reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0720 - Fee Schedule

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The director
			 has established the fee schedule in section (3) of this rule for professional
			 costs and direct worker purchases. The schedule sets maximum spending limits
			 per claim opening for each category; however, the insurer may spend more than
			 the maximum limit. Spending limits will be adjusted annually, effective July 1,
			 based on the conversion factor published with the cost-of-living matrix in
			 Bulletin 124.
(2) For workers
			 needing an extended training plan under OAR
			 436-120-0443, the fee schedule
			 spending limits for the Training category and Direct Employment/Training
			 Combined category listed below must be increased by 30 percent.
(3) Amounts include professional costs,
			 travel and wait time, and other travel expenses: [Table not included. See ED.
			 NOTE.]
NOTE: *Each limit is shown as a percentage of Oregon's state
				average weekly wage (SAWW), determined under ORS
				656.211. Dollar amounts are
				published in Bulletin 124 and are adjusted annually, effective July 1, based on
				changes in the SAWW.
(4) The
			 insurer must pay, within 60 days of receipt, the provider's bill for services
			 provided under the insurer-provider agreement. The insurer may not deny payment
			 on the grounds the worker was not eligible for the assistance if the provider
			 performed the services in good faith without knowledge of the
			 ineligibility.
Tables referenced are available from the agency.
To view attachments referenced in rule text,
click here to view
				  rule
.
Statutory/Other Authority: ORS
				  656.340(9)
				  & 656.726(4)
Statutes/Other Implemented: ORS
				  656.340 &
				  656.258
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0755 - Reimbursement from the Workers' Benefit Fund

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Reimbursement. The director will
			 reimburse the insurer for costs associated with providing vocational benefits
			 when:
(a) The director issues an order
			 overturning the insurer's denial of vocational benefits; and
(b) The insurer's denial is later upheld by a
			 final order.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0800 - Registration of Providers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 provider may not provide vocational assistance services unless the provider is
			 first registered by the director under this rule.
(2) A provider must submit an application,
			 Form 2814, "Vocational Assistance Certification Program Registration of
			 Vocational Assistance Provider," to the division that includes a description of
			 the specific vocational services to be provided and verification of staff
			 certifications under these rules.
(3) The director may approve or deny
			 registration based on the completed application and the department's
			 registration and counselor certification records.
(a) The registration will specify the scope
			 of authorized vocational services as determined by the provider's staff
			 certifications.
(b) Providers
			 whose registration is denied under this rule may appeal as described in OAR
			 436-120-0008.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0810 - Certification and Classification of Provider Staff

Current through Register Vol. 63, No. 7, July 1, 2024
(a) Individuals determining workers'
			 eligibility and providing vocational assistance must be certified by the
			 director and on the staff of a provider.
(b) An applicant for certification must
			 submit Form 1880, "Vocational Assistance Certification Program Individual
			 Certification Under OAR 436-120," to the division.
(c) All degrees required for certification
			 must be from an accredited institution and copies of transcripts must be
			 submitted with the application.
(d) If the director approves the application,
			 certification will be granted for five years. A counselor who is nationally
			 certified as described in subparagraph (3)(a)(B)(i) will be granted an initial
			 certification period to coincide with the counselor's national certification.
(e) Certified individuals must
			 notify the division within 30 days of any changes in address or telephone
			 number.
(f) An individual whose
			 certification is denied under this rule may appeal as described in OAR
			 436-120-0008.
(2) Classification of provider staff.
			 Certified individuals will be classified as follows:
(a) Vocational assistance counselor;
(b) Vocational assistance intern;
			 or
(c) Return-to-work specialist.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0820 - Renewal of Certification

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Required
			 documentation.
