reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0410

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0420

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0440

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0450

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0455

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0460

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0470

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0480

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4),
				  656.850 &
				  656.855
Stats. Implemented: ORS
				  656.850 &
				  656.855
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0500 - Assessment of Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
The director may assess a civil penalty under ORS
				656.745(2)
				against an employer or insurer that violates ORS chapter 656, OAR 436-050, or
				an order of the director.
Statutory/Other Authority: ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.745(2)
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0001

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726(4)(a)
				  & ORS 656.780(1)
Stats. Implemented: ORS
				  656.780
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0002

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.780(1)
Stats. Implemented: ORS
				  656
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0003 - Applicability of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Applicability. These rules apply to the certification of all workers'
			 compensation claims examiners on or after the effective date of these rules.
(2) Purpose. The purpose of these
			 rules is to establish standards for the certification of workers' compensation
			 claims examiners under ORS chapter 656.
(3) Director's discretion. The director may
			 waive any procedural rule as justice requires, unless otherwise obligated by
			 statute.
Stat. Auth.: ORS
				  656.726,
				  656.780
Stats. Implemented: ORS
				  656.780
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Except where the context requires otherwise, the definitions
				under ORS 656.005 and the following apply
				to OAR 436-055-0008 to
				436-055-0110:
(1) "Claims examiner" means anyone who has
			 primary responsibility for decision making or benefit determination in a claim.
(2) "Director" means the director
			 of the Department of Consumer and Business Services or the director's designee.
(3) "Hearings Division" means the
			 Hearings Division of the Workers' Compensation Board.
(4) "Insurer" means the State Accident
			 Insurance Fund Corporation; an insurer authorized under ORS chapter 731 to
			 transact workers' compensation insurance in this state ; an assigned claims
			 agent selected by the director under ORS
			 656.054; an employer certified
			 under ORS 656.430 that meets the
			 qualifications of a self-insured employer under ORS
			 656.407; or a service company
			 that processes claims for an insurer or self-insured employer under the
			 conditions prescribed in ORS
			 731.475(3) and
			 ORS 656.455(1).
(5) "Party" means a claimant for
			 compensation, the employer of the worker at the time of injury, the insurer of
			 the employer, or the insurer's service company, if any.
(6) "Process claims" means the determination
			 of compensability and management of workers' compensation claims.
Stat. Auth.: ORS
				  656.726
Stats. Implemented: ORS
				  656.780
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0008 - Administrative Review and Contested Cases

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Requests for hearings on sanctions and
			 civil penalties. Any party that disagrees with a proposed order, or proposed
			 assessment of civil penalty issued by the director under these rules, may
			 request a hearing by the Hearings Division under ORS
			 656.740. To request a hearing,
			 the party must:
(a) Mail or deliver a written
			 request to the Workers' Compensation Division within 60 days of the mailing
			 date of the proposed order or assessment; and
(b) Specify, in the request, the reasons why
			 the party disagrees with the proposed order or assessment.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0070 - Certification of Claims Examiners

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Claims examiner test. To become an Oregon certified claims examiner, an
			 individual must complete a test that demonstrates the individual's competency
			 in claims processing activities, subject to the following:
(a) The test must include questions that
			 demonstrate the individual's:
(A) Familiarity
			 with ORS chapter 656;
(B) Ability
			 to navigate OAR chapter 436;
(C)
			 Ability to perform claims processing activities; and
(D) Understanding of all of the components in
			 OAR 436-055-0085(1);
			 and
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0085 - Training for Interactions with Independent Medical Examination Providers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Director
			 approval of training curricula. Any training relating to interactions with
			 independent medical examination (IME) providers must follow a curriculum that
			 has been approved by the director. Curricula must include at least some of the
			 following components:
(a) Appropriate and
			 ethical communication with IME providers;
(b) Insurers' rights and responsibilities;
(c) Injured workers' rights and
			 responsibilities;
(d) IME
			 providers' standards of conduct requirement;
(e) IME complaint process and investigations
			 by the Workers' Compensation Division; or
(f) The requirements of ORS
			 656.325 and OAR 436-010.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0100 - Insurer Duties

