justicedao/ipfs_state_laws huggingface dataset:
436-080-0065 Determination of Assigned Claims Agent (1) When selecting an assigned claims agent, the d irector will consider: (a) Which claims agent can deliver the most timely and appropriate benefits to injured workers and can best control claim costs and administrative costs, based on claims processing performance and other available data; and (b) Any other factors the d irector considers appropriate. (2) If no qualified entity agrees to be an assigned claims agent, the director may require one or more of the three highest premium producing insurers to be assigned claims agents, based on the criteria under section (1) of this rule. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.054 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 1-1996, f. 1-3-96, cert. ef. 1-5-96
436-080-0080 Collection of Monies Withheld from Subject Workers The director will collect any unremitted monies withheld by a noncomplying employer from subject workers under ORS 656.506, as described under OAR 436-070. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.506 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 5-1978(Admin), f. 3-31-78, ef. 4-1-78; Renumbered from 436-052-0051, 5-1-85; WCD 7-1987, f. 12-18-87, ef. 1-1-88; WCD 5-1989, f. 12-22-89, cert. ef. 1-1-90; WCD 1-1996, f. 1-3-96, cert. ef. 1-5-96
436-085-0003 Purpose and Applicability (1) These rules carry out the workers’ compensation law related to the development and collection of assessments from insurers, self-insured employers, and self-insured employer groups. (2) These rules apply to assessments paid by insurers, self-insured employers, and self-insured employer groups under ORS 656.612 and 656.614. (3) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.612 & 656.614 History: WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 3-2011, f. 5-16-11, cert. ef. 7-1-11 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 10-1991, f. 12-13-91, cert. ef. 1-1-92 WCD 24-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-085-0005 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) "Assessable earned premium" means the amount of earned premium that is subject to premium assessment. (2) "Board" means the Workers’ Compensation Board and includes its Hearings Division. (3) "Director" means the director of the Department of Consumer and Business Services or the director’s designee. (4) "Earned premium" means the total amount of workers’ compensation insurance premium earned by an insurer before any modification for premium assessment purposes. (5) "Exempted earned premium" means premium earned on: (a) Insurance under the jurisdiction of the federal government, including the Longshore and Harbor Workers’ Compensation Act, Federal Employers Liability Act, and Jones Act; and (b) Employer liability increased limits premium that would be reported on Statutory Page 14 (Business in the State of Oregon), column 2, line 16 of the insurer’s annual statement under OAR 836-011-0000. (6) "Insurer" means the State Accident Insurance Fund Corporation or an insurer authorized under ORS chapter 731 to transact workers’ compensation insurance in this state. (7) "Premium assessments" means moneys due the director under ORS 656.612 and 656.614. (8) "Self-Insured employer" means an employer that has been certified under ORS 656.430 as having met the qualifications of a self-insured employer set out by ORS 656.407. (9) "Self-Insured employer group" means five or more employers certified under ORS 656.430 as having met the qualifications of a self-insured employer set out by ORS 656.407 and OAR 436-050-0260 through 436-050-0340. Statutory/Other Authority: ORS 656.612 & 656.726 Statutes/Other Implemented: ORS 656.612 & 656.614 History: WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 3-2011, f. 5-16-11, cert. ef. 7-1-11 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 24-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-085-0008 Administrative Review (1) Any party that disagrees with a proposed order or proposed assessment of civil penalty issued by the director under these rules may request a hearing by the board under ORS 656.740. To request a hearing, the party must: (a) Mail or deliver a written request to the Workers' Compensation Division within 60 days of the mailing date of the proposed order or assessment; and (b) Specify, in the request, the reasons why the party disagrees with the proposed order or assessment. (2) Any party that disagrees with an action taken under these rules, other than as described in section (1) of this rule, may request a hearing as provided under OAR 436-001-0019 by filing a request within 30 days of the mailing date of the notice of action. OAR 436-001 applies to the hearing. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704, 656.735, 656.740 & 656.745 History: WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 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 10-1991, f. 12-13-91, cert. ef. 1-1-92 WCD 24-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-085-0015 Premium Assessment; Determination of Assessable Premium: Insurers (1) For the purpose of these rules, "direct earned premium," as used in ORS 656.612 means "assessable earned premium." (2) Assessable earned premium must be calculated by making the following modifications to earned premium: (a) Subtracting exempted earned premium. The amount of exempted earned premium subtracted must be determined on a direct basis prior to reinsurance transactions; and (b) Adding large deductible premium credits or modifications. (3) Earned premium must be calculated in the same manner as direct premiums earned, as reported on Statutory Page 14 (Business in the State of Oregon), column 2, line 16 of the insurer’s annual statement under OAR 836-011-0000. Earned premium: (a) Excludes reinsurance accepted and is without deduction of reinsurance ceded; (b) Excludes large deductible credits or modifications; (c) Includes experience rating, premium discounts, retrospective rating, audit premiums, foreign terrorism premiums, domestic terrorism and catastrophic premiums, and other individual risk rating adjustments; and (d) Excludes deposit premiums. Statutory/Other Authority: ORS 656.612 & 656.726(4) Statutes/Other Implemented: ORS 656.612 History: WCD 10-2019, adopt filed 12/17/2019, effective 01/01/2020
436-085-0025 Premium Assessment; Manner and Intervals for Reporting and Payments: Insurers (1) Insurers must report and pay premium assessments using a completed Form 910, “Workers’ Compensation Insurer Premium Assessment Report.” The report must be signed by the person who prepares the report. (2) An insurer must report and pay premium assessment based on the insurer’s assessable earned premium and the premium assessment rate in effect under OAR 440-045 no later than: (a) November 15, for the quarter ending September 30; (b) February 15, for the quarter ending December 31; (c) May 15, for the quarter ending March 31; and (d) August 15, for the quarter ending June 30. (3) The director may allow an insurer to report and pay premium assessments annually when the insurer’s annual premium assessment has been less than $1,000 for at least two consecutive years. (a) An eligible insurer under this section may choose to: (A) Continue reporting and paying quarterly; or (B) Revert to reporting and paying quarterly after having reported and paid annually for at least one year. (b) The insurer must notify the director of its choice in writing before the first quarter’s premium assessment due date. An insurer’s reporting and payment frequency remains in effect for the full calendar year and cannot be changed mid-year. (4) The director may waive an insurer’s reporting requirement after confirming that the insurer has had no earned premium for at least four consecutive quarters. A waiver remains in effect until premium is earned. (5) Assessable earned premium reported by insurers is final except for corrections made as a result of audits by the director, examinations by the Division of Financial Regulation or insurance regulator of the insurer’s state of domicile, or detection of a clerical error by the insurer. All such corrections will be made at the premium assessment rate in effect for the year being corrected. (6) Each insurer, including each insurer operating within an insurer group, must report and pay premium assessment using a separate Form 910 and check. (7) The insurer must maintain sufficient documentation for the director to verify the amount of assessable earned premium reported to the director and any adjustments or corrections. Statutory/Other Authority: ORS 656.612 & 656.726(4) Statutes/Other Implemented: ORS 656.612 History: WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 3-2011, f. 5-16-11, cert. ef. 7-1-11 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 7-1995, f. 7-20-95, cert. ef. 10-1-95 WCD 10-1991, f. 12-13-91, cert. ef. 1-1-92 WCD 24-1990, f. 11-29-90, cert. ef. 12-26-90 WCD 5-1987, f. 12-18-87, cert. ef. 1-1-88 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-085-0035 Audits The director will monitor and conduct periodic audits of insurers, self-insured employers, and self-insured employer groups to ensure compliance with these rules. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.726 History: WCD 10-2019, amend filed 12/17/2019, effective 01/01/2020 WCD 2-2005, f. 3-24-05, cert. ef. 4-1-05 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-085-0060 Assessment of Civil Penalties The director may assess a civil penalty under ORS 656.745(2) against an insurer, self-insured employer, or self-insured employer group that violates ORS chapter 656, OAR 436-085, or an order of the director. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.745 History: 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 10-1991, f. 12-13-91, cert. ef. 1-1-92 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86