A certified individual must renew their certification
			 every five years by submitting Form 1880, "Vocational Assistance Certification
			 Program Individual Certification under OAR 436-120," and the following
			 documentation to the division no later than 30 days before the end of the
			 certification period:
(a) Current
			 certification by the Commission on Rehabilitation Counselor Certification
			 (CRCC), the Commission for Case Managers Certification (CCMC), or the
			 Certification of Disability Management Specialists Commission (CDMSC);
			 or
(b) Verification of a minimum of
			 60 hours of continuing education units under this rule within the five years
			 before renewal.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0830 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.340(9)
				  & 656.726(4)
Stats. Implemented: ORS
				  656.340
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0840 - Professional Standards for Providers and Counselors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers
			 and counselors must:
(a) Determine
			 eligibility and provide assistance in an objective manner not subject to any
			 conditions other than those prescribed in these rules;
(b) Fully inform the worker of the categories
			 and kinds of vocational assistance under OAR 436-120 and re-employment
			 assistance under OAR 436-110;
(c)
			 Document all case activities in legible file notes or reports;
(d) Provide only vocationally relevant
			 information about workers in written and oral reports;
(e) Recommend workers only for suitable
			 employment;
(f) Fully inform the
			 worker of the purpose and results of all testing and evaluations; and
(g) Comply with generally accepted standards
			 of conduct in the vocational rehabilitation profession.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0900 - Audits, Penalties and Sanctions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Insurers and employers at injury must
			 fully participate in any department audit, periodic program review,
			 investigation, or review, and provide records and other information as
			 requested.
(2) If the director
			 finds the insurer or employer at injury failed to comply with OAR 436-120, the
			 director may impose one or more of the following sanctions:
(a) Reprimand by the director;
(b) Recovery of reimbursements;
(c) Denial of reimbursement requests; or
(d) A civil penalty under ORS
			 656.745.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 120 - VOCATIONAL ASSISTANCE TO INJURED WORKERS › Section 436-120-0915 - Sanctions of Providers and Counselors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers and counselors must fully
			 participate in any department audit, periodic program review, investigation, or
			 review, and provide records and other information as requested.
(2) If the director finds any provider or
			 counselor failed to comply with OAR 436-120, the director may impose one or
			 more of the following sanctions:
(a)
			 Reprimand by the director;
(b)
			 Probation, in which the department systematically monitors the provider's or
			 counselor's compliance with OAR 436-120 for a specified length of time.
			 Probation may include the requirement a counselor receive supervision or
			 successfully complete specified training, personal counseling, or drug or
			 alcohol treatment;
(c) Suspension,
			 which is the termination of registration or certification to determine
			 eligibility and provide vocational assistance to Oregon injured workers for a
			 specified period of time. The provider or counselor may reapply for
			 registration or certification at the end of the suspension period. If granted,
			 the provider or counselor will be placed on probation as described in
			 subsection (2)(b) of this rule; or
(d) Revocation, which is a permanent
			 termination of registration or certification to determine eligibility and
			 provide vocational assistance to Oregon injured workers.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0001 - Authority for Rules

Current through Register Vol. 63, No. 7, July 1, 2024
These rules are promulgated under the director's authority
				pursuant to ORS 656.726(4) and
				656.174.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0002 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of these rules is to implement ORS
				656.170 and
				656.172, and to establish and
				provide procedures and requirements for the administration and enforcement of
				programs entered into under ORS
				656.170 and
				656.172.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0003 - Applicability of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules
			 shall be applicable on their effective date and thereafter to carry out the
			 provisions of ORS 656.170 and
			 656.172.
(2) Notwithstanding sections 2 and 3, chapter
			 841, Oregon Laws 1999 (ORS
			 656.170 and
			 656.172), prior to January 1,
			 2002 the director may issue letters of eligibility to only two qualified unions
			 for participation in an alternative dispute resolution system authorized under
			 section 2 of the 1999 Act (656.170). The director may not issue letters of
			 eligibility after January 1, 2002.
(3) These rules apply to parties to a
			 collective bargaining agreement only insofar as and only to the extent that the
			 agreement contains the provisions provided by ORS
			 656.170, has been approved by
			 the director, and for which eligibility has been established under these
			 rules.