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Insurer's
			 responsibility to employ certified or qualified examiners. An insurer may only
			 employ Oregon certified claims examiners to process claims. An Oregon certified
			 claims examiner must have primary responsibility for all activities related to
			 the determination of compensability and management of a claim including, but
			 not limited to, calculating benefits and authorizing payments to workers.
(2) Claims examiner trainees and
			 temporary claims examiners. Notwithstanding section (1), an insurer may employ
			 a claims examiner trainee or a temporary claims examiner who is not certified
			 to assist with claims processing activities, subject to the following:
(a) A "claims examiner trainee" is an
			 individual hired by an insurer to assist with claims processing activities who
			 has no previous experience as an Oregon certified claims examiner, or who did
			 not have current Oregon claims examiner certification in the 12 months before
			 the date of hire. An individual may only work as a claims examiner trainee for
			 up to 12 months in any five-year period;
(b) A "temporary claims examiner" is an
			 individual hired by an insurer to assist with claims processing activities who
			 has at least two years of prior experience as an Oregon certified claims
			 examiner. An individual may only work as a temporary claims examiner for up to
			 90 days in any 12-month period;
(c) The claims examiner trainee or temporary
			 claims examiner must work under the direct supervision of a certified claims
			 examiner; and
(d) The claims
			 examiner trainee or temporary claims examiner may not represent the insurer in
			 communications with the director or the Workers' Compensation Board.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 55 - CERTIFICATION OF CLAIMS EXAMINERS › Section 436-055-0110 - Assessment of Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Penalties for failure to comply with statutes, rules, and orders.
The director may assess a civil penalty under ORS
			 656.745(2)
			 against an insurer that violates ORS chapter 656, OAR 436-055, or an order of
			 the director.
(2)
Penalties
			 for failure to comply with ORS
			 656.780.
The director may
			 assess a civil penalty against an insurer that fails to maintain or produce
			 certification and training records as required by these rules, or that employs
			 anyone other than an Oregon certified claims examiner to process
			 claims.
Statutory/Other Authority: ORS
				  656.726 & ORS
				  656.780
Statutes/Other Implemented: ORS
				  656.780 &
				  656.745
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0001 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.210(2),
				  656.262(11),
				  656.264,
				  656.265(6),
				  656.325,
				  656.331,
				  656.704 &
				  656.726(4)
Stats. Implemented: ORS
				  656.210(2),
				  656.262(11),
				  656.264,
				  656.265(6),
				  656.325,
				  656.331,
				  656.704 &
				  656.726(4)
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0002 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.262(11),
				  656.447,
				  656.704,
				  656.726(4)
				  & 656.745
Stats. Implemented: ORS
				  656.262(11),
				  656.447,
				  656.704,
				  656.726(4)
				  & 656.745
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0003 - Purpose, Applicability, Forms, and Bulletins

