reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0155 - Penalty to Worker for Untimely Processing

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
If the insurer unreasonably delays or unreasonably
			 refuses to pay compensation, attorney fees or costs, or unreasonably delays
			 acceptance or denial of a claim:
(a) The
			 director may require the insurer to pay:
(A) A
			 penalty, payable to the worker, of up to 25 percent of the amounts then due,
			 determined by the matrix attached to these rules in Appendix "B." When there
			 are no "amounts then due" upon which to assess a penalty, no penalty will be
			 issued under this rule; and
(B) A
			 fee to the worker's attorney under ORS
			 656.262(11) and
			 OAR 436-001-0420.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0160 - Use of Sight Draft to Pay Compensation Prohibited

Current through Register Vol. 63, No. 7, July 1, 2024
Insurers may not use a sight draft to pay any benefits or
				payments due a worker or beneficiary under ORS chapter 656.
Stat. Auth.: ORS
				  656.726(4)
Stats. Implemented: ORS
				  656.726(4)
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0170 - Recovery of Overpayment of Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Benefits
			 paid a worker.
An insurer may recover overpayment of benefits paid to a
			 worker as specified by ORS
			 656.268(12), (13), (14), and
			 (16), unless authority is granted by an
			 administrative law judge or the board.
(2)
Benefits due a worker.
An
			 insurer may recover an overpayment from any benefits currently due on any claim
			 the worker has with that insurer. The insurer must explain in writing the
			 reason, the amount, and the method of recovery to the worker and the worker's
			 attorney, if any, or to the worker's beneficiaries.
(3)
Permanent partial disability
			 offsets.
When overpaid benefits are offset against monthly permanent
			 partial disability award payments, the insurer must recover the benefits from
			 the total amount of the award. The insurer must pay out the remainder of the
			 award at 4.35 times the temporary total disability rate, or at least $108.75,
			 starting with the first month's payment.
(4)
Supplemental disability
			 benefits.
The director, through its assigned processing administrator
				described under OAR 436-060-0035(2)(d),
				may recover overpayments of supplemental disability benefits under the same
				conditions provided under ORS
				656.268(12), (13), (14), and
				(16), or may require the insurer to do so. If
				the insurer recovers an overpayment on behalf of the assigned processing
				administrator, the insurer must reimburse the assigned processing
				administrator.
Statutory/Other Authority: ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.268(12) (13),(14), &
				  (16)
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0180 - Designation and Responsibility of a Paying Agent

