Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 30 - CLAIM CLOSURE AND RECONSIDERATION › Section 436-030-0065 - Review of Permanent Total Disability Awards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The insurer must reexamine each permanent
			 total disability claim at least once every two years or when requested to do so
			 by the director to determine if the worker has materially improved, either
			 medically or vocationally, and is capable of regularly performing work at a
			 suitable and gainful occupation. The insurer must notify the worker and the
			 worker's attorney if the worker is represented whenever the insurer intends to
			 reexamine the worker's permanent total disability status. Workers who fail to
			 cooperate with the reexamination may have benefits suspended under OAR
			 436-060-0095.
(2) A worker receiving permanent total
			 disability benefits must submit to a vocational evaluation, if requested by the
			 director, insurer, or self-insured employer under ORS
			 656.206(8).
(3) Any decision by the insurer to reduce
			 permanent total disability must be communicated in writing to the worker, and
			 to the worker's attorney if the worker is represented, andaccompanied by
			 documentation supporting the insurer's decision. That documentation must
			 include: medical reports, including sufficient information necessary to
			 determine the extent of permanent partial disability, vocational and
			 investigation reports (including visual records, if available) that demonstrate
			 the worker's ability to regularly perform a suitable and gainful occupation,
			 and all other applicable evidence.
(4) An award of permanent total disability
			 for scheduled injuries before July 1, 1975, may be considered for reduction
			 only when the insurer has evidence that the medical condition has
			 improved.
(5) Except for section
			 (4) of this rule, an award of permanent total disability may be reduced only
			 when the insurer has a preponderance of evidence that the worker has materially
			 improved, either medically or vocationally, and is regularly performing work at
			 a suitable and gainful occupation or is currently capable of doing so.
			 Preexisting disability must be included in redetermination of the worker's
			 permanent total disability status.
(6) When the insurer reduces a permanent
			 total disability claim, the insurer must, based upon sufficient information to
			 determine the extent of permanent partial disability, issue a Notice of
			 Closure, Permanent Total Disability Reduction (Form 1644p) that reduces the
			 permanent total disability and awards permanent partial disability, if
			 any.
(7) Notices of Closure
			 reducing permanent total disability are appealable to the board.
(8) If a worker is receiving permanent total
			 disability benefits and sustains a new compensable injury, the worker is
			 eligible for additional benefits for the new compensable injury, except that
			 the worker's eligibility for compensation for the new compensable injury is
			 limited to medical benefits under ORS
			 656.245 and permanent partial
			 disability benefits for impairment, as determined in the manner set forth in
			 ORS 656.214(2).
Statutory/Other Authority: ORS
				  656.268 &
				  656.726
Statutes/Other Implemented: ORS
				  656.268,
				  656.726,
				  656.206,
				  656.214,
				  656.283,
				  656.319,
				  656.325 &
				  656.331