Or. Admin. Code § 436-060-0015 - Required Notice and Information
(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.
(2)
Penalty for failure to provide
notice to worker's attorney. The director may assess a civil penalty
against an insurer that intentionally or repeatedly fails to give notice as
required under section (1) of this rule.
(3)
Information provided to
worker. The insurer or service company must provide:
(a) Form 1138, "What happens if I'm hurt on
the job?" to every worker who has a disabling claim with the first disability
check or earliest written correspondence. For nondisabling claims, Form 3283,
"A Guide for Workers Recently Hurt on the Job," may be provided in place of
Form 1138, unless the worker specifically requests Form 1138;
(b) Form 3283 to its insured employers. Form
3283 may be printed on the back of Form 801;
(c) Form 3058, "Notice to Worker," or an
equivalent form, to the worker with the initial notice of acceptance of the
claim under OAR 436-060-0140(6).
If an equivalent form is provided, it must include all of the information
included on Form 3058;
(d) The
additional notices required under OAR
436-060-0018,
436-060-0030,
436-060-0035,
436-060-0095,
436-060-0105,
436-060-0135,
436-060-0140, and
436-060-0180; and
(e) With the first disability check or
earliest written correspondence, contact information that will:
(A) Reasonably lead the worker to an Oregon
certified claims examiner during regular Oregon business hours; and
(B) Reasonably ensure that inquiries from the
worker are responded to within 48 hours, not including Saturday, Sunday, or
legal holidays under ORS
187.010 and
187.020.
(4)
Notice of change of processing
location. When the insurer changes claims processing locations, service
companies, or self-administration, the insurer must provide at least 10 days
prior notice to workers with open or active claims, their attorneys, and
attending physicians. The notice must provide the name of a contact person,
telephone number, email address, and mailing address of the new claim
processor.
(5)
Notice of
change in rate of compensation and benefit amounts. When the insurer
changes the rate of compensation, the wage used to calculate benefit amounts,
or the method of calculation used to determine benefits, the insurer must
provide a written explanation of any change to the worker and the worker's
attorney, if any.
(6)
Notice
of wage used to calculate benefits at closure. Before closure of a
disabling claim the insurer must send a notice to the worker that:
(a) Documents the wage upon which benefits
were based;
(b) Informs the worker
that work disability, if applicable, will be determined when the claim is
closed; and
(c) Explains how the
worker can appeal the insurer 's wage calculation if the worker disagrees with
the wage.
(7)
Notice of end of temporary disability benefits. In addition to
other requirements in OAR chapter 436, the insurer may not end temporary
disability benefits until written notice has been mailed or delivered to the
worker and the worker's attorney, if the worker is represented. The notice must
state the reason that temporary disability benefits are no longer due and
payable. This notice requirement does not apply to temporary disability
benefits paid under ORS
656.210(4).
(8)
Notice of medically stationary
status. An insurer must mail or deliver a written notice to a worker and
the worker's attorney, if the worker is represented, within seven days
following receipt of information that the worker is medically
stationary.
Notes
Forms referenced are available from the agency.
Statutory/Other Authority: ORS 656.331, ORS 656.726(4) & ORS 656.745
Statutes/Other Implemented: ORS 656.331, ORS 656.726(4), ORS 656.745, ORS 656.262 & ORS 656.268
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