Or. Admin. R. 436-120-0710 - Direct Worker Purchases: Categories
The insurer must provide the direct worker purchases listed in this rule if necessary for the worker to participate in vocational assistance or to meet the requirements of a suitable job. The insurer may not require the worker to submit a financial statement in order to qualify for direct worker purchases.
(1) Tuition, fees, books,
and supplies. Payment for tuition, fees, books, and supplies for training or
studies is limited to those items identified as mandatory by the instructional
facility, trainer, or employer. The insurer must pay the cost in full, and may
not require the worker to apply for grants to pay for tuition, books, or other
expenses associated with training.
(2) Wage reimbursement. The amount of wage
reimbursement for on-the-job training must be agreed to in a contract between
the training employer and the insurer.
(3) Travel expenses. Travel expenses for
transportation, meals, and lodging that are required for participation in
vocational assistance, including but not limited to job search, required
meetings with the counselor, and meetings with employers or at training sites
as required by the plan or plan development. The conditions and rates for
payment of travel expenses are as follows:
(a) Transportation costs will be paid at
public transportation rates when public transportation is available; otherwise,
mileage will be paid at the rate published in Bulletin 112. Costs incidental to
mileage, such as parking fees, also will be paid. For workers receiving
temporary total disability or equivalent income, private car mileage will be
paid only for mileage in excess of the miles the worker traveled to and from
work at the time of injury. Mileage payment in conjunction with moving expenses
will be allowed only for one vehicle and for a single one-way trip. To receive
reimbursement for private car mileage, the worker must provide the insurer with
a copy of the driver's valid driver's license and proof of insurance coverage.
(b) For overnight travel, meal and
lodging expenses will be reimbursed at the rate published in Bulletin 112.
(c) Payment for special travel
costs will be made in excess of the amounts specified in this section when
special transportation or lodging is necessary because of the physical needs of
the worker, or when the insurer finds prevailing costs in the travel area are
substantially higher than average.
(4) Tools and equipment. Payment for tools
and equipment for training or employment is limited to items identified as
mandatory for the training or initial employment, such as starter sets.
Purchases may not include what the trainer or employer ordinarily would provide
to all employees or trainees in the training or employment, or what the worker
already owns.
(5) Moving expenses.
Payment for moving expenses is limited to workers with employment or training
outside reasonable commuting distance. In determining the necessity of paying
moving expenses, the insurer may consider the availability of employment or
training that does not require moving, or that requires less than the proposed
moving distance. Payment is limited to moving household goods weighing not more
than 10,000 pounds. If necessary, payment includes reasonable costs of meals
and lodging for the worker's family and mileage under section (3) of this rule.
(6) Second residence allowance.
The purpose of the second residence allowance is to enable the worker to
participate in training outside reasonable commuting distance. The allowance
must equal the rental expense reasonably necessary, plus not more than $200 a
month toward all other expenses of the second residence, excluding refundable
deposits. In order to qualify for second residence allowance, the worker must
maintain a permanent residence.
(7) Primary residence allowance. The primary
residence allowance applies when the worker must change residence for training
or employment. Payment includes the first month's rent and the last month's
rent only if required before moving in.
(8) Medical and psychological examinations.
Payment for medical examinations and psychological examinations must be for
conditions not related to the compensable injury when necessary for determining
the worker's ability to participate in vocational assistance.
(9) Physical or work capacities evaluations.
(10) Living expense allowance.
Payment for living expenses is limited to workers involved in a vocational
evaluation at least five hours daily for four or more consecutive days, and not
receiving temporary disability payments. The worker will not be barred from
receiving a living expense allowance if the worker is unable to participate
five hours daily because of limitations caused by the injury. Payment must be
based on the worker's temporary total disability rate if the worker's claim
were reopened.
(11) Work
adjustment, on-the-job evaluation, or situational assessment costs.
(12) Membership fees and occupational
certifications, licenses, and related testing costs. Payment for membership
fees, occupational certifications and licenses, and related testing costs is
limited to $500.
(13) Clothing.
Clothing purchases may not include items the trainer or employer would provide
or the worker already possesses.
(14) Child or disabled adult care services.
Child or disabled adult care services are payable when required to enable the
worker to participate in vocational assistance at rates prescribed by the
Oregon Department of Human Services. For workers receiving temporary total
disability compensation or equivalent income, these costs will be paid only
when in excess of what the worker paid for such services at the time of injury,
adjusted using the cost-of-living matrix in Bulletin 124.
(15) Dental work, eyeglasses, hearing aids,
and prosthetic devices. Payment for dental work, eyeglasses, hearing aids, and
prosthetic devices is required even if not related to the compensable injury if
they will enable the worker to obtain suitable employment or participate in
training.
(16) Union dues and
fees. Payment for labor union dues and fees is limited to initiation fees, or
back dues and one month's current dues.
(17) Vehicle rental or lease. Payment for
vehicle rental or lease is required when there is no reasonable alternative
enabling the worker to participate in vocational assistance or accept an
available job. The worker must provide the insurer with proof of a valid
driver's license and insurance coverage. Payment is limited to $1,000.
(18) Other purchases. Payment for
other purchases the insurer considers necessary for the worker's participation
in vocational assistance is limited to $1,000.
Notes
Stat. Auth.: ORS 656.340(9) & 656.726(4)
Stats. Implemented: ORS 656.340
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