(4) Except as otherwise
			 provided by law, the provisions of ORS chapter 656, OAR chapter 436, and OAR
			 chapter 438 apply to programs entered into under these rules, unless the
			 collective bargaining agreement expressly specifies otherwise.
(5) Applicable to this chapter, the director
			 may, unless otherwise obligated by statute, waive any procedural rules as
			 justice so requires.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of these rules, unless the context requires
				otherwise:
(1) "Alternative dispute
			 resolution system" means a process that exists outside the normal Workers'
			 Compensation system to settle disputes arising from a workers' compensation
			 claim.
(2) "Arbitration" means the
			 hearing and determination of a case in controversy by an arbiter.
(3) "Collective bargaining representative"
			 means a person who represents a union.
(4) "Construction carve-out program" means a
			 program established pursuant to ORS
			 656.170 and
			 656.172 for either an
			 alternative dispute resolution system or use of a list of medical service
			 providers, or both, which the director has approved and for which eligibility
			 has been established under these rules.
(5) "Director" means the Director of the
			 Department of Consumer and Business Services, or the director's delegate for
			 the matter.
(6) "Division" means
			 the Workers' Compensation Division of the Department of Consumer and Business
			 Services.
(7) "Employer" is limited
			 to a private employer, or group of employers, engaged in construction;
			 construction maintenance; or activities limited to rock, sand, gravel, cement
			 and asphalt operations; heavy duty mechanics; surveying; or construction
			 inspection.
(8) "Employee" is
			 limited to an employee of an employer defined by section (7) of this
			 rule.
(9) "Insurer" includes
			 "insurer," "guaranty contract insurer," and "self-insured employer" as defined
			 by ORS 656.005.
(10) "Letter of eligibility" means a letter
			 issued by the director under ORS
			 656.172(4)
			 indicating that eligibility to participate in a construction carve-out program
			 has been established under ORS
			 656.170 and ORS
			 656.172.
(11) "Mediation" means the act or process of
			 intervening between conflicting parties to promote reconciliation, settlement,
			 or compromise.
(12) "Plan
			 administrator" means the person responsible for administering the Construction
			 Carve-Out Program.
(13) "Union"
			 means a collective bargaining union that is recognized or certified as the
			 exclusive bargaining representative of employees for an employer or group of
			 employers.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0006 - Administration of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
Any orders issued by the division in carrying out the
				director's authority under ORS chapter 656 and these rules are considered
				orders of the director.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0008 - Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If the
			 director determines that a proposed construction carve-out program is not
			 eligible, the director will issue a notice to the employer or collective
			 bargaining representative.
(a) Under ORS
			 656.704(2), if
			 the employer or collective bargaining representative disagrees with the notice,
			 it may request a hearing by filing a request for hearing as provided in OAR
			 436-001-0019 within 60 days of
			 the mailing date of the notice.
(b)
			 OAR 436-001 applies to the hearing.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0010 - Qualifying

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An employer,
			 group of employers or collective bargaining representative may not establish or
			 continue to participate in a construction carve-out program under ORS
			 656.170 until the proposed
			 program has been approved by the director and the director has issued a letter
			 of eligibility. An application containing the information described in
			 subsections (2) and (3) of this rule must be submitted to the
			 director.
(2) The employer or group
			 of employers must provide at least the following:
(a) Payroll records sorted by National
			 Council on Compensation Insurance (NCCI) classification for one of the three
			 years prior to the year in which the collective bargaining agreement takes
			 effect.
