justicedao/ipfs_state_laws huggingface dataset:
436-070-0050 Assessment of Civil Penalties The director may assess a civil penalty under ORS 656.745(2) against an employer that does not comply with ORS chapter 656, OAR 436-070, or an order of the director. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.745 History: WCD 11-2021, amend filed 10/12/2021, effective 01/01/2022 WCD 12-2019, amend filed 12/18/2019, effective 01/01/2020 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
436-075-0003 Applicability of Rules (1) These rules apply to all requests for reimbursement from the Retroactive Program involving benefits payable under: (a) ORS 656.204 Death; (b) ORS 656.206 Permanent Total Disability; (c) ORS 656.208 Death During Permanent Total Disability; and (d) ORS 656.210 Temporary Total Disability for injuries before April 1, 1974. (2) 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 656.204 [OL 2017, ch. 71], ORS 656.206 [OL 2017, ch. 70], ORS 656.208, ORS 656.209, ORS 656.210, ORS 656.236, ORS 656.289 & ORS 656.506 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 10-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0005 Definitions Unless a term is specifically defined elsewhere in these rules or the context otherwise requires, the definitions of ORS chapter 656 are hereby incorporated by reference and made a part of these rules. For the purposes of these rules, unless the context requires otherwise: (1) “Child” is as defined in ORS chapter 656 applicable at the worker’s date of injury. (2) “Department” means the Department of Consumer and Business Services. (3) “Director” means the director of the Department of Consumer and Business Services or the director’s designee. (4) “Insurer” means the State Accident Insurance Fund Corporation, an insurer authorized under ORS Chapter 731 to transact workers’ compensation insurance in this state, or an employer or employer group that has been certified as self-insured under ORS 656.430. (5) “Mailed” or “mailing date,” unless otherwise specified, means: (a) The date a document is postmarked; (b) The date automatically produced by electronic transmission (e.g., email or facsimile); (c) The date a hand-delivered document is stamped or punched in by the recipient; or (d) The date of a phone, or in-person request, when allowed under these rules. (6) “Retroactive Program benefit” means the additional amount paid to an eligible worker or beneficiary when benefit levels are lower than what is currently paid for like injuries. (7) “Spouse” includes cohabitants under ORS 656.226. (8) “Statutory benefit” means any benefit payable to or on behalf of the injured worker under the law in effect at the time of the worker’s injury, as modified by marital and dependency status changes. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.005 & ORS 656.726(4) History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 10-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0008 Administrative Review (1) Any party aggrieved by a proposed order or proposed assessment of civil penalty issued under ORS 656.745 may request a hearing by the Hearings Division of the Workers’ Compensation Board under ORS 656.740. To request a hearing the party, or assigned claims agent, must: (a) Mail or deliver a written request for hearing to the Workers’ Compensation Division within 60 days of the mailing date of the proposed order or assessment; and (b) Specify the reasons why the party or assigned claims agent disagrees with the proposed order or assessment in the request. (2) Any party that disagrees with an action or order of the director under these rules, other than as described in section (1) of this rule, 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 656.726(4) Statutes/Other Implemented: ORS 656.704, ORS 656.740 & ORS 656.745 History: WCD 26-2024, minor correction filed 06/18/2024, effective 06/18/2024 WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 10-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0010 Criteria for Eligibility (1) The department will issue a bulletin to notify all insurers of changes in the Retroactive Program benefit levels whenever the director determines a change is necessary under ORS 656.506(7). (2) Eligibility for Retroactive Program benefits is based on the worker’s injury date as follows: (a) Workers or beneficiaries eligible to receive either death or permanent total disability benefits become eligible for Retroactive Program benefit increases when the benefits granted under the Retroactive Program bulletin exceed the benefits provided by the statute in effect at the time of the injury. (b) Workers receiving temporary total disability benefits are eligible for Retroactive Program benefit increases as follows: (A) Workers with injuries occurring before July 1, 1973 are eligible for Retroactive Program benefit increases; (B) Workers with injuries occurring from July 1, 1973 through April 1, 1974 may be eligible for benefits according to the limits defined in the Retroactive Program bulletin; and (C) Workers with injuries occurring on or after April 1, 1974 are not eligible to receive Retroactive Program increases to their temporary total disability benefit. (3) A claim is not eligible for Retroactive Program benefits if all issues except compensable medical services are disposed of under ORS 656.236 or settled under ORS 656.289 before becoming eligible under section (2) of this rule. (4) Costs for claims of subject workers of a noncomplying employer under ORS 656.052 are not eligible for reimbursement from the program, but remain a cost recoverable from the employer under ORS 656.054(2). Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.236, ORS 656.289 & ORS 656.506 History: WCD 16-2018, minor correction filed 09/17/2018, effective 09/17/2018 WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0020 Death Benefit (1) Death benefits must be paid to eligible beneficiaries under ORS 656.204, OAR 436-060-0075, and the benefit schedules in the Retroactive Program bulletin. (2) The statutory death benefit for injuries occurring from July 1, 1973 through April 1, 1974 will be reduced by the Social Security benefits received by the worker’s surviving spouse, not to exceed the July 1, 1973 statutory benefit level. The amount of reduction to the statutory benefit is a Retroactive Program benefit. The insurer may request reimbursement only for the adjusted Retroactive Program benefit. (3) At least once every two years, the insurer must verify that all beneficiaries receiving death benefits for which the insurer may request reimbursement from the Retroactive Program are alive and remain eligible for those benefits. Insurers’ questions regarding beneficiaries’ status must be reasonably pertinent to the continuing eligibility of those persons for benefits. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.204 [OL 2017, ch. 71] & ORS 656.506 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0030 Permanent Total Disability Benefit (1) Permanent total disability benefits must be paid under ORS 656.206 and the benefit schedules in the Retroactive Program bulletin. (2) Benefits payable for a partial month must be calculated by dividing the monthly benefit by the actual number of days in the month and multiplying that result by the number of days payable. (3) Except as specified in OAR 436-060-0075(7), benefits for beneficiaries must be paid to the date of any status change. (4) Any Social Security offset determined under ORS 656.209 must first be applied against the statutory portion of the permanent total disability benefit. Any amount of the Social Security offset that exceeds the statutory benefit must be applied against the Retroactive Program benefit. The insurer may request reimbursement only for that portion of the Retroactive Program benefit that has not been offset. (5) At least once every two years, the insurer must verify that all beneficiaries receiving benefits for which the insurer may request reimbursement from the Retroactive Program are alive and remain eligible for those benefits. Such “status checks” of beneficiaries may occur at the same time the insurer re-examines the permanent total disability claim under OAR 436-030-0065(1). Insurers’ questions regarding beneficiaries’ status must be reasonably pertinent to the continuing eligibility of those persons for benefits. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.206 [OL 2017, ch. 70], ORS 656.209 & ORS 656.506 History: WCD 5-2025, amend filed 12/23/2025, effective 01/01/2026 WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0040 Death During Permanent Total Disability (1) If the injured worker dies during the period of permanent total disability, death benefits must be paid to eligible beneficiaries under ORS 656.208, 656.204, OAR 436-060-0075, and the benefit schedules in the Retroactive Program bulletin. (2) The statutory death benefit for injuries occurring from July 1, 1973 to April 1, 1974 will be reduced by the Social Security benefits received by the worker or the worker’s surviving spouse, not to exceed the July 1, 1973 statutory benefit level. The amount of reduction to the statutory benefit is a Retroactive Program benefit. The insurer may request reimbursement only for the adjusted Retroactive Program benefit. (3) At least once every two years, the insurer must verify that all beneficiaries receiving death benefits for which the insurer may request reimbursement from the Retroactive Program are alive and remain eligible for those benefits. Insurers’ questions regarding beneficiaries’ status must be reasonably pertinent to the continuing eligibility of those persons for benefits. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.204 [OL 2017, ch. 71], ORS 656.208 & ORS 656.506 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0050 Temporary Total Disability (1) Temporary total disability benefits must be paid under ORS 656.210, OAR 436-060-0150, and the benefit schedules in the Retroactive Program bulletin. (2) The computation of benefits under these rules and the Retroactive Program bulletin may not reduce temporary total disability benefits currently being paid. Statutory/Other Authority: ORS 656.506 Statutes/Other Implemented: ORS 656.210 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0065 Dispositions (1) Any disposition of the claim by the parties under ORS 656.236, or settlement of the claim under ORS 656.289, is not eligible for reimbursement from the Retroactive Program unless it is approved by the director