Or. Admin. Code § 436-030-0145 - Reconsideration Time Frames and Postponements
(1) When appealing a Notice of Closure for
claims that are medically stationary or that statutorily qualified for closure
on or after June 7, 1995, a request for reconsideration must be mailed within:
(a) Sixty (60) days of the mailing date of
the Notice of Closure for a worker's request.
(b) Seven (7) days of the mailing date of the
Notice of Closure for an insurer's request. An insurer's request for
reconsideration is limited to the findings used to rate impairment.
(c) Sixty (60) days of the mailing date of
the Notice of Closure for a beneficiary's request if the Notice of Closure was
mailed to the beneficiary under ORS
656.268(5)(b).
(d) One year of the date the Notice of
Closure was mailed to the estate of the worker if the Notice of Closure was not
mailed to the beneficiary under ORS
656.268(5)(b).
(2) The reconsideration proceeding
begins upon:
(a) The director's receipt of the
worker's, estate's, or beneficiary's request for reconsideration, if the
insurer has not previously requested reconsideration consistent with (1)(b) of
this rule; or
(b) The 61st day
after the closure of the claim, if the insurer has requested reconsideration
consistent with (1)(b) of this rule, unless the director receives, within the
appeal time frames in section (1) of this rule, a request for reconsideration
or a statement by the worker, estate, beneficiary, or representative
instructing the director to start the reconsideration proceeding.
(3) Fourteen days from the date of
the director's notice of the start of the reconsideration proceeding, the
reconsideration request and all other appropriate information submitted by the
parties will become part of the record used in the reconsideration proceeding.
Requests for a medical arbiter panel must be submitted within this time frame.
(a) Evidence received or issues raised
subsequent to the 14-day deadline will be considered in the reconsideration
proceeding to the extent practicable.
(b) Upon review of the record the director
may request, under ORS
656.268(6), any
additional information deemed necessary for the reconsideration and set
appropriate time frames for response.
(c) Except as provided in sections (4),(5),
and (6) of this rule, the director will, within 18 working days from the date
the reconsideration proceeding begins, either mail an Order on Reconsideration
or notify the parties that the reconsideration proceeding is postponed for not
more than 60 additional days as provided under ORS
656.268(6).
(4) The director may delay the
reconsideration proceeding and toll the reconsideration timeline for up to 45
days when both parties provide written notice to the director requesting the
delay for settlement negotiations. The notice is only effective if the director
receives it before the 18th working day after the reconsideration proceeding
begins.
(a) This delay of the reconsideration
proceeding expires:
(A) When the director
receives a written request from either party to resume the reconsideration
proceeding;
(B) When the director
receives a copy of the approved settlement resolving some or all of the issues
raised at the reconsideration proceeding; or
(C) On the next calendar day following the
authorized delay period.
(b) The director may authorize only one delay
period for each reconsideration proceeding.
(5) When the director provides notice the
worker failed to attend the medical arbiter examination without good cause or
failed to cooperate with the arbiter examination and suspends benefits under
ORS 656.268(8), the
reconsideration proceeding will be postponed for up to 60 additional days from
the date the director determines and provides notice, to allow completion of
the arbiter process.
(6) The
reconsideration proceeding may be stayed under the following circumstances:
(a) The parties consent to deferring the
reconsideration proceeding, under ORS
656.268(8)(i)(B),
when the medical arbiter examination is not medically appropriate because the
worker's medical condition is not stationary; or
(b) When a claim disposition agreement (CDA)
is filed. If this occurs, the reconsideration proceeding is stayed until the
CDA is either approved or set aside.
(7) If the director fails to mail an Order on
Reconsideration or a Notice of Postponement under the time frames specified in
ORS 656.268, the reconsideration
request is automatically deemed denied. The parties may immediately thereafter
proceed as though the director had issued an Order on Reconsideration affirming
the Notice of Closure.
(8)
Notwithstanding any other provision regarding the reconsideration proceeding,
the director may extend nonstatutory time frames to allow the parties
sufficient time to present evidence and address their issues and
concerns.
Notes
Statutory/Other Authority: ORS 656.726
Statutes/Other Implemented: ORS 656.268
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