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the
			 purpose of this rule:
(a)
"Compensable
			 injury"
means an accidental injury or damage to a prosthetic appliance,
			 or an occupational disease arising out of and in the course of employment with
			 any Oregon employer, and which requires medical services or results in
			 disability or death.
(b)
"Exposure"
means a specific incident or period during which a
			 compensable injury may have occurred.
(c)
"Responsibility"
means
			 liability under the law for the acceptance and processing of a compensable
			 claim.
(d)
"Earliest
			 claim"
means the earliest date of:
(A)
			 A written request for compensation from a subject worker or someone on the
			 worker's behalf; or
(B) The subject
			 employer's notice or knowledge of the compensable
			 injury.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0195 - Miscellaneous Monetary Adjustments Among Insurers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. The director may order monetary
			 adjustments between insurers when a worker has a right to compensation, but
			 there is a dispute between insurers that does not fall under the director's
			 authority in ORS 656.307 and OAR
			 436-060-0190.
(a) When any litigation on the issues in
			 question is final, insurers must make any necessary monetary adjustments
			 between themselves, consistent with the determination of coverage for
			 compensation paid to the worker, medical providers, and others for which they
			 are responsible, within 30 days of receiving enough information to determine
			 the benefits paid and the relationship to the conditions involved.
(b) Any balance due after making such
			 adjustments must be paid in a timely manner to the worker, medical providers
			 and other parties under OAR 436-009 and
			 436-060-0150.
(c) Any failure to obtain reimbursement from
			 an insurer under this rule is not recoverable from the Consumer and Business
			 Services Fund.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0200 - Assessment of Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Penalties for inducing failure to report claims.
The director will
			 assess a civil penalty under ORS
			 656.745(1)
			 against an employer or insurer that intentionally or repeatedly induces workers
			 to fail to report accidental injuries, causes employees to collect accidental
			 injury claims as off-the-job injury claims, persuades workers to accept less
			 than the compensation due or makes it necessary for workers to resort to
			 proceedings against the employer to secure compensation due. For the purpose of
			 this section:
(a)
"Intentionally"
means the employer or insurer acted with a
			 conscious objective to engage in the conduct or cause any result described in
			 this section; and
(b)
"Repeatedly"
means more than once in any 12-month
			 period.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0400 - Penalty and Attorney Fee for Untimely Payment of Disputed Claims Settlement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Right
			 to request penalties and attorney fees. If the insurer fails to pay amounts due
			 on a disputed claims settlement within five business days of receipt of notice
			 from the worker that the payment is late, the worker or worker's attorney may
			 request penalties and attorney fees.
(2) Requirements for requests. Requests for
			 penalties and attorney fees under this rule must be in writing, state what
			 payments were delayed or remain unpaid, and be mailed or delivered to the
			 division within 180 days of the date of notice to the insurer. In order to be
			 awarded an attorney fee the attorney must submit a signed, current retainer
			 agreement.
(3) Required response
			 from the insurer. When notified by the director that a penalty or attorney fees
			 have been requested under this rule, the insurer must respond in writing to the
			 division.
(a) The response must include any
			 information or documentation requested by the director.
(b) The response must be mailed or delivered
			 to the division within 14 days of the date of the director's inquiry letter;
			 and
(c) Copies of the response,
			 including any attachments, must be sent simultaneously to the worker and the
			 worker's attorney, if any.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0500 - Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
General.
When an insurer
			 elects to pay supplemental disability due a worker with multiple jobs at the
			 time of injury, the director will reimburse the supplemental amount quarterly,
			 after receipt and approval of documentation of compensation paid by the insurer
			 or service company. The director will reimburse the insurer, in care of the
			 service company, if applicable.
(2)
Requests for reimbursement.
Requests for reimbursement must be
			 submitted on Form 3504, "Supplemental Disability Benefits Quarterly
			 Reimbursement Request," and must include at least:
(a) Identification and address of the insurer
			 responsible for processing the claim;
(b) The worker's name, WCD file number, date
			 of injury, Social Security number (if known), and the insurer claim
			 number;
(c) Whether the claim is
			 disabling or nondisabling;
(d) The
			 primary and secondary employers' legal names;
(e) The primary and secondary employers'
			 policy numbers;
(f) The weekly wage
			 of all jobs at the time of the injury separated by employer;
(g) The start and end dates for the periods
			 of supplemental disability due and payable to the worker;
(h) The amount of supplemental disability
			 paid for the periods in subsection (g);
(i) The quarter and year in which the payment
			 was made;
(j) A signed payment
			 certification statement verifying the payments; and
(k) Any other information the director
			 requires.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 60 - CLAIMS ADMINISTRATION › Section 436-060-0510 - Reimbursement of Permanent Total Disability Benefits from the Workers' Benefit Fund

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General. The
			 insurer may request reimbursement of permanent total disability benefits paid
			 after the date of the notice of closure under ORS
			 656.206(6)(a).
(2) Requirements for requests.
			 Requests for reimbursement must be filed within one year of the mailing date of
			 the final order upholding the notice of closure and include:
(a) Sufficient information to identify the
			 insurer and the injured worker;
(b) The net dollar amount of permanent total
			 disability benefits paid. "Net dollar amount" means the total compensation paid
			 less any recoveries, including, but not limited to, third party recoveries or
			 amounts reimbursable from the Retroactive Program or Reopened Claims Program;
			 and
(c) A statement certifying
			 that payment has been made.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0001

