Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0150 - Timely Payment of Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
Benefits are considered paid when addressed to the last
			 known address of the worker or beneficiary and deposited in the U.S. Mail, or
			 when funds are transferred to a financial institution for deposit in the
			 worker's or beneficiary's account by approved electronic equivalent.
(2)
Saturday, Sunday, or legal
			 holidays.
Payments due on a Saturday, Sunday, or legal holiday under ORS
			 187.010 and
			 187.020 may be paid on the last
			 working day before, or the first working day after, the Saturday, Sunday, or
			 legal holiday. Subsequent payments may revert back to the payment schedule in
			 place before the Saturday, Sunday, or legal holiday.
(3)
Withheld compensation.
Compensation withheld under ORS
			 656.268(13) and
			 (14), and ORS
			 656.596(2),
			 will not be considered late if the insurer notifies the worker in writing why
			 benefits are being withheld and the amount that must be offset before any
			 further benefits are payable.
(4)
Timely payment of temporary disability.
Insurers must timely
			 process the first payment of temporary disability compensation. The first
			 payment of temporary disability on a claim must also include all temporary
			 disability benefits due as of the date of payment, unless there is a reasonable
			 basis to exclude those benefits at the time the payment issued. The director
			 may assess a penalty under OAR
			 436-060-0200 against an insurer
			 that does not make the first payment of temporary disability under the time
			 frames of this section, or does not accurately report timeliness of first
			 payment information.
(a) The payment of
			 temporary disability benefits must be made no later than the 14th day after:
(A) The date of the employer's notice or
			 knowledge of the claim and of the worker's disability, if the attending
			 physician or authorized nurse practitioner has authorized temporary disability
			 compensation. Temporary disability accrued before the date of the employer's
			 notice or knowledge of the claim is due within 14 days of claim
			 acceptance;
(B) The date the
			 attending physician or authorized nurse practitioner authorizes temporary
			 disability, if the authorization is more than 14 days after the date of the
			 employer's notice or knowledge of the claim and of the worker's
			 disability;
(C) The start of
			 authorized vocational training under ORS
			 656.268(10), if
			 the insurer has previously closed the claim;
(D) The date the insurer receives medical
			 evidence supported by objective findings that shows the worker is unable to
			 work due to a worsening of the compensable condition under ORS
			 656.273;
(E) The date of any director's order,
			 including, but not limited to, a reconsideration order, that orders payment of
			 temporary disability. If the insurer has appealed a reconsideration order, the
			 appeal stays payment of temporary disability benefits except those that accrue
			 from the date of the order, under ORS
			 656.313;
(F) The date of a notice of claim closure
			 issued by the insurer that finds the worker entitled to temporary
			 disability;
(G) The date a notice
			 of closure is set aside by a reconsideration order;
(H) The date any litigation authorizing
			 retroactive temporary disability becomes final. Temporary disability accruing
			 from the date of the order must begin no later than the 14th day after the date
			 the order is filed. For the purpose of this rule, the "date the order is filed"
			 for litigation from the board is the signature date, and from the courts, it is
			 the date of the appellate judgment;
(I) The date the director refers a claim to
			 the insurer for processing under ORS
			 656.029;
(J) The date the director refers a
			 noncomplying employer claim to an assigned claims agent under ORS
			 656.054;
(K) The date a claim disposition agreement is
			 disapproved by the Worker's Compensation Board or administrative law judge, if
			 temporary disability benefits are otherwise due;
(L) The date the director designates a paying
			 agent under ORS 656.307;
(M) The date a claim is reclassified from
			 nondisabling to disabling, if temporary disability is due and payable;
			 or
(N) The date an insurer
			 voluntarily rescinds a denial of a disabling claim.