Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 30 - CLAIM CLOSURE AND RECONSIDERATION › Section 436-030-0015 - Insurer Responsibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an insurer
			 issues a Notice of Closure (Form 1644), the insurer is responsible for:
(a) Providing the director, the parties, and
			 the worker's attorney if the worker is represented, a copy of the Notice of
			 Closure, a copy of the Notice of Closure Worksheet (Form 2807) upon which the
			 Notice is based, a completed Insurer Notice of Closure Summary (Form 1503), and
			 an Updated Notice of Acceptance at Closure that specifies which conditions are
			 compensable, as prescribed in OAR
			 436-030-0020;
(b) Maintaining a copy of the worksheet and
			 records upon which the Notice of Closure is based in its claim file for audit
			 purposes under OAR 436-050; and
(c)
			 Issuing the Updated Notice of Acceptance at Closure on the same date as the
			 Notice of Closure.
(A) The Updated Notice of
			 Acceptance at Closure must contain the following title, information, and
			 language:
(i) Title: "Updated Notice of
			 Acceptance at Closure";
(ii)
			 Information: A list of all compensable conditions, even if a condition was
			 denied, ordered accepted by litigation, and is under appeal. Any conditions
			 under appeal and those which were the basis for this claim opening must be
			 specifically identified; and
(iii)
			 Language, in bold print:
"Notice to Worker: This notice restates and includes all
				prior acceptances. The conditions that were the basis of this claim opening
				were the only conditions considered at the time of claim closure. The insurer
				or self-insured employer is not required to pay any disability compensation for
				any condition specifically identified as under appeal, unless and until the
				condition is found to be compensable after all litigation is complete. Appeal
				of any denied conditions or objections to this notice will not delay claim
				closure. Any condition found compensable after the Notice of Closure is issued
				will require the insurer to reopen the claim for processing of that condition.
				If you believe a condition has been incorrectly omitted from this notice, or
				this notice is otherwise deficient, you must communicate the specific objection
				to the insurer in writing.";
(B) In the case of an instant fatality, the
			 Updated Notice of Acceptance may be combined with the Notice of Closure if the
			 following is included:
(i) Title: "Updated
			 Notice of Acceptance and Closure";
(ii) Information: A statement that
			 beneficiaries may be entitled to death benefits under ORS
			 656.204 and
			 656.208, and the medically
			 stationary date; and
(iii)
			 Language, in bold print:
"Notice to Worker's Beneficiary or Estate: This notice
				restates any prior acceptances. The insurer is required to determine the
				appropriate benefits to be paid to any beneficiaries and begin those payments
				within 30 days of the mailing date of this notice.
If you disagree with the notice of acceptance, you may
				appeal the decision to the Workers' Compensation Board, 2601 25th Street SE,
				Suite 150, Salem, OR 97302-1280 within 30 days of the mailing
				date.
A beneficiary who was mailed this notice may request
				reconsideration of the notice by the Workers' Compensation Division, Appellate
				Review Unit, 350 Winter Street NE, PO Box 14480 Salem, OR 97309-0405 within 60
				days of the mailing date of this notice.
Beneficiaries who were not mailed a copy of this notice
				may request reconsideration of this notice within one year of the date this
				notice was mailed to the estate of the worker.
If you have questions about this notice, you may contact
				the Ombudsman for Injured Workers, the Workers' Compensation Division, or
				consult with an attorney."
(C) If the "Initial Notice of Acceptance" is
			 issued at the same time as the "Updated Notice of Acceptance at Closure," both
			 titles must appear near the top of the document.
(D) When an omission or error requires
			 correcting an Updated Notice of Acceptance at Closure, the document must be
			 clearly titled "Corrected Updated Notice of Acceptance at Closure."