(b) A proposed plan for the
			 construction carve-out program, along with four copies, in which it is
			 demonstrated how the proposed construction carve-out program will meet the
			 requirements of ORS 656.170,
			 656.172, and these
			 rules;
(c) A copy of the collective
			 bargaining agreement;
(d) An
			 estimate of the number of employees covered by the collective bargaining
			 agreement;
(e) A copy of a valid
			 license when that license is required of the employer or group of employers to
			 conduct business in Oregon;
(f) A
			 signed, sworn statement that no action has been taken by any administrative
			 agency or court of the United States to invalidate the collective bargaining
			 agreement;
(g) The name, address,
			 and telephone number of the contact person of the employer or group of
			 employers;
(h) A statement from the
			 insurer or self-insured employer that the insurer or self-insured employer is
			 willing to insure the risk under the terms of the collective bargaining
			 agreement; and
(i) If applicable, a
			 list of the names, addresses, and specialties of the medical service providers
			 who will provide medical services under the construction carve-out program,
			 together with appropriate evidence of any licensing, registration or
			 certification requirements for that individual to practice. This list shall
			 indicate which medical service providers will act as attending
			 physicians.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0020 - Alternative Dispute Resolution

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 A construction carve-out program may establish and operate an alternative
			 dispute resolution system governing disputes between employees, employers, and
			 their insurers. Any such system may include, but not be limited to:
(a) Limitations on the liability of the
			 employer while determinations regarding the compensability of an injury are
			 being made;
(b) A method for
			 resolving disputes involving compensability of injuries and the amount of
			 compensation due for a compensable injury, medical services, and legal
			 services;
(c) A method for payment
			 of compensation for injuries incurred under the collective bargaining
			 agreement, when the worker is no longer subject to the agreement; or
(d) Arbitration and mediation
			 procedures.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0030 - Medical Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 construction carve-out program may establish a list of medical service
			 providers that the parties agree is the exclusive source of all medical
			 treatment provided under ORS chapter 656.
(2) A construction carve-out program shall
			 establish a method for access to medical services for workers no longer subject
			 to the agreement when those injuries were sustained under the collective
			 bargaining agreement.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0040 - Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
Benefit amounts that exceed the statutory rates under ORS
				chapter 656 shall not be subject to reimbursement from the Workers' Benefit
				Fund.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0045 - Multiple Claims; Expiration or Termination of Collective Bargaining Agreement; Responsibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Disputes involving multiple claims when one or more of the claims are not
			 subject to the collective bargaining agreement shall be resolved pursuant to
			 ORS 656.307,
			 656.308, and OAR chapter
			 436.
(2) Upon expiration of the
			 collective bargaining agreement without renewal, or after termination of any
			 arrangement under ORS
			 656.170 and
			 656.172, the insurer is
			 responsible for benefits and claims in accordance with the provisions of ORS
			 chapter 656 unless otherwise provided for under the agreement.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0050 - Duties and Responsibilities of Employer

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An employer or group of employers that
			 participates in a construction carve-out program shall comply with coverage
			 requirements under ORS
			 656.017.
(2) The participating employer or group of
			 employers shall report all claims made under the program to the insurer as with
			 other claims.
(3) The participating
			 employer or group of employers shall comply with the terms of the collective
			 bargaining agreement and construction carve-out program.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0060 - Insurer Duties and Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer who contracts to provide
			 coverage to an employer or group of employers under a construction carve-out
			 program shall timely report claims made under the construction carve-out
			 program to the director.
(2) The
			 insurer shall provide benefits in accordance with the terms of the collective
			 bargaining agreement and construction carve-out program.