before it is submitted to the Workers’ Compensation Board. (2) Requests for the director’s approval of proposed dispositions must be made in writing, and must include: (a) A copy of the proposed disposition that specifies the amount of the proposed contribution to be made from the Retroactive Program; (b) A statement from the insurer indicating how the amount of the contribution was calculated; and (c) Any other information required by the director. (3) The director will not approve the disposition if: (a) The ratio of the amount requested from the program to the total amount of the disposition exceeds the percentage of current benefits due the worker from the program; or (b) The settlement exceeds a reasonable projection of future liability. (4) The insurer must submit dispositions to the Workers’ Compensation Division in the format prescribed by the director. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.236 & ORS 656.289 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 10-1990(Temp), f. 6-18-90, cert. ef. 7-1-90
436-075-0070 Reimbursement (1) Reimbursement from the Retroactive Program will be authorized by the Workers’ Compensation Division on a quarterly basis. (2) Requests for reimbursement must be mailed or delivered to the Workers’ Compensation Division within 30 days after the end of each calendar quarter to be processed in that quarterly disbursement. (3) Requests for reimbursement mailed or delivered to the Workers’ Compensation Division more than 30 days after the end of the quarter will be processed with the next quarterly disbursement. (4) A separate request for reimbursement must be submitted for each insurer and include a signed certification that the payments reported on the request have been made in the amounts reported. (5) The insurer must use Form 3285, “Request for Reimbursement from the Retroactive Program,” or an equivalent form, to request reimbursement from the Retroactive Program. (a) If an equivalent form is used, it must include all of the data elements on Form 3285; and (b) Each request must accurately reflect the marital and dependency status in effect and eligible for reimbursement in the period requested. (6) The director will not process any request that does not meet the requirements of section (4) and (5) of this rule. (7) The department will recover any overpayment made to an insurer as a result of an insurer reporting error or incorrect information submitted on a quarterly request form. (8) If a denied claim is found to be compensable by an administrative law judge, the Workers’ Compensation Board, or the Court of Appeals, and that decision is subsequently reversed by a higher level of appeal, the insurer will receive reimbursement for Retroactive Program benefit payments required to be made while the claim was in an accepted status. Statutory/Other Authority: ORS 656.506 & ORS 656.726(4) Statutes/Other Implemented: ORS 656.506 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0090 Third Party Recovery (1) In a third party recovery, previously reimbursed Retroactive Program benefits are a portion of the paying agency’s lien. (2) When the insurer learns of third-party settlement negotiations on any claim for which it has received reimbursement from the Retroactive Program, the insurer must notify the Workers’ Compensation Division. (3) The insurer must make remittance on recovered Retroactive Program benefits to the department in the quarter following the recovery in amounts determined under ORS 656.591 and 656.593. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.506, ORS 656.591 & ORS 656.593 History: WCD 6-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-075-0100 Assessment of Civil Penalties Under ORS 656.745 the director may assess a civil penalty against an insurer for failure to comply with these rules. Penalty orders will be issued under ORS 656.447 and 656.704 and are subject to review under OAR 436-075-0008. Statutory/Other Authority: ORS 656.745 Statutes/Other Implemented: ORS 656.204, 656.726, 656.745 & 656.447 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 23-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 10-1990(Temp), f. 6-18-90, cert. ef. 7-1-90 WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90
436-080-0003 Applicabililty and Purpose of Rules (1) Purpose. These rules carry out the provisions of ORS 656.017, 656.052, 656.054, 656.407, 656.735, and 656.740. (2) Applicability. These rules apply to all orders issued under ORS 656.052, 656.735, or 656.740 on or after the effective date of these rules. (3) Director’s discretion. The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.017, 656.052, 656.054, 656.735 & 656.740 History: WCD 20-2018, amend filed 11/15/2018, effective 01/01/2019 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 2-1998, f. 1-9-98, cert. ef. 1-23-98 WCD 1-1996, f. 1-3-96, cert. ef. 1-5-96 WCD 4-1992, f. 1-10-92, cert. ef. 2-1-92 WCD 26-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 7-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1978, f. 3-31-78, cert. ef. 4-1-78, Renumbered from 436-052-0055 WCB 15-1975, f. 9-22-75, cert. ef. 10-11-75 WCB 4-1974, f. 2-13-74, cert. ef. 3-11-74 WCB 4-1973(Temp), f. & cert. ef. 12-6-73
