Available and anticipated openings. (e) Specific openings found in the course of a labor market search are not, in themselves, proof a reasonable labor market exists. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340(7) History: WCD 15-2024, amend filed 06/07/2024, effective 07/01/2024 WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0420 WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96 WCD 10-1994, f. 11-1-94, cert. ef 1-1-95, Renumbered from 436-120-0081 WCD 11-1987, f. 12-17-87, ef. 1-1-88
436-120-0511 Limited Training (1) Eligibility. A worker who is not authorized to work in the United States is only eligible for limited training. The worker must meet all eligibility requirements under OAR 436-120-0145. (2) Limited training plan requirements and benefits. (a) A limited training plan must meet all requirements and comply with limitations specified under OAR 436-120-0443, 436-120-0445, 436-120-0500, and 436-120-0510, unless otherwise specified under section (3) of this rule. (b) A limited training plan includes the vocational assistance specified under OAR 436-120-0443, 436-120-0445, 436-120-0500, and 436-120-0510, unless excluded under section (3) of this rule. (c) OAR 436-120-0520, 436-120-0523, 436-120-0527, and 436-120-0720 apply to limited training plans. (3) Limited training plan exclusions. (a) Limited training may not include any of the following: (A) On-the-job training; (B) Direct employment services; (C) Job placement services; (D) Return-to-work monitoring under OAR 436-120-0443(17); or (E) Return-to-work services under OAR 436-120-0500(6). (b) OAR 436-120-0197(1)(e) does not apply when a worker completes a limited training plan. (4) Re-evaluation of limited training plan. The insurer must reconsider the category of vocational assistance under OAR 436-120-0177(3) if the worker becomes authorized to work in the United States before or during a limited training plan. A worker who is authorized to work in the United States is eligible for direct employment services or training. Statutory/Other Authority: 656.340(9) & 656.726(4) Statutes/Other Implemented: 656.340 History: WCD 15-2024, adopt filed 06/07/2024, effective 07/01/2024
436-120-0523 Re-evaluating a Training Plan (1) Reasons to re-evaluate a plan. The insurer must re-evaluate a training plan and modify or replace the plan when appropriate to ensure the worker’s success, when: (a) A change occurs in the worker’s limitations that may make the training inappropriate; or (b) In an academic program: (A) There is an indication the worker may not maintain at least a 2.0 grade point average for two grading periods; or (B) There is an indication the worker may not complete the minimum credit hours required under the training plan. (2) Academic program. In an academic program: (a) The counselor must notify the insurer, and the insurer may give the worker a written warning of the possible end of training, when the worker: (A) Fails to maintain a 2.0 grade point average for two consecutive grading periods; or (B) Fails to complete the minimum credit hours in the training plan curriculum. (b) If the insurer is going to end training for a reason listed in subsection (a), the worker must be given a written warning before training is ended. (3) Non-academic program. In a non-academic program, the counselor must notify the insurer, and the insurer may give the worker a written warning of the possible end of training, at the first indication that the worker’s performance in training is unsatisfactory and may not result in employment in that field. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340(7) History: Renumbered from 436-120-0448, WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 5-2012, f. 10-3-12, cert. ef. 11-1-12 WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10, Renumbered from 436-120-0447 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10, Renumbered from 436-120-0440 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0450 & 436-120-0460 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0075 & 436-120-0085 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88, Renumbered from 436-120-0030 WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0060 WCD 5-1983, f. 12-14-83, cert. ef. 1-1-84 WCD 2-1983, f. & cert. ef. 6-30-83 WCD 11-1982(Temp), f. 12-29-82, cert. ef. 1-1-83
436-120-0527 Ending a Training Plan (1) Reasons to end training. Training ends when: (a) The worker has successfully completed training; (b) The worker’s eligibility for vocational assistance has ended under OAR 436-120-0165; (c) The worker is not actively engaged in the training; (d) The worker fails, after written warning, to maintain at least a 2.0 grade point average for two consecutive grading periods; (e) The worker fails, after written warning, to complete the minimum credit hours in the training plan curriculum for two consecutive grading periods; (f) In a non-academic program, the worker’s performance in training is unsatisfactory and further training is not likely to result in employment in that field; or (g) The training plan was not going to be successful due to reasons beyond the worker’s control. (2) Notice of end of training. When training ends, the insurer must mail a NOTICE OF END OF TRAINING to the worker. The notice must: (a) Include the date the training plan ended. The effective date is the worker’s last date of attendance; and (b) State whether the worker is entitled to more training. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340(7) History: Renumbered from 436-120-0451, WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 5-2012, f. 10-3-12, cert. ef. 11-1-12, Renumbered from 436-120-0447 WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10, Renumbered from 436-120-0440 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0450 & 436-120-0460 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0075 & 436-120-0085 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88, Renumbered from 436-120-0030 WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0060 WCD 5-1983, f. 12-14-83, cert. ef. 1-1-84 WCD 2-1983, f. & cert. ef. 6-30-83 WCD 11-1982(Temp), f. 12-29-82, cert. ef. 1-1-83
436-120-0530 Director Review of Return-to-Work Plan The director may review return-to-work plans and supporting information. If the director finds a return-to-work plan or its supporting information does not conform to these rules: (1) The director will notify the insurer and provider in writing of the preliminary finding of nonconformance. The notification will inform the insurer of changes or information required to bring the plan into conformance. (2) The insurer must, within 30 days of notification, make appropriate changes, supply additional information requested by the director, or explain why no change should be made. (3) If the insurer does not respond timely or is unable to bring the plan into conformance, the director will return the plan to the parties with notification that the plan does not conform to OAR 436-120 and may order the insurer to develop a plan that conforms to the rules. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340 History: WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00 WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0170 & 436-120-0215 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88 WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0172 WCD 5-1983(Admin), f. 12-14-83, cert. ef. 1-1-84