(3) The insurer shall segregate all loss and
			 payroll data for reporting and research purposes. Data shall be forwarded to
			 the director upon request.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0070 - Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In
			 order to ensure the construction carve-out program continues to comply with the
			 eligibility requirements of these rules, the employer, or group of employers,
			 and collective bargaining representative shall:
(a) Upon renegotiation of the collective
			 bargaining agreement, provide the director with a copy no less than 30 days
			 before the agreement takes effect, including an estimate of the number of
			 employees covered by the agreement; and
(b) On an annual basis, provide the director
			 the following:
(A) A copy of a valid license
			 when that license is required of the employer or group of employers to conduct
			 business in Oregon;
(B) A signed,
			 sworn statement that no action has been taken by any administrative agency or
			 court of the United States to invalidate the collective bargaining
			 agreement;
(C) The name, address,
			 and telephone number of the contact person of the employer or group of
			 employers;
(D) A statement from the
			 insurer or self-insured employer that the insurer or self-insured employer is
			 willing to insure the risk under the terms of the collective bargaining
			 agreement;
(E) A copy of the most
			 recent LM-2 or LM-3 filing with the United States Department of Labor, and a
			 signed, sworn statement that the document is a true and correct copy;
			 and
(F) The name, address, and
			 telephone number of the contact person for the collective bargaining
			 representative.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0090 - Suspension or Revocation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Prior
			 eligibility of a construction carve-out program may be suspended or revoked if
			 any of the following occur:
(a) The director
			 finds a serious danger to the public health or safety;
(b) The construction carve-out program fails
			 to provide services under the terms of the collective bargaining
			 agreement;
(c) The employer, or
			 group of employers, collective bargaining representative, and/or insurer fails
			 to comply with ORS chapter 656, OAR 436-140, or orders of the director;
			 or
(d) The employer, or group of
			 employers, collective bargaining representative, and/or insurer submits any
			 false or misleading information pertaining to the eligibility.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0100 - Monitoring/Auditing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The director
			 may conduct periodic audits of construction carve-out programs as necessary to
			 ensure compliance with ORS
			 656.170,
			 656.172, and these
			 rules.
(2) All records of a
			 construction carve-out program shall be produced upon request of the
			 director.
Stat. Auth.: ORS
				  656.726(4)
				  & ORS 656.174
Stats. Implemented: ORS
				  656.170, ORS
				  656.172 & ORS
				  656.174
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0120 - Sanctions and Civil Penalties; Rule Violations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The director may assess a civil penalty
			 under ORS 656.745 against an employer,
			 group of employers, or insurer that violates ORS chapter 656, OAR 436-140, or
			 an order of the director.
(2) Any
			 complaint alleging a violation of these rules must be made in writing to the
			 director. The complaint must:
(a) State the
			 grounds for the alleged rule violation;
(b) Include the specific instances of the
			 alleged rule violation;
(c) State
			 the complainant's request for correction and relief; and
(d) Include sufficient documentation to
			 support the complaint.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 140 - CONSTRUCTION CARVE-OUT PROGRAMS › Section 436-140-0130 - Service of Orders

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 order or notice of the director shall include a notice of the party's appeal
			 rights and shall be served upon the party when the director does any of the
			 following:
(a) Notifies an applicant that a
			 program is not approved pursuant to OAR
			 436-140-0010(4);
(b) Suspends or revokes eligibility of a
			 construction carve-out program pursuant to OAR
			 436-140-0090; or
(c) Assesses a civil penalty under the
			 provisions of OAR 436-140-0120.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0001 - Authority for Rules

Current through Register Vol. 63, No. 7, July 1, 2024
These rules are promulgated under the director's authority
				contained in ORS 656.726(4) and
				ORS 656.445.
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0002 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of these rules is to establish guidelines for
				regulating, managing, and disbursing moneys in the Workers' Benefit Fund for
				the purpose of advancing funds to injured workers who have not received payment
				of compensation due from an insurer in default.
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0003 - Applicability of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules
			 carry out the provisions of ORS
			 656.445.
(2) Applicable to this chapter, the director
			 may, unless otherwise obligated by statute, in the director's discretion waive
			 any procedural rules as justice so requires.
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR
				436-150-0001 through
				436-150-0040, unless the context
				requires otherwise:
(1)
			 "Compensation," for the purposes of this program, means temporary and permanent
			 disability due injured workers pursuant to ORS chapter 656, and out-of-pocket
			 expenses for injured workers in accordance with OAR
			 436-009-0025, such as
			 prescription and mileage reimbursements. Compensation does not include amounts
			 payable to providers, or benefits payable pursuant to claim settlements or
			 claim disposition agreements.