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726 &
				  656.506
Stats. Implemented: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0002

Current through Register Vol. 63, No. 7, July 1, 2024
Stat Auth: ORS
				  656.506 &
				  656.726(4)
Stats. Impltd: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0003 - Purpose and Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Purpose.
These rules prescribe the rate of the Workers' Benefit
			 Fund assessment under ORS
			 656.506 effective Jan. 1, 2022,
			 the method and manner for calculating the assessment rate, and the method and
			 manner in which employers are to pay the assessment.
(2)
Applicability.
(a) These rules apply to all
			 employers.
(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 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Except where the context requires otherwise, the construction
				of these rules is governed by the definitions in the Workers' Compensation Law
				and as follows:
(1) "Assessments"
			 means the funds due from employees and employers pursuant to ORS
			 656.506.
(2) "Employee" means a subject Oregon worker
			 as defined in ORS 656.005 and any otherwise
			 nonsubject worker for whom coverage is elected under ORS
			 656.039.
(3) "Fund" means the Workers' Benefit Fund as
			 created in ORS 656.506.
(4) "Fund balance" means the balance of the
			 fund after revenue and investment income has been added and expenditures have
			 been subtracted.
Statutory/Other Authority: ORS
				  656.506
Statutes/Other Implemented: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0008 - Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Contested
			 case hearings regarding sanctions and civil penalties: Any employer as defined
			 by ORS 656.005 aggrieved by a proposed
			 order or proposed assessment of civil penalty of the director issued pursuant
			 to ORS 656.745 may request a hearing by
			 the Hearings Division of the Workers' Compensation Board in accordance with
			 656.740.
(a) The request for hearing must be
			 sent in writing to the administrator of the Workers' Compensation Division. No
			 hearing will 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 within 60 days after the mailing 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 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0010 - Assessment Rate: Method and Manner of Determining

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The assessment
			 owed by an employer under this rule division and ORS
			 656.506 must be calculated using
			 the method in OAR 436-070-0020 and based on a rate
			 of 2.2 cents per hour.
(2) Factors
			 considered by the director in developing the rate include, but are not limited
			 to:
(a) The estimated annual fund
			 expenditures and revenues;
(b) The
			 fund balance requirements;
(c) The
			 estimated annual hours worked per employee;
(d) The estimated number of employees covered
			 by workers' compensation insurance; and
(e) Other records relating to fund
			 expenditures and revenues.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0020 - Assessments: Manner and Intervals for Filing and Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every employer must compute the total
			 assessment amount due for each employee by multiplying the assessment rate
			 determined in OAR 436-070-0010 by the number of
			 hours or parts of an hour the employee worked in the pay period.
(a) If actual hours worked are not tracked,
			 an employer may either calculate the assessments using a flat rate, use
			 contract information stating the number of hours an employee works, or come up
			 with a reasonable method for calculating hours worked. If the flat rate method
			 is used, the calculation must be based on 40 hours per week for employees paid
			 weekly or biweekly, or 173.33 hours per month for employees paid monthly or
			 semi-monthly.
(b) The employer will
			 retain from the moneys earned by each employee one half (1/2) of the amount
			 due. In addition, the employer will be assessed an amount equal to the amount
			 retained from each employee.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0040 - Monitoring/Auditing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Employers must
			 maintain payroll and employment records which reflect the total hours worked by
			 all employees for the current calendar year plus three prior calendar
			 years.
(2) Pursuant to ORS
			 656.726, the director may
			 inspect the books, records and payrolls of employers pertinent to the
			 administration of these rules. Employers must provide the director with all
			 pertinent books, records and payrolls upon request.
Statutory/Other Authority: ORS
				  656.726
Statutes/Other Implemented: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 70 - WORKERS' BENEFIT FUND ASSESSMENT › Section 436-070-0050 - 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 that violates ORS chapter 656, OAR 436-070, or an order of
				the director.
Statutory/Other Authority: ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.745
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0001

