Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0165 - End of Eligibility for Vocational Assistance

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Reasons for ending eligibility.
A worker's eligibility for
			 vocational assistance ends when any of the following conditions apply:
(a) Based on
new information
that did not exist or that could not have been obtained with reasonable effort
			 at the time the insurer determined eligibility, the worker no longer meets the
			 eligibility requirements;
(b) The
			 worker has been employed in
suitable employment
for at least 60
			 days after the date of injury or date of aggravation;
(c) The worker has been employed in suitable
			 employment that is modified or new employment resulting from an
employer-at-injury activated use of the Preferred Worker Program
under OAR 436-110 and:
(A) If there is no
			 worksite modification, premium exemption has been effective for 12
			 months;
(B) If there is a worksite
			 modification, 12 months have passed since the director determined it to be
			 complete; or
(C) During the
			 12-month period in paragraph (A) or (B), the worker is terminated for cause or
			 voluntarily resigns for a reason unrelated to the work
			 injury;
(d) The worker,
			 before beginning an authorized return-to-work plan,
refused an offer of
			 suitable employment
. If the employer-at-injury offers employment to a
			 worker who is not medically stationary, the offer must be made in accordance
			 with OAR 436-060-0030;
(e) The worker, before beginning an
			 authorized return-to-work plan,
left suitable employment
after the
			 injury or aggravation for a reason unrelated to the limitations caused by the
			 injury;
(f) The worker, before
			 beginning an authorized return-to-work plan,
refused or failed to make a
			 reasonable effort in available light-duty work
intended to result in
			 suitable employment. Before ending eligibility, the insurer must document the
			 existence of one or more suitable jobs that would be available for the worker
			 after completion of the light-duty work. If the employer at injury offers such
			 employment to a worker who is not medically stationary, the offer must be made
			 in accordance with OAR
			 436-060-0030;
(g) The worker, after completing an
			 authorized training plan,
refused an offer of suitable
			 employment;
(h) The worker
declined or became unavailable
for vocational assistance.
(A) The insurer must determine if the reasons
			 are for reasonable or unreasonable cause before ending the worker's
			 eligibility.
(B) If the reason was
			 for incarceration, this reason must be stated in the notice to the
			 worker.
(C) Declining vocational
			 assistance to accept modified or new employment that results from an
			 employer-at-injury activated use of the Preferred Worker Program, under OAR
			 436-110, is reasonable cause;
(i) The worker
refused a suitable
			 training site
after the counselor and worker have agreed in writing upon
			 a return-to-work goal;
(j) The
			 worker
failed after written warning to participate in the development or
			 implementation
of a return-to-work plan. No written warning is required
			 if the worker fails to attend two consecutive training days and fails, without
			 reasonable cause, to notify the counselor or the insurer by the close of the
			 next business day;
(k) The worker's
			 lack of suitable employment
cannot be resolved by providing vocational
			 assistance
. This includes circumstances in which the worker cannot
			 benefit from, or participate in, vocational assistance because of medical
			 conditions unrelated to the injury;
(l) The worker
misrepresented
			 information
relevant to providing vocational assistance;
(m) The worker
refused after written
			 warning to return property
provided by the insurer or reimburse the
			 insurer as required. No vocational assistance will be provided under subsequent
			 openings of the claim until the worker returns the property or reimburses the
			 funds;
(n) The worker
misused
			 funds
provided for the purchase of property or services. No vocational
			 assistance will be provided under subsequent openings of the claim until the
			 worker reimburses the insurer for the misused funds;
(o) After written warning the worker
			 continues to
harass
any participant to the vocational process.
			 This subsection does not apply if such behavior is the result of a documented
			 medical or mental condition;
(p)
			 The worker entered into a
claim disposition agreement
and disposed
			 of vocational rights. The parties may agree in writing to suspend vocational
			 assistance pending approval of the agreement by the Workers' Compensation
			 Board. The insurer must end eligibility when the Workers' Compensation Board
			 approves the claim disposition agreement that disposes of vocational assistance
			 rights. No notice regarding the end of eligibility is required; or
(q) The worker received
maximum direct
			 employment services or maximum limited training services
and is not
			 entitled to other categories of vocational assistance.