(2)
			 "Default" means an insurer has failed to make payments of compensation due
			 injured workers pursuant to ORS chapter 656 for which there is no dispute over
			 the right of the worker to receive such compensation or the amount
			 therein.
(3) "Director" means the
			 director of the Department of Consumer and Business Services or the director's
			 delegate for the matter.
(4)
			 "Hearings Division" means the Hearings Division of the Workers' Compensation
			 Board.
(5) "Insurer" means an
			 insurer authorized under ORS chapter 731 to transact workers' compensation
			 insurance in this state.
(6)
			 "Oregon Insurance Guaranty Association" or "OIGA" means the association created
			 by ORS 734.550.
(7) "Paying Agency" means the insurer, or the
			 insurer's authorized representative, responsible for paying compensation due
			 under ORS chapter 656.
Stat. Auth.: ORS
				  656.445,
				  656.726(4)
Stats. Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0006 - Administration of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
Any orders issued by the division in carrying out the
				director's authority to enforce ORS Chapter 656 and these rules are considered
				orders of the director.
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0008 - Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any party as defined by ORS
			 656.005, and including the
			 Oregon Insurance Guaranty Association, aggrieved by a proposed order or
			 proposed assessment of civil penalty of the director or division issued
			 pursuant to ORS 656.745 may request a hearing by
			 the Hearings Division of the Workers' Compensation Board in accordance with ORS
			 656.740.
(a) The request for hearing must be sent in
			 writing to the Administrator of the Workers' Compensation Division. No hearing
			 shall be granted unless the request specifies the grounds upon which the person
			 requesting the hearing contests the proposed order or assessment.
(b) The request for hearing must be filed
			 with the Administrator of the Workers' Compensation Division by the aggrieved
			 person within 60 days after the mailing date of the proposed order or
			 assessment. No hearing will be granted unless the request is mailed or
			 delivered to the administrator within 60 days after the mailing date of the
			 proposed order or assessment.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0010 - Criteria for Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In
			 order for the director to authorize expenditures from the Workers' Benefit Fund
			 Claims Program there must be:
(a) Verification
			 from an authority from the insurer's state of domicile that the insurer
			 responsible for payment of compensation is in default, such as a notice of
			 voluntary or involuntary rehabilitation, conservatorship, or other information
			 indicating the insurer cannot or will not make payments of compensation;
			 and
(b) An order of the director
			 authorizing disbursements to injured workers from the Workers' Benefit Fund
			 Claims Program. The order shall specify the qualifying claims, duration of
			 payment obligation, and maximum expenditure limitation. The maximum expenditure
			 limitation may not exceed the amount of securities on deposit for the insurer
			 pursuant to ORS 731.628.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0020 - Limitation of Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Payment
			 of compensation shall be limited to the amount of securities on deposit for the
			 insurer pursuant to ORS
			 731.628 and only to the extent
			 the monies are available in the Workers' Benefit Fund.
(2) Payments for individual claims shall be
			 limited to compensation that becomes due and payable during the period of
			 default.
(3) Notwithstanding any
			 other provision of these rules, the director may, in the director's discretion,
			 authorize additional benefits for specific claims in cases of extreme
			 hardship.
(4) In the event of
			 insufficient funds in the Workers' Benefit Fund, the director shall have final
			 authority to determine an equitable distribution, which will proportionately
			 distribute the available funds among the claims having qualified for
			 reimbursement under the Program.
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0030 - Payment of Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Payment
			 of compensation may be made by the director after receipt of documentation that
			 compensation is due and payable.