436-080-0005 Definitions Unless a term is defined in these rules or the context otherwise requires, the definitions of ORS chapter 656 are incorporated by reference and made part of these rules. For the purpose of these rules, unless the context requires otherwise: (1) “ Board ” means the Workers’ Compensation Board and includes its Hearings Division. (2) “ Director ” means the director of the Department of Consumer and Business Services or the director’s designee. (3) “ Noncomplying employer order ” means an order issued under these rules declaring an employer to be a noncomplying employer and containing the amount of civil penalty assessed under ORS 656.735, if any. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.726 History: WCD 20-2018, amend filed 11/15/2018, effective 01/01/2019 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 5-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 7-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1978, f. 3-31-78, cert. ef. 4-1-78, Renumbered from 436-052-0008
436-080-0010 Issuance of Noncomplying Employer Order; Requests for Hearing (1) Issuance of noncomplying employer order. If the director determines that a person has engaged as a subject employer without qualifying as a carrier-insured employer or a self-insured employer as provided in ORS 656.017 and 656.407, the director will issue a noncomplying employer order. (2) Request for hearing. An employer may contest a noncomplying employer order by requesting a hearing under ORS 656.740, subject to the following: (a) The request for hearing must be made in writing; (b) The request must specify the grounds upon which the employer contests the order; (c) The request must be filed with the director within 60 calendar days after the mailing date of the order; and (d) OAR 436-001-0030(2) through (5) apply to hearings requested under this section. (3) Proceedings to enjoin a noncomplying employer. The director may request the Department of Justice to commence proceedings to enjoin a noncomplying employer that does not request a hearing within the timeframe specified under subsection (2)(c) of this rule from employing subject workers without complying with ORS 656.017. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.017, 656.052, 656.735, 656.407 & 656.740 History: WCD 4-2019, minor correction filed 05/24/2019, effective 05/24/2019 WCD 20-2018, amend filed 11/15/2018, effective 01/01/2019 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 1-1996, f. 1-3-96, cert. ef. 1-5-96 WCD 26-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1978, f. 3-31-78, cert. ef. 4-1-78, Renumbered from 436-052-0015 WCB 15-1975, f. 9-22-75, cert. ef. 10-11-75 WCB 4-1974, f. 2-13-84, cert. ef. 3-11-74 WCB 4-1973(Temp), f. & cert. ef. 12-6-73 WCB 10-1970, f. & cert. ef. 7-24-70
436-080-0060 When a Worker Files a Claim for an Injury (1) Referral of claim to assigned claims agent. If a worker files a claim for an injury sustained while the worker was employed by a noncomplying employer, the director will: (a) Refer the claim, with a copy of the noncomplying employer order and the results of the compliance investigation, to the assigned claims agent for processing; and (b) Issue a Notice of Referral to the worker, the worker’s representative, if represented, and the employer. The notice will inform the employer of its right to object to the claim. (2) Request for hearing to object to a claim. An employer may request a hearing to object to a claim referred to the assigned claims agent under this rule. The request for hearing must be filed with the board within 60 calendar days after the mailing date of the Notice of Referral issued under subsection (1)(b) of this rule. (3) Processing of claim. When the assigned claims agent accepts or denies the claim, it must notify the worker, employer, and the d irector within the time provided by ORS 656.262. (4) Nonsubjectivity determinations. If a worker files a claim for an injury and the director determines that the worker was not a subject worker, or the employer was not a subject employer, the director will notify the worker and the employer by issuing a nonsubjectivity determination. (5) Request for hearing on nonsubjectivity determination. A worker may request a hearing on a nonsubjectivity determination, subject to the following: (a) The request for hearing must be filed within 60 days after the mailing date of the determination; (b) The request for hearing must be sent to the director; (c) The worker and employer are parties to the hearing; and (d) OAR 436-001-0030(2) through (5) apply to hearings requested under this section. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.054 & 656.740 History: WCD 20-2018, amend filed 11/15/2018, effective 01/01/2019 WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04 WCD 2-1998, f. 1-9-98, cert. ef. 1-23-98 WCD 9-1997(Temp), f. & cert. ef. 8-1-97 WCD 1-1996, f. 1-3-96, cert. ef. 1-5-96 WCD 14-1992, f. & cert. ef. 10-13-92 WCD 8-1992(Temp), f. & cert. ef. 4-15-92 WCD 26-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 7-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1978, f. 3-31-78, cert. ef. 4-1-78, Renumbered from 436-052-0040 WCB 15-1979, f. 9-22-75, cert. ef. 10-11-75 WCB 4-1974, f. 2-13-74, cert. ef. 3-11-74 WCB 4-1973(Temp), f. & cert. ef. 12-6-73