436-120-0700 Direct Worker Purchases (1) Purchases, generally. (a) The insurer must provide the direct worker purchase categories listed in OAR 436-120-0710 as necessary for the worker’s participation in vocational assistance and to meet the requirements of a suitable job. (b) The worker is no longer eligible for these purchases once eligibility ends unless the purchases are necessary to complete a plan. (c) Direct worker purchases include partial purchase, lease, rental, and payment. (2) Exclusions. Direct worker purchases do not include: (a) Purchases of real property; (b) Payment of fines or other penalties; or (c) Payment of additional driver’s license costs, increased insurance costs, or any other costs attributable to problems with the worker's driving record. (3) Alternative purchases. In making its decision regarding a direct worker purchase, the insurer may choose the least expensive, adequate alternative. If the worker wants a direct worker purchase that is more expensive than that authorized by the insurer, the worker may select that alternative and pay the difference in cost. (4) Approval or denial. Within 14 days of its receipt of a request for a direct worker purchase, the insurer must approve the purchase or notify the worker of its denial. (5) Payment. The insurer must pay for approved direct worker purchases in time to prevent delay in the provision of services, but in no event later than 30 days after the insurer receives the worker’s request or proof of payment, whichever is later. (6) Advancement of costs, worker reimbursement. The worker may pay for mileage, child or senior care, or for purchases such as clothing, books, and supplies or the worker may request an advance of any of these costs based on documentation of need. (a) The insurer must reimburse costs within 30 days of receiving a written request from the worker and any supporting documentation. (b) The insurer must return denied requests for reimbursement to the worker within 30 days of receiving the request with an explanation of the reason for nonpayment. (7) Right and title to nonexpendable purchases. The insurer must assign to the worker right and title to the nonexpendable direct worker purchases paid by the insurer. (a) The insurer must make such assignment no later than the 60th day of continuous employment unless the worker remains eligible and the suitability of the employment is in question. (b) The insurer may repossess nonexpendable property if the worker no longer requires the property for training or employment. (c) The insurer may require repayment of advancements or reimbursements if the worker misrepresented information material to the purchase decision or if the worker used the funds for something other than the approved purchase. Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340 History: WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0087 WCD 11-1987, f. 12-17-87, ef. 1-1-88
436-120-0720 Fee Schedule (1) The director has established the fee schedule in section (3) of this rule for professional costs and direct worker purchases. The schedule sets maximum spending limits per claim opening for each category; however, the insurer may spend more than the maximum limit. Spending limits will be adjusted annually, effective July 1, based on the conversion factor published with the cost-of-living matrix in Bulletin 124. (2) For workers needing an extended training plan under OAR 436-120-0443, the fee schedule spending limits for the Training category and Direct Employment/Training Combined category listed below must be increased by 30 percent. (3) Amounts include professional costs, travel and wait time, and other travel expenses: [Table not included. See ED. NOTE.] NOTE: *Each limit is shown as a percentage of Oregon's state average weekly wage (SAWW), determined under ORS 656.211. Dollar amounts are published in Bulletin 124 and are adjusted annually, effective July 1, based on changes in the SAWW. (4) The insurer must pay, within 60 days of receipt, the provider’s bill for services provided under the insurer-provider agreement. The insurer may not deny payment on the grounds the worker was not eligible for the assistance if the provider performed the services in good faith without knowledge of the ineligibility. [ED. NOTE: Tables referenced are available from the agency.] [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: ORS 656.340(9) & 656.726(4) Statutes/Other Implemented: ORS 656.340 & 656.258 History: WCD 15-2024, amend filed 06/07/2024, effective 07/01/2024 WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07 WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05 WCD 3-2004, f. 3-5-04, cert. ef. 4-1-04 WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02 WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01 WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00 WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96 WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0070 & 436-120-0215 WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88 WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0120 WCD 5-1983, f. 12-14-83, cert. ef. 1-1-84 WCD 2-1983, f. & cert. ef. 6-30-83 WCD 11-1982(Temp), f. 12-29-82, cert. ef. 1-1-83 WCD 4-1981, f. 12-4-81, cert. ef. 1-1-82 WCD 6-1980, f. 5-22-80, cert. ef. 6-1-80
436-120-0755 Reimbursement from the Workers’ Benefit Fund (1) Reimbursement. The director will reimburse the insurer for costs associated with providing vocational benefits when: (a) The director issues an order overturning the insurer’s denial of vocational benefits; and (b) The insurer’s denial is later upheld by a final order. (2) Required documentation. To receive reimbursement from the Workers’ Benefit Fund, the insurer must provide the division with the following documentation, within one year from the date of the final order: (a) Worker’s name and Workers’ Compensation Division’s claim file number; (b) Date and order number of the director’s order appealed; (c) Itemized listing with dates of service for all costs incurred after the date of the director’s order that was reversed. All costs, in order to be reimbursed, must meet all conditions set forth in these rules, and reimbursement requests must: (A) Use terms, “direct employment” or “training” to show the category of vocational assistance provided; (B) List provider costs by category of “professional services”; (C) List direct worker purchases by the categories in OAR 436-120-0710, and include purchase dates and costs; (D) Show temporary total disability paid between the start and end dates of the return to work plan; and (E) List any other costs incurred in providing vocational benefits as a result of the order that was appealed. (d) Signed statement certifying that the requested reimbursement amount was actually paid; and (e) The insurer’s name and address where reimbursement is to be sent. (3) Administrative costs not reimbursable. No reimbursement is allowed for the insurer’s administrative costs. Statutory/Other Authority: 656.726(4) Statutes/Other Implemented: ORS 656.313, 656.605, OL 2005, Ch. 588, sec. 4 & 5 History: WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06