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.506 &
				  656.726
Stats. Implemented: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0003 - Applicability of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These
			 rules apply to all requests for reimbursement from the Retroactive Program
			 involving benefits payable under:
(a) ORS
			 656.204 Death;
(b) ORS
			 656.206 Permanent Total
			 Disability;
(c) ORS
			 656.208 Death During Permanent
			 Total Disability; and
(d) ORS
			 656.210 Temporary Total
			 Disability for injuries before April 1, 1974.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0005 - 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
				purposes of these rules, unless the context requires otherwise:
(1) "Child" is as defined in ORS chapter 656
			 applicable at the worker's date of injury.
(2) "Department" means the Department of
			 Consumer and Business Services.
(3)
			 "Director" means the director of the Department of Consumer and Business
			 Services or the director's designee.
(4) "Insurer" means the State Accident
			 Insurance Fund Corporation, an insurer authorized under ORS Chapter 731 to
			 transact workers' compensation insurance in this state, or an employer or
			 employer group that has been certified as self-insured under ORS
			 656.430.
(5) "Mailed" or "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 stamped or punched in 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 75 - RETROACTIVE PROGRAM › Section 436-075-0008 - Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any party aggrieved by a proposed order
			 or proposed assessment of civil penalty issued under ORS
			 656.745 may request a hearing by
			 the Hearings Division of the Workers' Compensation Board under ORS
			 656.740. To request a hearing
			 the party, or assigned claims agent, must:
(a)
			 Mail or deliver a written request for hearing to the Workers' Compensation
			 Division within 60 days of the mailing date of the proposed order or
			 assessment; and
(b) Specify the
			 reasons why the party or assigned claims agent disagrees with the proposed
			 order or assessment in the request.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0010 - Criteria for Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 department will issue a bulletin to notify all insurers of changes in the
			 Retroactive Program benefit levels whenever the director determines a change is
			 necessary under ORS 656.506(7).
(2) Eligibility for Retroactive Program
			 benefits is based on the worker's injury date as follows:
(a) Workers or beneficiaries eligible to
			 receive either death or permanent total disability benefits become eligible for
			 Retroactive Program benefit increases when the benefits granted under the
			 Retroactive Program bulletin exceed the benefits provided by the statute in
			 effect at the time of the injury.
(b) Workers receiving temporary total
			 disability benefits are eligible for Retroactive Program benefit increases as
			 follows:
(A) Workers with injuries occurring
			 before July 1, 1973 are eligible for Retroactive Program benefit
			 increases;
(B) Workers with
			 injuries occurring from July 1, 1973 through April 1, 1974 may be eligible for
			 benefits according to the limits defined in the Retroactive Program bulletin;
			 and
(C) Workers with injuries
			 occurring on or after April 1, 1974 are not eligible to receive Retroactive
			 Program increases to their temporary total disability benefit.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0020 - Death Benefit

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Death
			 benefits must be paid to eligible beneficiaries under ORS
			 656.204, OAR
			 436-060-0075, and the benefit
			 schedules in the Retroactive Program bulletin.
(2) The statutory death benefit for injuries
			 occurring from July 1, 1973 through April 1, 1974 will be reduced by the Social
			 Security benefits received by the worker's surviving spouse, not to exceed the
			 July 1, 1973 statutory benefit level. The amount of reduction to the statutory
			 benefit is a Retroactive Program benefit. The insurer may request reimbursement
			 only for the adjusted Retroactive Program benefit.
(3) At least once every two years, the
			 insurer must verify that all beneficiaries receiving death benefits for which
			 the insurer may request reimbursement from the Retroactive Program are alive
			 and remain eligible for those benefits. Insurers' questions regarding
			 beneficiaries' status must be reasonably pertinent to the continuing
			 eligibility of those persons for benefits.
Statutory/Other Authority: ORS
				  656.506 & ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.204 [OL 2017, ch. 71] &
				  ORS 656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0030 - Permanent Total Disability Benefit

