Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0190 - Monetary Adjustments among Parties and Department of Consumer and Business Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. An
			 order of the director under ORS
			 656.307 and OAR
			 436-060-0180 applies only to the
			 period before the order of the administrative law judge determining the
			 responsible paying party. Payment of compensation made after the order may not
			 be recovered from the Consumer and Business Services Fund, unless the director
			 concludes payment was made before the administrative law judge's order was
			 received by the paying agent designated under OAR
			 436-060-0180. After the
			 administrative law judge's order, any necessary monetary adjustments must be
			 made under OAR 436-060-0195.
(2) Determination of benefits paid. When all
			 litigation on the issue of responsibility is final, the insurer ultimately held
			 to be responsible must, before paying any compensation, contact any
			 nonresponsible insurer to determine what compensation has already been paid.
			 When contacted by the responsible insurer, the nonresponsible insurer must
			 provide the requested information necessary for the responsible insurer to make
			 a timely payment to the worker, medical providers or others, but in any case no
			 later than 20 days after the date of contact. Failure to respond to the
			 responsible insurer's inquiry in a timely manner may result in
			 non-reimbursement otherwise due from the responsible insurer or from the
			 Consumer and Business Services Fund.
(3) Reimbursement of nonresponsible insurers.
			 The responsible insurer must reimburse any nonresponsible insurers for
			 compensation the nonresponsible insurer paid that the responsible insurer is
			 responsible for, but has not already paid, within 30 days of receiving enough
			 information to determine the benefits paid and the relationship to the
			 conditions involved. Any balance remaining due the worker, medical providers or
			 others must be paid in a timely manner under OAR 436-009 and
			 436-060-0150. Payment of
			 compensation that results in duplicate payment to the worker, medical providers
			 or others as a result of failing to contact the nonresponsible insurer does not
			 release the responsible insurer from the requirement to reimburse any
			 nonresponsible insurers for its costs.
(4) Direction of unresolved adjustments. The
			 director may direct any necessary monetary adjustment between the parties that
			 is not otherwise ordered by the administrative law judge or voluntarily
			 resolved by the parties. The director will not order an insurer to pay
			 compensation above that required by law, as it relates to the insurer's claim,
			 except in the situation described in section (3) of this rule. Any insurer that
			 fails to make monetary adjustments within 30 days of an order by the director
			 may be subject to civil penalties under OAR
			 436-060-0200. Only compensation
			 paid as a result of an order by the director under OAR
			 436-060-0180 and consistent with
			 this rule is recoverable from the Consumer and Business Services Fund when such
			 compensation is not reimbursed to the nonresponsible insurer by the responsible
			 insurer.
(5) Unnecessary costs.
			 When the director determines improper or untimely claim processing by the
			 designated paying agent has resulted in unnecessary costs, the director may
			 deny reimbursement from the responsible insurer and the Consumer and Business
			 Services Fund.
Stat. Auth.: ORS
				  656.726(4)
Stats. Implemented: ORS
				  656.307(3)