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Purpose.
The purpose of the
			 rules in OAR 436-060 is to prescribe uniform standards for insurers to process
			 workers' compensation claims under ORS chapter 656.
(2)
Applicability.
(a) The rules are subject to the
			 applicability provisions under ORS
			 656.202.
(b) The director may waive procedural rules
			 as justice requires, unless otherwise obligated by statute.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless a term is specifically defined elsewhere in these rules
				or the context otherwise requires, the definitions of ORS chapter 656 are
				hereby incorporated by reference and made a part of these rules. For the
				purpose of these rules unless the context requires otherwise:
(1)
"Aggravation"
means an
			 actual worsening of the compensable conditions after the last award or
			 arrangement of compensation that satisfies the requirements of ORS
			 656.273.
(2)
"Authorized nurse
			 practitioner"
means a nurse practitioner authorized to provide
			 compensable medical services under ORS
			 656.245 and OAR
			 436-010.
(3)
"Board"
means the Workers' Compensation Board and includes its Hearings
			 Division.
(4)
"Business
			 days"
means Monday through Friday, excluding legal holidays. Legal
			 holidays are those listed in ORS
			 187.010 and
			 187.020.
(5)
"Date stamp"
means to stamp
			 or display the initial receipt date and the recipient's name on a paper or
			 electronic document, regardless of whether the document is printed or displayed
			 electronically.
(6)
"Dependent"
means any of the individuals listed under ORS
			 656.005(10)
			 who, at the time of an accident, depended in whole or in part for support on
			 the earnings of a worker who dies as a result of an injury.
(7)
"Designated paying agent"
means the insurer temporarily ordered responsible to pay compensation for a
			 compensable injury under ORS
			 656.307.
(8)
"Director"
means the
			 director of the Department of Consumer and Business Services or the director's
			 designee.
(9)
"Disposition"
or
"claim disposition"
means the
			 written agreement to release rights or obligations under ORS
			 656.236.
(10)
"Division"
means the
			 Workers' Compensation Division of the Department of Consumer and Business
			 Services.
(11)
"Employer"
means a subject employer under ORS
			 656.023.
(12)
"Inpatient"
means a worker
			 who is admitted to a hospital before and extending past midnight for treatment
			 and lodging.
(13)
"Insurer"
means the State Accident Insurance Fund Corporation; an
			 insurer authorized under ORS chapter 731 to transact workers' compensation
			 insurance in Oregon; or an employer or employer group certified under ORS
			 656.430 that meets the
			 qualifications of a self-insured employer under ORS
			 656.407.
(14)
"Mailing date,"
unless
			 otherwise specified, means:
(a) The date a
			 document is postmarked;
(b) The
			 date automatically produced by electronic transmission (e.g., email or
			 facsimile);
(c) The date a
			 hand-delivered document is received by the recipient; or
(d) The date of a phone or in-person request,
			 when allowed under these rules.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0006 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.704 &
				  656.726(4)
Stats. Implemented: ORS
				  656.704 &
				  656.726(4)
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0008 - Administrative Review and Contested Cases

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Request
			 for hearing on an action concerning a worker's right to compensation.
Any party, or assigned claims agent, that disagrees with an action taken under
			 these rules that concerns a worker's right to compensation, or the amount of
			 compensation due, may request a hearing by the board under ORS chapter 656 and
			 OAR chapter 438.
(2)
Request
			 for hearing on proposed sanctions or civil penalties.
Any party, or
			 assigned claims agent, that disagrees with a proposed order or proposed
			 assessment of civil penalty of the director issued under ORS
			 656.254,
			 656.260,
			 656.735,
			 656.740, or
			 656.745 may request a hearing by
			 the board. To request a hearing the party, or assigned claims agent, must:
(a) Mail or deliver a written request for
			 hearing to the division within 60 days of the mailing date of the proposed
			 order or assessment; and
(b)
			 Specify, in the request, the reasons why they disagree with the proposed order
			 or assessment.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0009 - Access to Department of Consumer and Business Services Workers' Compensation Claim File Records