436-100-0001 Authority for Rules These rules are promulgated under the Director’s authority contained in ORS 656.726 and 656.727. Statutory/Other Authority: ORS 656 Statutes/Other Implemented: ORS 656.209, 656.726 & ORS 656.727 History: WCD 2-1984, f. & ef. 2-22-84, Renumbered from 436-057-0001 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0002 Purpose of Rules The purpose of these rules is to establish requirements and procedures for offsetting permanent total disability benefits against social security disability benefits. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered to 436-057-0004 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0003 Applicability of Rules (1) These rules are effective January 1, 2016, to carry out the provisions of ORS 656.209 and 656.727. (2) These rules apply to: (a) Those workers receiving awards for permanent total disability and eligible for and receiving federal social security disability benefits; and (b) Injured workers whose period of disability under the Social Security Administration began on or after June 1, 1965. (3) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0003 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0005 Definitions (1) “Authorization” means an order issued by the Workers’ Compensation Division directing the paying agent to offset the worker’s permanent total disability benefits by the amount specified in the order. (2) “Beneficiary” means an injured worker, and the spouse, child or dependent of a worker, who is entitled to receive payments under ORS 656.001 through 656.794. (3) “Department” means the Department of Consumer and Business Services. (4) “Director” means the director of the Department of Consumer and Business Services or the director’s designee. (5) “Division” means the Workers’ Compensation Division. (6) “Federal Disability Benefit Limitation” means the amount determined under 42 USC 224(a) and Social Security Administration rules. (7) “Offset” means a reduction of permanent total disability benefits based on the amount of federal social security disability benefits received by a worker. (8) “Paying agency” or “paying agent” means the self-insured employer or insurer paying benefits to the worker or beneficiaries. (9) “Performance Section” means the Performance Section of the Workers’ Compensation Division. (10) “Permanent total disability benefits” means compensation to an injured worker awarded permanent total disability compensation under ORS 656.206. (11) “Worker” means any worker receiving permanent total disability benefits. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.209 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0005 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0006 Administration of Rules In administration of these rules, orders of the Workers’ Compensation Division are deemed orders of the director. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.209 & 656.726 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0008 Administrative Review (1) Any worker aggrieved by any offset authorization of the division may apply to the Workers’ Compensation Division for a reconsideration of that authorization before requesting a hearing. (2) Any party aggrieved may request a hearing under ORS 656.283. Statutory/Other Authority: ORS 656.726 & 656.727 Statutes/Other Implemented: ORS 656.209 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98, Renumbered from 436-057-0998 WCD 2-1984, f. & cert. ef. 2-22-84 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0010 Criteria for Eligibility (1) Permanent total disability benefits must be offset by the workers’ social security disability benefits. However, the total combined benefit, permanent total disability benefits plus social security disability benefits, must not be offset to an amount less than the greater of: (a) The amount the worker would have received under ORS chapter 656; or (b) The Federal Disability Benefit Limitation. (2) Permanent total disability benefits must not be paid by the paying agent in an amount greater than authorized by ORS Chapter 656. (3) Offset of permanent total disability benefits must be made by a paying agent only in an amount and as authorized by the director. (4) Offset of permanent total disability benefits will be authorized by the director only upon actual receipt of federal social security disability benefits by the injured worker. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0100 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0020 Requirements of Workers (1) Workers entitled to receive permanent total disability benefits must make application for federal social security disability benefits. (2) Workers and eligible beneficiaries must, upon department request, execute a release form authorizing the Social Security Administration to make disclosure to the department of such information regarding the injured workers as will enable the department to carry out the provisions of ORS 656.209 and these rules. (3) Whenever there is a change in the federal social security beneficiary eligibility, the worker must notify the Performance Section. (4) Upon request of the department, the worker may be required at any time to furnish additional information regarding social security disability benefits. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 & 656.727 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0115 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0030 Authorization of Offset; Effective Date (1) Authorization issued by the department will be directed to the paying agent with a copy to the injured worker. (2) A paying agent making payment of permanent total disability benefits will be entitled to social security disability offset only as authorized by the department. (3) The department will review the social security offset calculation when notified of a change in the status of a worker subject to social security offset. An amended authorization will be issued, if necessary. (4) Whenever there is a change in eligibility status of the worker or any one of the worker’s beneficiaries receiving benefits for permanent total disability subject to offset, the paying agent must notify the Performance Section. (5) The paying agent must, immediately upon the death of a worker, terminate payment of previously authorized permanent total disability benefits offset and begin payment of other compensation due under ORS Chapter 656, if any. (6) The effective date of offset must be the effective date established in the authorization. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 & 656.727 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0130 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-100-0040 Sanctions Against Worker for Failure to Cooperate with the Department (1) Any worker entitled to receive permanent total disability benefits who fails to comply with these rules will be subject to suspension of benefits until the worker has complied. (2) If a worker fails to comply with these rules, the director will make a written demand upon the worker by personal service or registered mail. If the worker fails to comply within 20 days of receipt of the demand, the director may authorize suspension of benefits until the worker complies. (3) An order of suspension of benefits will continue in force from the date issued until the date the worker actually complies with these rules. (4) No compensation will become due or be payable during a period of suspension of benefits. Statutory/Other Authority: ORS 656.209 & 656.727 Statutes/Other Implemented: ORS 656.209 & 656.727 History: WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16 WCD 2-1984, f. & cert. ef. 2-22-84, Renumbered from 436-057-0150 WCD 4-1983(Temp), f. & cert. ef. 9-1-83 WCB 7-1978, f. 6-5-78, cert. ef. 6-6-78
436-105-0003 Purpose and Applicability (1) Purpose. (a) The rules in OAR 436-105 explain who qualifies for and how to request assistance and reimbursements from the Employer-at-Injury Program. (b) The Employer-at-Injury Program encourages the early return to work of injured workers by providing incentives from the Workers’ Benefit Fund to employers. (c) The Employer-at-Injury Program is activated by the employer and administered by the insurer. (d) The purpose of Employer-at-Injury Program assistance is to : (A) Enabl e the worker to perform transitional work within the worker’s limitations that resulted in the worker’s eligibility for the Employer-at-Injury Program; (B) Prevent a worsening of the worker’s compensable injury or occupational disease; or (C) If the claim has not been accepted or denied, prevent a worsening of the claimed workers’ compensation injury or occupational disease. (2) Applicability. (a) These rules apply to: (A) All individual employer-at-injury programs started on or after the effective date of these rules, unless otherwise provided in paragraph (B) or (C) of this subsection; (B) All wage subsidy reimbursement requests when the wage subsidy period began on or after the effective date of these rules; and (C) All reimbursement requests received by the division on or after the effective date of these rules for worksite modification or program purchases, regardless of when the purchase was made. (b) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.622 & 656.726(4) Statutes/Other Implemented: ORS 656.622 History: WCD 11-2019, amend filed 12/18/2019, effective 01/01/2020 WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 3-2013, f. 4-12-13, cert. ef. 7-1-13 WCD 5-2012, f. 10-3-12, cert. ef. 11-1-12 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 4-2005, f. 5-26-05, cert. ef. 7-1-05 WCD 8-2004, f. 7-15-04, cert. ef. 8-1-04 WCD 4-2004(Temp), f. 3-22-04, cert. ef. 4-1-04 thru 9-27-04 WCD 5-2003, f. 5-16-03, cert. ef. 6-8-03 WCD 12-2002(Temp), f. & cert. ef. 12-11-02 thru 6-8-03 WCD 7-2001, f. 8-14-01, cert. ef. 10-1-01
436-105-0004 Submitting Documents or Information; Calculating Time (1) Documents submitted to the division may be: (a) Mailed to the division’s mailing address with sufficient postage and placed in the custody of the U.S. Postal Service; (b) Hand delivered to the division’s Salem office; (c) Faxed, if the document transmitted indicates it has been delivered by fax, is sent to the correct fax number, and indicates the date it was sent; or (d) Sent by any other method authorized by the director. (2) Timeliness of documents submitted to the division: (a) If a document is mailed, it will be considered submitted on the date it is postmarked. (b) If a document is hand-delivered, it must be delivered during regular business hours and marked as received to be considered submitted on that date. (c) If a document is faxed, it must be received by 11:59 p.m. Pacific Time to be considered submitted on that date. (d) Time periods allowed under these rules are calculated in calendar days. The first day is not included. The last day is included unless it is a Saturday, Sunday, or legal holiday. In that case, the period runs until the end of the next day that is not a Saturday, Sunday, or legal holiday. Legal holidays are those listed in ORS 187.010 and 187.020. Statutory/Other Authority: ORS 656.622 & 656.726(4) Statutes/Other Implemented: ORS 656.622 History: WCD 11-2019, adopt filed 12/18/2019, effective 01/01/2020