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Permanent total disability benefits must
			 be paid under ORS 656.206 and the benefit
			 schedules in the Retroactive Program bulletin.
(2) Benefits payable for a partial month must
			 be calculated by dividing the monthly benefit by the actual number of days in
			 the month and multiplying that result by the number of days payable.
(3) Benefits for beneficiaries must be paid
			 to the date of any status change.
(4) Any Social Security offset determined
			 under ORS 656.209 must first be applied
			 against the statutory portion of the permanent total disability benefit. Any
			 amount of the Social Security offset that exceeds the statutory benefit must be
			 applied against the Retroactive Program benefit. The insurer may request
			 reimbursement only for that portion of the Retroactive Program benefit that has
			 not been offset.
(5) At least once
			 every two years, the insurer must verify that all beneficiaries receiving
			 benefits for which the insurer may request reimbursement from the Retroactive
			 Program are alive and remain eligible for those benefits. Such "status checks"
			 of beneficiaries may occur at the same time the insurer re-examines the
			 permanent total disability claim under OAR
			 436-030-0065(1).
			 Insurers' questions regarding beneficiaries' status must be reasonably
			 pertinent to the continuing eligibility of those persons for
			 benefits.
Statutory/Other Authority: ORS
				  656.506 & ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.206 [OL 2017, ch. 70], ORS
				  656.209 & ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0040 - Death During Permanent Total Disability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If the injured worker dies during the
			 period of permanent total disability, death benefits must be paid to eligible
			 beneficiaries under ORS
			 656.208,
			 656.204, OAR
			 436-060-0075, and the benefit
			 schedules in the Retroactive Program bulletin.
(2) The statutory death benefit for injuries
			 occurring from July 1, 1973 to April 1, 1974 will be reduced by the Social
			 Security benefits received by the worker or the worker's surviving spouse, not
			 to exceed the July 1, 1973 statutory benefit level. The amount of reduction to
			 the statutory benefit is a Retroactive Program benefit. The insurer may request
			 reimbursement only for the adjusted Retroactive Program benefit.
(3) At least once every two years, the
			 insurer must verify that all beneficiaries receiving death benefits for which
			 the insurer may request reimbursement from the Retroactive Program are alive
			 and remain eligible for those benefits. Insurers' questions regarding
			 beneficiaries' status must be reasonably pertinent to the continuing
			 eligibility of those persons for benefits.
Statutory/Other Authority: ORS
				  656.506 & ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.204 [OL 2017, ch. 71], ORS
				  656.208 & ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0050 - Temporary Total Disability

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Temporary total disability benefits must be paid under ORS
			 656.210, OAR
			 436-060-0150, and the benefit
			 schedules in the Retroactive Program bulletin.
(2) The computation of benefits under these
			 rules and the Retroactive Program bulletin may not reduce temporary total
			 disability benefits currently being paid.
Stat. Auth.: ORS
				  656.506
Stats. Implemented: ORS
				  656.210
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0065 - Dispositions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any disposition
			 of the claim by the parties under ORS
			 656.236, or settlement of the
			 claim under ORS 656.289, is not eligible for
			 reimbursement from the Retroactive Program unless it is approved by the
			 director before it is submitted to the Workers' Compensation Board.
(2) Requests for the director's approval of
			 proposed dispositions must be made in writing, and must include:
(a) A copy of the proposed disposition that
			 specifies the amount of the proposed contribution to be made from the
			 Retroactive Program;
(b) A
			 statement from the insurer indicating how the amount of the contribution was
			 calculated; and
(c) Any other
			 information required by the director.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0070 - Reimbursement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Reimbursement
			 from the Retroactive Program will be authorized by the Workers' Compensation
			 Division on a quarterly basis.
(2)
			 Requests for reimbursement must be mailed or delivered to the Workers'
			 Compensation Division within 30 days after the end of each calendar quarter to
			 be processed in that quarterly disbursement.
(3) Requests for reimbursement mailed or
			 delivered to the Workers' Compensation Division more than 30 days after the end
			 of the quarter will be processed with the next quarterly disbursement.
(4) A separate request for
			 reimbursement must be submitted for each insurer and include a signed
			 certification that the payments reported on the request have been made in the
			 amounts reported.
(5) The insurer
			 must use Form 3285, "Request for Reimbursement from the Retroactive Program,"
			 or an equivalent form, to request reimbursement from the Retroactive Program.
(a) If an equivalent form is used, it must
			 include all of the data elements on Form 3285; and
(b) Each request must accurately reflect the
			 marital and dependency status in effect and eligible for reimbursement in the
			 period requested.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0090 - Third Party Recovery