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
Under ORS
			 192.318 and OAR
			 440-005-0015(1)
			 the director, as custodian of public records, adopts this rule to protect the
			 integrity of claim file records and prevent interference with the regular
			 discharge of the department's duties.
(2)
Access to public records.
The department rules on Access of Public Records, Fees for Record Search and
			 Copies of Public Records are found in OAR 440-005, accessible at:
			 http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_440/440_005.html [File
			 Link Not Available].
(a) The director will
			 provide the first copy of any document to a worker, worker's attorney, insurer
			 of record, or the insurer's legal representatives and service companies without
			 charge.
(b) Additional copies will
			 be provided at the rates set forth in OAR 440-005. Payment of fees for access
			 to records must be made in advance unless the director determines
			 otherwise.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0010 - Employer Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
A subject employer must accept notice of a claim for
			 workers' compensation benefits from a worker or the worker's attorney under ORS
			 656.265.
(a) Form 801, "Report of Job Injury or
			 Illness," must be readily available for workers to report their injuries. The
			 employer must provide Form 801 to the worker:
(A) Immediately upon request by the worker or
			 worker's attorney under ORS
			 656.265(6);
			 or
(B) Upon receiving notice or
			 knowledge of an accident that may involve a compensable injury under ORS
			 656.262(3)(a).
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0011 - Insurer Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. The insurer must process and
			 file claims and reports required by the director in compliance with ORS chapter
			 656, OAR chapter 436, and orders of the director.
(a) All forms must be legible and include all
			 information required by this rule.
(b) The insurer may not submit forms, or
			 their electronic equivalents, by email, facsimile, electronic data interchange
			 (EDI), or other electronic means, without the director's prior authorization.
(c) Electronic forms, when
			 allowed, must include the same fields and elements as their paper counterparts.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0012 - Notices and Correspondence Following the Death of a Worker

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If a worker is
			 deceased, regardless of the cause of death, an insurer must:
(a) Address all future notices and
			 correspondence to the worker's estate or qualified beneficiaries;
(b) Provide a written notice of acceptance or
			 denial of a claim to the estate of the worker; and
(c) Issue a Notice of Closure, when
			 applicable, to the estate of the worker. The insurer must mail the worker's
			 copy of the Notice of Closure to the worker's last known address. The insurer
			 may mail copies of the Notice of Closure to any known or potential
			 beneficiaries.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0015 - Required Notice and Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Notice to
			 worker's attorney.
If a worker is represented by an attorney, and the
			 attorney has given written notice of representation, the insurer must provide
			 written notice to the worker's attorney before, or at the same time, as the
			 insurer:
(a) Requests the worker to submit to
			 a medical examination;
(b) Contacts
			 the worker regarding any matter that may result in denial, reduction, or
			 termination of the worker's benefits; or
(c) Contacts the worker regarding any matter
			 relating to the disposition of a claim under ORS
			 656.236.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0017 - Release of Claim Documents

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For
			 the purpose of this rule:
(a)
"Documents"
means the written records making up, or relating to,
			 the worker's claim, including but not limited to:
(A) Medical records, including any
			 correspondence to and from medical experts who provide reports to the
			 insurer;
(B) Vocational records,
			 including any correspondence to and from vocational experts who provide reports
			 to the insurer;
(C) Records of all
			 compensation paid;
(D) Payroll
			 records;
(E) Recorded
			 statements;
(F) Insurer generated
			 records, excluding a claims examiner's generated file notes, such as
			 documentation or justification concerning setting or adjusting reserves, claims
			 management strategy, or any privileged communications;
(G) All forms and notices on the claim
			 required by ORS chapter 656 or OAR chapter 436;
(H) Notices of closure; and
(I) Electronic transmissions and
			 correspondence between the insurer, service providers, worker, director, or
			 board.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0018 - Nondisabling and Disabling Claim Reclassification

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
If the insurer changes the classification of an accepted
			 claim, the insurer must:
(a) Notify the
			 director under OAR 436-060-0011;
(b) Send the worker and the worker's
			 attorney, if any, a "Modified Notice of Acceptance" explaining the change in
			 status; and
(c) Close the claim
			 under ORS 656.268(5), if
			 the claim qualifies for closure.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0019 - Determining and Paying the Three Day Waiting Period