(2) Documentation to support payment from the
			 Workers' Benefit Fund Claims Program shall be submitted by the paying agent to
			 include, but not be limited to:
(a) Insurer
			 name, address, and policy number;
(b) Injured worker name, address, insurer
			 claim number, Workers' Compensation Division claim number, and date of
			 injury;
(c) Employer name and
			 address;
(d) Amount, duration, and
			 purpose of compensation due;
(e)
			 Amounts payable for support pursuant to ORS
			 656.234, along with supporting
			 documentation; and
(f) Any other
			 information deemed necessary by the director.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 150 - WORKERS' BENEFIT FUND CLAIMS PROGRAM › Section 436-150-0040 - Accounting and Repayment of Payment of Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The director shall establish an account
			 of record to monitor all expenditures and transactions relating to the Workers'
			 Benefit Fund Claims Program and these rules. The accounting shall provide a
			 detailed record of payments to each injured worker and the respective insurer
			 responsible for the claim to include, but not be limited to, information as
			 specified in OAR 436-150-0030(2).
(2) When the obligation to make payment of
			 compensation is assumed by the Oregon Insurance Guaranty Association (OIGA) due
			 to the insolvency of an insurer, the OIGA shall reimburse the Workers' Benefit
			 Fund for all moneys advanced to injured workers for covered claims, as
			 specified by OAR 734.510(4) and these rules. The OIGA shall reimburse the
			 director within 60 days of receipt of sufficient information necessary to
			 support the covered claims. All moneys received from the OIGA by the director
			 shall be placed into the Workers' Benefit Fund.
(3) If an insurer defaults in its payments to
			 injured workers, but later resumes its obligation to make payments, the insurer
			 shall reimburse the director for any moneys paid to the injured worker. Such
			 payment shall be in such amounts and at such intervals as prescribed by an
			 order of the director. Failure of the insurer to comply with the order of the
			 director may result in civil penalty pursuant to ORS
			 656.745.
(4) Any dispute over an amount owing the
			 director in accordance with these rules shall be resolved pursuant to OAR
			 436-150-0008(2).
Statutory/Other Authority: ORS
				  656.445 &
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.445
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0001 - Authority, Applicability, Purpose, and Administration of these Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules are
			 promulgated under the director's authority contained in ORS
			 656.726(4).
(2) These rules apply to workers'
			 compensation related transactions filed with the director by electronic data
			 interchange (EDI) on or after Oct. 1, 2014.
(3) The purpose of these rules is to require
			 workers' compensation medical bill data reporting by electronic data
			 interchange.
(4) Orders issued by
			 the division in carrying out the director's authority to enforce ORS chapter
			 656 are considered orders of the director.
(5) The director may waive procedural rules
			 as justice requires, unless otherwise obligated by statute.
Stat. Auth.: ORS
				  656.264 &
				  656.726(4)
Stats. Implemented: ORS Ch. 84 &
				  656.264
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0004 - Adoption of Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) The director adopts, by reference, IAIABC
			 EDI Implementation Guide for Medical Bill Payment Records, Release 2.0, dated
			 Feb 1, 2014.
(b) The director
			 adopts, by reference, the ASC X12 Implementation Acknowledgment for Health Care
			 Insurance (999), dated February 2011.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0040 - Recognized Received Date

Current through Register Vol. 63, No. 7, July 1, 2024
An electronic record is received when:
(1) The record enters the division's
			 designated information processing system;
(2) All the required data elements and
			 electronic records are in the form and format specified in these rules in the
			 proper sequence; and
(3) The
			 record can be fully processed by the division's information processing
			 system.
Stat. Auth.: ORS
				  656.264 &
				  656.726(4)
Stats. Implemented: ORS
				  84.043 &
				  656.264
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0060 - Testing Procedures and Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
Testing and transition to production:
(1) Before testing can begin, or the division
			 can accept medical billing data, the trading partner must submit a completed
			 Medical Billing Data EDI Trading Partner Profile (Form 4015) to the division's
			 EDI Coordinator. Form 4015 is available on the division's website:
			 http://wcd.oregon.gov/operations/edi/ediindex.html#bill [File Link Not
			 Available].
(2) For test purposes
			 each transmission must conform to the standards specified in OAR
			 436-160-0004.
(3) Test files will be evaluated in terms of
			 whether the data sent was received in the correct standardized format and fully
			 processed by the division's information processing system.