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In a
			 third party recovery, previously reimbursed Retroactive Program benefits are a
			 portion of the paying agency's lien.
(2) When the insurer learns of third-party
			 settlement negotiations on any claim for which it has received reimbursement
			 from the Retroactive Program, the insurer must notify the Workers' Compensation
			 Division.
(3) The insurer must make
			 remittance on recovered Retroactive Program benefits to the department in the
			 quarter following the recovery in amounts determined under ORS
			 656.591 and
			 656.593.
Statutory/Other Authority: ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.506, ORS
				  656.591 & ORS
				  656.593
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 75 - RETROACTIVE PROGRAM › Section 436-075-0100 - Assessment of Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
Under ORS
				656.745 the director may assess
				a civil penalty against an insurer for failure to comply with these rules.
				Penalty orders will be issued under ORS
				656.447 and
				656.704 and are subject to
				review under OAR 436-075-0008.
Stat. Auth.: ORS
				  656.745
Stats. Implemented: ORS
				  656.204,
				  656.726,
				  656.745 &
				  656.447
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0001

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS 656
Stats. Implemented: ORS
				  656.054,
				  656.704,
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0002

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.054 &
				  656.726
Stats. Implemented: ORS
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0003 - Applicabililty of Rules

Current through Register Vol. 63, No. 7, July 1, 2024
These rules are effective January 1, 2004 and carry out the
				provisions of:
(1) ORS
			 656.017 - Employer required to
			 pay compensation and perform other obligations and duties.
(2) ORS
			 656.052 - Prohibition against
			 employment without coverage; proposed order declaring noncomplying employer;
			 effect of failure to comply.
(3)
			 ORS 656.054 - Claim of injured
			 worker of noncomplying employers; notice of proposed penalty; recovery of costs
			 from noncomplying employer.
(4) ORS
			 656.735 - Civil penalty for
			 noncomplying employers; amount; liability of corporate officers; effect of
			 final order; penalty as preferred claim; disposition of moneys
			 collected.
(5) ORS
			 656.740 - Review of proposed
			 order declaring noncomplying employer, proposed assessment or civil penalty;
			 insurer as party; hearing.
Statutory/Other Authority: ORS
				  656.054 &
				  656.726
Statutes/Other Implemented: ORS
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of these rules unless the context requires
				otherwise:
(1) "Department" means the
			 Department of Consumer and Business Services.
(2) "Director" means the director of the
			 Department of Consumer and Business Services or the director's
			 delegate.
(3) "Division" means the
			 Workers' Compensation Division of the Department of Consumer and Business
			 Services.
(4) "Hearings Division"
			 means the Hearings Division of the Workers' Compensation Board.
Statutory/Other Authority: ORS 656
Statutes/Other Implemented: ORS
				  656.054,
				  656.704 &
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0006

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.054 &
				  656.726
Stats. Implemented: ORS
				  656.052,
				  656.054 &
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0010 - Issuance of Noncomplying Employer Order; Requests for Hearing

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Issuance
			 of noncomplying employer order.
If the director determines that a person
			 has engaged as a subject employer without qualifying as a carrier-insured
			 employer or a self-insured employer as provided in ORS
			 656.017 and
			 656.407, the director will issue
			 a noncomplying employer order.
(2)
Request for hearing.
An employer may contest a noncomplying
			 employer order by requesting a hearing under ORS
			 656.740, subject to the
			 following:
(a) The request for hearing must be
			 made in writing;
(b) The request
			 must specify the grounds upon which the employer contests the order;
(c) The request must be filed with the
			 director within 60 calendar days after the mailing date of the order;
			 and
(d) OAR
			 436-001-0030(2) through
			 (5) apply to hearings requested under this
			 section.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0020