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Determining the three-day waiting period.
			 The three-day waiting period is three consecutive calendar days, beginning with
			 the first day the worker leaves work or loses wages as a result of the
			 compensable injury, subject to the following:
(a) If the worker leaves work, but returns
			 and completes the work shift without loss of wages, that day is not considered
			 to be the first day of the three-day waiting period;
(b) If the worker leaves work, but returns
			 and completes the work shift and receives reduced wages, that day is considered
			 to be the first day of the three-day waiting period;
(c) If the worker leaves work and does not
			 complete the work shift, that day is considered to be the first day of the
			 three-day waiting period, even if there is no loss of wages;
(d) If the worker leaves work or loses wages
			 during a work shift that extends into another calendar day, the first day of
			 the three-day waiting period is the date the employer uses for payroll
			 purposes.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0020 - Payment of Temporary Total Disability Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Employer payment of temporary disability.
An employer may pay
			 temporary disability compensation with the approval of the insurer. If the
			 insurer approves an employer to make such payment:
(a) The insurer continues to be responsible
			 for determining the worker's entitlement to compensation, and ensuring timely
			 payment of compensation;
(b) The
			 employer must provide the insurer with payment documentation that is adequate
			 to meet the insurer's responsibilities; and
(c) The insurer must reimburse the employer
			 for any temporary disability compensation paid to the worker under this
			 section.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0025 - Worker's Weekly Wage Calculation and Rate of Temporary Disability Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Continuation of wages, insured employers.
An employer may not
			 continue to pay wages in place of temporary disability benefits. However, with
			 the worker's consent, the employer may pay the worker amounts in addition to
			 the temporary disability benefits due to the worker, if the employer:
(a) Identifies temporary disability benefits
			 separately from other payments; and
(b) Does not withhold payroll deductions from
			 the temporary disability benefits.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0030 - Payment of Temporary Partial Disability Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Rate of temporary partial disability.
The amount of temporary
			 partial disability compensation due a worker must be determined by multiplying
			 the worker's rate of compensation for temporary total disability by the
			 percentage of wages lost by the worker post injury.
(a) To calculate the rate of temporary
			 disability, the insurer must:
(A) Subtract the
			 worker's post-injury wages from any kind of work from the worker's wages at the
			 time of injury under OAR
			 436-060-0025;
(B) Divide the difference under paragraph (A)
			 by the worker's wages at the time of injury under OAR
			 436-060-0025 to arrive at the
			 percentage of loss of wages; and
(C) Multiply the worker's current rate of
			 compensation for temporary total disability by the percentage of loss of wages
			 in paragraph (B).
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0035 - Supplemental Disability for Workers with Multiple Jobs at the Time of Injury

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the purpose
			 of this rule:
(a)
"Primary job"
means the job at which the injury occurred, or the job where the worker was
			 employed at the time of medical verification that the worker is unable to work
			 because of disability caused by occupational disease;
(b)
"Secondary job"
means any
			 other job held by the worker in Oregon subject employment at the time of
			 injury;
(c)
"Temporary
			 disability"
means wage loss replacement for the primary job;
(d)
"Supplemental disability"
means wage loss replacement for the secondary jobs that exceeds the temporary
			 disability, up to, but not exceeding, the maximum established by ORS
			 656.210; and
(e)
"Insurer"
has the same
			 meaning as OAR 436-060-0005(13),
			 and also includes service companies.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0040 - Payment of Permanent Partial Disability Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. A permanent partial disability
			 award exceeding $6,000 may be paid monthly by the insurer. If it is paid
			 monthly, it must be paid at 4.35 times the weekly temporary disability rate at
			 the time of closure. A permanent partial disability award less than $6,000 must
			 be paid under OAR 436-060-0060.
(2) Reopened claims. If a claim is reopened
			 as a result of a new medical condition, or an aggravation of the conditions
			 resulting from the worker's compensable injury:
(a) Any permanent partial disability benefits
			 due must continue; and
(b) If any
			 temporary disability benefits are due, permanent partial disability benefits
			 must be paid concurrently.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0045 - Payment of Compensation During Worker Incarceration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. A worker is not eligible to
			 receive temporary disability compensation for periods of time during which the
			 worker is incarcerated for commission of a crime. All other compensation
			 benefits must be provided the worker as if the worker were not incarcerated,
			 except as provided in OAR 436-120. For the purpose of this rule:
(a) A worker is incarcerated for commission
			 of a crime when:
(A) In pretrial detention;
			 or
(B) Imprisoned following
			 conviction for a crime; and
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0055 - Payment of Medical Services on Nondisabling Claims; Employer/Insurer Responsibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 General. Notwithstanding the choice made by the employer under this rule, the
			 employer and insurer must process nondisabling claims in accordance with all
			 statutes and rules governing claims processing. The employer, however, may
			 reimburse the medical service costs paid by the insurer as prescribed in
			 section (3) of this rule.
(2)
			 Notice to employers. Before the beginning of each policy year, the insurer must
			 notify the insured or prospective insured employer of the employer's right to
			 reimburse medical service costs on accepted, nondisabling claims up to the
			 maximum amount as published in Bulletin 345. The notice must advise the
			 employer:
(a) Of the procedure for making
			 such payments as outlined in section (3) of this rule;
(b) Of the general impact on the employer if
			 the employer chooses to make such payments;
(c) That the employer is choosing not to
			 participate if the employer does not respond in writing within 30 days of
			 receipt of the insurer's notice;
(d) That the employer's written election to
			 participate in the reimbursement program remains in effect, without further
			 notice from the insurer, until the employer advises otherwise in writing or is
			 no longer insured by the insurer; and
(e) That the employer may participate later
			 in the policy period upon written request to the insurer, however, the earliest
			 reimbursement period is the first completed period, established under
			 subsection (3)(a) of this rule, following receipt of the employer's request.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0060 - Lump Sum Payment of Permanent Partial Disability Awards