(4) The EDI Coordinator will determine the
			 number of required transactions per test submission based on the anticipated
			 volume of production transactions.
(5) To be approved to send production
			 transmissions, the sender must:
(a)
			 Accomplish secure file transfer protocol (SFTP) uploads and downloads;
(b) Demonstrate the ability to
			 send transmissions to the division that are in the correct format and can be
			 processed through the division's information processing system;
(c) Resolve any consistently recurring
			 errors, and demonstrate the ability to correct and resubmit corrections to
			 errors identified by the division;
(d) Send transmissions to the division that
			 do not result in a 999 acknowledgment indicating a rejection;
(e) Send transmissions to the division
			 without transaction level technical errors;
(f) Demonstrate the ability to receive and
			 process acknowledgement transactions; and
(g) Achieve an acceptance rate of at least 90
			 percent.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0405 - Insurers' Reporting Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Insurers with an average of at least 100
			 accepted disabling claims per year, based on the average accepted disabling
			 claim volume for the previous three calendar years, are required to
			 electronically submit detailed medical bill payment data to the Department of
			 Consumer and Business Services under OAR
			 436-160-0415.
(2) The director will notify an insurer when
			 the insurer has reached a three-year average accepted disabling claim count of
			 at least 100. The insurer is required to report medical bill payment data
			 beginning with the date specified in the notice and must continue to report in
			 subsequent years.
(3) If the
			 insurer's claim count drops below an average of 50 accepted disabling claims,
			 based on the average accepted disabling claim volume for the previous three
			 calendar years, insurers may apply to the director for an exemption from the
			 reporting requirement.
(4) The
			 list of insurers required to report medical bill data is published in Bulletin
			 359.
(5) Insurers that do not meet
			 the requirement to submit medical data under (1) of this rule may voluntarily
			 submit medical billing data.
Stat. Auth.: ORS
				  656.726(4)
Stats. Implemented: ORS
				  656.264
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0410 - Electronic Medical Bill Data Transmission and Format Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 transmission data and format requirements are included in the IAIABC EDI
			 Implementation Guide for Medical Bill Payment Records, Release 2.0 (Feb 1,
			 2014), and Appendices A and B of these rules. Oregon-specific information can
			 be found on the division's Electronic Data EDI webpage:
			 http://www.cbs.state.or.us/wcd/operations/edi/ediindex.html [File Link Not
			 Available].
(2) Data elements are
			 listed in Appendices A and B:
(a) Appendix A
			 shows all medical bill data elements accepted by EDI in Oregon, and whether the
			 data element is "Fatal Technical" (F), "Mandatory" (M), "Mandatory Conditional"
			 (MC), "If Applicable/Available with Item Reject if Invalid" (AR), or "If
			 Applicable/Available with Item Accept if Invalid" (AA) for each transaction
			 type.
(b) Appendix B lists
			 mandatory conditional data elements that are mandatory under specific
			 conditions.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0415 - Oregon ASC X12 837 Medical Bill Data Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Event reporting
			 requirements:
(a) Medical bills, including
			 interpreter bills under OAR 436-009, must be reported within 60 days of the
			 date paid.
(b) Denied medical
			 bills for accepted claims must be reported within 60 days of date of denial.
			 Denied bills are defined as any bills in which there is a non-zero charge and a
			 zero payment.
(c) Transactions
			 must be received and accepted by the division within 60 days of either the date
			 paid or the date denied to be considered timely reported. If a transaction is
			 initially rejected it must be corrected, resubmitted, and accepted within the
			 original 60 day time period to be considered timely reported.
(d) Cancellations must be reported as soon as
			 the payer knows that a medical bill was sent in error.
(e) Corrections/Replacements must be reported
			 within 60 days of changes to any of the "Fatal Technical," "Mandatory," or
			 "Mandatory Conditional" data elements in Appendices A and B.
(f) Bills received by the insurer before Oct.
			 1, 2014, may be reported to the Division using the IAIABC reporting standard
			 version 1.1.