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726
Stats. Implemented: ORS
				  656.052,
				  656.735 &
				  656.740
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0030

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  656.726
Stats. Implemented: ORS
				  656.052,
				  656.735 &
				  656.740
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0040 - Assessment of Civil Penalties Against Noncomplying Employer; Hearing on Proposed Assessment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In
			 accordance with ORS 656.735(1), the
			 amount of penalty for a person's first violation of 656.052(1) shall be the
			 greater of $1,000 or twice the premium the employer would have paid during the
			 non-complying period if insurance had been provided.
(a) The division may reduce the amount of the
			 penalty due, to 105% of the amount of premium the employer would have paid
			 during the noncomplying period if insurance had been provided if, prior to the
			 penalty order becoming final, the employer:
(A) Agrees to not contest the penalty
			 order;
(B) Provides evidence
			 satisfactory to the division that it is no longer a subject employer or, if it
			 is still a subject employer, that it has now complied with ORS
			 656.052(1);
(C) Provides adequate payroll information to
			 enable the division to calculate the amount of premium the employer would have
			 paid during the noncomplying period if insurance had been provided;
			 and
(D) Makes arrangements
			 satisfactory to the division for prompt payment of the reduced penalty
			 amount.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0060 - When a Worker Files a Claim for an Injury

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the division issues an order under
			 OAR 436-080-0010 declaring an
			 employer a noncomplying employer, and a subject worker has filed a claim for an
			 injury sustained during the period of noncompliance while the worker was
			 employed by such employer, the division will:
(a) Refer the claim with a copy of the order
			 and the results of its investigation to the assigned claims agent for
			 processing as required by ORS
			 656.054; and
(b) Inform the worker, the worker's
			 representative, if represented, and the employer that the claim has been
			 referred to the assigned claims agent;
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0065 - Determination Of Assigned Claims Agent

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When selecting an assigned claims agent,
			 the director will consider claims processing performance data collected by the
			 division. That data and data provided by potential assigned claims agents will
			 be used to determine which claims agent can deliver the most timely and
			 appropriate benefits to injured workers and can best control claim costs and
			 administrative costs. In addition, the director may use any other factors the
			 director considers appropriate.
(2)
			 If no qualified entity agrees to be an assigned claims agent, the director may
			 require one or more of the three highest premium producing insurers to be
			 assigned claims agents. In addition to the premium consideration, the criteria
			 described in section (1) of this rule will be used to make that
			 determination.
Statutory/Other Authority: ORS
				  656.054 &
				  656.726
Statutes/Other Implemented: ORS
				  656.054
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0070 - Reimbursement of Assigned Claims Agent for Claims Costs for Injured Workers of Noncomplying Employers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an
			 assigned claims agent pays compensation to a claimant or incurs other costs on
			 a claim referred to it under ORS
			 656.054, the assigned claims
			 agent shall report the payment to the department as established by contract
			 with the assigned claims agent. Any amounts received by the assigned claims
			 agent and reported to the department under subsections (5) and (6) of this rule
			 will be offset against such expenditures. Subject to section (3) of this rule,
			 costs incurred by the assigned claims agent for which reimbursement will be
			 allowed include:
(a) All compensation paid
			 claimant.
(b) All expenses incurred
			 for medical services.
(c) Attorney
			 fees paid to the claimant in addition to any compensation, and sums assessed
			 under ORS 656.382(3) and
			 paid by the assigned claims agent, but not fees and sums paid under ORS
			 656.262(11) and
			 656.382(1).
(d) A reasonable amount for administrative
			 costs at a rate proposed by the assigned claims agent and approved by the
			 director prior to June 30 of each year. Late requests for increase on the rate
			 of reimbursement, if approved, shall be effective on the date the request was
			 received by the director.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 80 - NONCOMPLYING EMPLOYERS › Section 436-080-0080 - Collection of Subject Worker's Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the division finds the noncomplying
			 employer has withheld monies from subject workers pursuant to ORS
			 656.506, it will collect such
			 money from the noncomplying employer.
(2) Fiscal and Business Services is
			 responsible for collecting from noncomplying employers those workers' payments
			 not collected by the Workers' Compensation Division and referred to it by the
			 Workers' Compensation Division.
Statutory/Other Authority: ORS
				  656.726
Statutes/Other Implemented: ORS
				  656.506
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 85 - PREMIUM ASSESSMENT › Section 436-085-0001