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
When an award for permanent partial disability is $6,000
			 or less, the insurer must pay the total amount of the award to the worker in a
			 lump sum. When the award for permanent partial disability exceeds $6,000, the
			 worker or worker's attorney may request a lump sum payment of all or part of
			 the award. The insurer may only deny the request for lump sum payment if any of
			 the following apply:
(a) The worker has not
			 waived the right to appeal the adequacy of the award;
(b) The award has not become final by
			 operation of law;
(c) The payment
			 of compensation has been stayed pending a request for hearing or review under
			 ORS 656.313; or
(d) The worker is enrolled and actively
			 engaged in an authorized training plan under OAR 436-120. For dates of injury
			 before Jan. 1, 2005, the insurer may not approve a request for lump sum payment
			 of unscheduled permanent disability. For dates of injury on or after Jan. 1,
			 2005, the insurer may not approve a request for lump sum payment of work
			 disability when the worker:
(A) Has been
			 found eligible for an authorized training plan under OAR 436-120 and will start
			 the plan within 30 days of the date of the decision on the lump sum
			 request;
(B) Is actively enrolled
			 and engaged in an authorized training plan under OAR 436-120; or
(C) Has temporarily withdrawn from an
			 authorized training plan under OAR 436-120.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0075 - Payment of Death Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
If death results from a worker's compensable injury or
				occupational disease, benefits must be paid as follows:
(1)
Final disposition of the body and
			 funeral expenses.
(a) The insurer must
			 pay the cost of final disposition of the body and funeral expenses, up to the
			 maximum benefit under ORS
			 656.204(1);
			 and
(b) The worker's estate,
			 beneficiaries, or other parties may submit bills related to final disposition
			 of the body and funeral up to 60 days after the date of death or date of claim
			 acceptance, whichever is later. Any portion of the benefit that remains unpaid
			 after this period must be paid to the worker's estate.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0095 - Medical Examinations; Suspension of Compensation; and Independent Medical Examination Notice

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
A worker must
			 submit to independent medical examinations reasonably requested by the insurer
			 or the director.
(a) The conditions of the
			 examination must be consistent with conditions described in OAR
			 436-010-0265.
(b) If the worker refuses or fails to submit
			 to, or otherwise obstructs, an independent medical examination reasonably
			 requested by the insurer or the director under ORS
			 656.325(1), the
			 director may suspend compensation by order:
(A) The worker must have the opportunity to
			 dispute the suspension of compensation before the director will issue the
			 order; and
(B) Compensation will be
			 suspended until the examination has been completed. The worker is not entitled
			 to compensation during or for the period of suspension.
(c) Any action of a worker's observer allowed
			 under OAR 436-010-0265(6)
			 that obstructs the examination may be considered an obstruction of the
			 examination by the worker for the purpose of this rule.
(d) The director may determine whether
			 special circumstances exist that would not warrant suspension of compensation
			 for failure to attend or obstruction of the examination.
(e) The director may impose a monetary
			 penalty against the worker under OAR
			 436-010-0265.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0105 - Suspension of Compensation for Insanitary or Injurious Practices, Refusal of Treatment or Failure to Participate in Rehabilitation; Reduction of Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
The director may
			 suspend compensation by order when the worker commits insanitary or injurious
			 acts that imperil or delay recovery; refuses to submit to medical or surgical
			 treatment reasonably required to promote recovery; or fails or refuses to
			 participate in a physical rehabilitation program.
(a) The worker must have the opportunity to
			 dispute the suspension of compensation before the director will issue an
			 order.
(b) The worker is not
			 entitled to compensation during or for the period of suspension.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0135 - Injured Worker, Worker's Attorney Responsible to Assist in Investigation; Suspension of Compensation and Notice to Worker

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Worker's responsibility to assist in investigation.
A worker must
			 submit to and fully cooperate with in person or telephone interviews and other
			 formal or informal information gathering techniques reasonably requested by the
			 insurer. Interviews may be recorded on audio or video by one or more of the
			 parties if prior written notice is given of the intent to record an
			 interview.
(2)
Request to
			 suspend compensation.
The insurer may request for the director to
			 suspend compensation by order when the worker refuses or fails to cooperate in
			 an investigation of an initial claim for compensation, a claim for a new
			 medical condition, a claim for an omitted medical condition, or an aggravation
			 claim as required by ORS
			 656.262(14),
			 under the following conditions:
(a) The
			 insurer must notify the worker in writing that an interview or deposition has
			 been scheduled, or of other investigation requirements:
(A) The notice must be sent to the worker and
			 copied to the worker's attorney, if any, and must contain the following:
(i) The date, time, and place of the
			 interview or deposition, if scheduled;
(ii) Any other reasonable investigation
			 requirements;
(iii) That the
			 interview, deposition, or any other investigation requirements are related to
			 the worker's compensation claim; and
(iv) The following statement:
(I) In prominent or bold text:
"The workers' compensation law requires injured workers
				to cooperate and assist the insurer or self-insured employer in the
				investigation of claims for compensation. Injured workers are required to
				submit to and fully cooperate with personal and telephonic interviews and other
				formal or informal information gathering techniques. If you do not reasonably
				cooperate with the investigation of this claim, payment of your compensation
				benefits may be suspended and your claim may be denied in accordance with ORS
				656.262 and OAR
				436-060."
(II)
			 Effective no later than Oct. 1, 2024, the text in (iv)(I) of this paragraph
			 must be replaced with the following language in bold and formatted as follows:
The law requires you to cooperate and assist in the
				investigation of your workers' compensation claim. This means you must take
				part and fully cooperate with:
- Personal and telephone interviews, and
- Other formal or informal information gathering
				techniques.
If you do not reasonably cooperate:
- Your workers' compensation benefits may be suspended,
				and
- Your claim may be denied under ORS
				656.262 and OAR
				436-060.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0137 - Vocational Evaluations for Permanent Total Disability Benefits; and Suspension of Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Requests
			 for vocational evaluations.
A worker receiving permanent total
			 disability benefits must attend a vocational evaluation reasonably requested by
			 the insurer or the director.
(2)
Allowed number of vocational evaluations.
The insurer may request
			 no more than three separate vocational evaluations without authorization from
			 the director. Insurers that fail to obtain authorization from the director for
			 additional vocational evaluations may be assessed a civil penalty.
(a) To request authorization the insurer
			 must:
(A) Submit a written request for
			 authorization that includes:
(i) The reasons
			 for an additional vocational evaluation;
(ii) The conditions to be
			 evaluated;
(iii) The dates, times,
			 places, and purposes of previous evaluations;
(iv) Copies of previous vocational evaluation
			 notification letters to the worker; and
(v) Any other information requested by the
			 director;
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0140 - Acceptance or Denial of a Claim