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS 656
Stats. Implemented: ORS
				  656.612,
				  656.614 &
				  656.726
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 85 - PREMIUM ASSESSMENT › Section 436-085-0003 - Purpose and Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 These rules carry out the workers' compensation law related to the development
			 and collection of assessments from insurers, self-insured employers, and
			 self-insured employer groups.
(2)
			 These rules apply to assessments paid by insurers, self-insured employers, and
			 self-insured employer groups under ORS
			 656.612 and
			 656.614.
(3) The director may waive procedural rules
			 as justice requires, unless otherwise obligated by statute.
Statutory/Other Authority: ORS
				  656.726(4)
Statutes/Other Implemented: ORS
				  656.612 &
				  656.614
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 85 - PREMIUM ASSESSMENT › Section 436-085-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless a term is defined elsewhere in these rules, the
				definitions of ORS chapter 656 are incorporated by reference and made a part of
				these rules. For the purpose of these rules, unless the context requires
				otherwise:
(1)
"Assessable
			 earned premium"
means the amount of earned premium that is subject to
			 premium assessment.
(2)
"Board"
means the Workers' Compensation Board and includes its
			 Hearings Division.
(3)
"Director"
means the director of the Department of Consumer and
			 Business Services or the director's designee.
(4)
"Earned premium"
means the
			 total amount of workers' compensation insurance premium earned by an insurer
			 before any modification for premium assessment purposes.
(5)
"Exempted earned premium"
means premium earned on:
(a) Insurance under
			 the jurisdiction of the federal government, including the Longshore and Harbor
			 Workers' Compensation Act, Federal Employers Liability Act, and Jones Act;
			 and
(b) Employer liability
			 increased limits premium that would be reported on Statutory Page 14 (Business
			 in the State of Oregon), column 2, line 16 of the insurer's annual statement
			 under OAR 836-011-0000.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 85 - PREMIUM ASSESSMENT › Section 436-085-0008 - Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) 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 board
			 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 85 - PREMIUM ASSESSMENT › Section 436-085-0015 - Premium Assessment; Determination of Assessable Premium: Insurers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the purpose
			 of these rules, "direct earned premium," as used in ORS
			 656.612 means "assessable earned
			 premium."
(2) Assessable earned
			 premium must be calculated by making the following modifications to earned
			 premium:
(a) Subtracting exempted earned
			 premium. The amount of exempted earned premium subtracted must be determined on
			 a direct basis prior to reinsurance transactions; and
(b) Adding large deductible premium credits
			 or modifications.
Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 85 - PREMIUM ASSESSMENT › Section 436-085-0025 - Premium Assessment; Manner and Intervals for Reporting and Payments: Insurers

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Insurers must report and pay premium assessments using a completed Form 910,
			 "Workers' Compensation Insurer Premium Assessment Report." The report must be
			 signed by the person who prepares the report.
(2) An insurer must report and pay premium
			 assessment based on the insurer's assessable earned premium and the premium
			 assessment rate in effect under OAR 440-045 no later than:
(a) November 15, for the quarter ending
			 September 30;
(b) February 15, for
			 the quarter ending December 31;
(c)
			 May 15, for the quarter ending March 31; and
(d) August 15, for the quarter ending June
			 30.