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Claim
			 investigations.
The insurer is required to conduct a "reasonable"
			 investigation based on all available information in determining whether to deny
			 a claim.
(a) A reasonable investigation is
			 whatever steps a reasonably prudent person with knowledge of the legal
			 standards for determining compensability would take in a good faith effort to
			 ascertain the facts underlying a claim, giving due consideration to the cost of
			 the investigation and the likely value of the claim.
(b) In determining whether an investigation
			 is reasonable, the director will only look at information contained in the
			 insurer's claim record at the time of denial. The insurer may not rely on any
			 fact not documented in the claim record at the time of denial to establish that
			 an investigation was reasonable.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0141 - Claims for COVID-19 or Exposure to SARS-CoV-2

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Definitions.
For the purpose
			 of this rule:
(a) "COVID-19" means a disease
			 caused by the severe acute respiratory syndrome coronavirus 2
			 (SARS-CoV-2).
(b) "Isolation" means
			 the physical separation and confinement of a person who is infected or
			 reasonably believed to be infected with COVID-19 from nonisolated persons to
			 prevent or limit the transmission of COVID-19 to nonisolated persons.
(c) "Medical service provider" means a person
			 duly licensed to practice one or more of the healing arts.
(d) "Presumptive case" means:
(A) The person has not tested positive for
			 COVID-19;
(B) The person has an
			 acute illness with at least two of the following symptoms: shortness of breath,
			 cough, fever, new loss of smell or taste, or radiographic evidence of viral
			 pneumonia;
(C) There is no more
			 likely alternative diagnosis; and
(D) The person, within the 14 days before
			 illness onset, had close contact with a confirmed case of COVID-19.
(e) "Quarantine" means the
			 physical separation and confinement of a person who has been or may have been
			 exposed to COVID-19 or SARS-CoV-2 and who does not show signs or symptoms of
			 COVID-19, from persons who have not been exposed to COVID-19 or SARS-CoV-2, to
			 prevent or limit the transmission of COVID-19 to other persons.
(f) "SARS-CoV-2" means the strain of
			 coronavirus that causes COVID-19.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0147 - Worker Requested Medical Examination

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Eligibility.
The worker is eligible for a worker requested medical
			 examination if:
(a) The worker has made a
			 timely request for a board hearing on a denial of compensability;
(b) The denial is based on one or more
			 independent medical examination reports; and
(c) The attending physician or authorized
			 nurse practitioner does not concur with the report or reports.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0153 - Electronic Payment of Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
Benefits may be
			 paid through a direct deposit system, automated teller machine card or debit
			 card, or other means of electronic transfer if the worker voluntarily consents.
(a) Except as provided under (1)(c) of this
			 rule, an insurer must obtain the worker's consent before initiating electronic
			 payments. The consent may be written or verbal. The insurer must provide the
			 worker a written confirmation when consent is obtained verbally.
(b) An employer making payments under OAR
			 436-060-0020(1)
			 may assume the worker consents to having benefits paid through a direct deposit
			 system if that is the method the employer usually uses to pay the worker's
			 wages.
(c) A self-insured employer
			 paying benefits may assume the worker consents to having benefits paid through
			 a direct deposit system if that is the method the employer usually uses to pay
			 the worker's wages.
(d) The worker
			 may discontinue receiving electronic payments by notifying the insurer or
			 employer in writing.