(1)
Requests
for vocational evaluations. A worker receiving permanent total
disability benefits must attend a vocational evaluation reasonably requested by
the insurer or the director.
(2)
Allowed number of vocational evaluations. The insurer may request
no more than three separate vocational evaluations without authorization from
the director. Insurers that fail to obtain authorization from the director for
additional vocational evaluations may be assessed a civil penalty.
(a) To request authorization the insurer
must:
(A) Submit a written request for
authorization that includes:
(i) The reasons
for an additional vocational evaluation;
(ii) The conditions to be
evaluated;
(iii) The dates, times,
places, and purposes of previous evaluations;
(iv) Copies of previous vocational evaluation
notification letters to the worker; and
(v) Any other information requested by the
director;
(B) Provide a
copy of the request to the worker and the worker's attorney, if any.
(b) The director will review the
request and determine if additional information is needed.
(A) Upon receipt of a request for additional
information from the director, the parties will have 14 days to
respond.
(B) If the parties do not
provide the requested information, the director will approve or disapprove the
request for authorization based on available information.
(c) The director's decision approving or
denying more than three vocational evaluations may be appealed to the board
within 60 days of the order.
(d)
For purposes of determining the number of insurer required vocational
evaluations, any evaluations scheduled but not completed are not counted as a
statutory vocational evaluation.
(3)
Notice to worker. The
insurer must notify the worker of the evaluation at least 10 days before the
date of evaluation.
(a) The notice sent for
each evaluation, including evaluations that have been rescheduled, must contain
the following:
(A) The name of the vocational
assistance provider or facility;
(B) A statement of the specific purpose for
the evaluation;
(C) The date, time
and place of the evaluation;
(D)
The first and last name of the attending physician or authorized nurse
practitioner or a statement that there is no attending physician or authorized
nurse practitioner, whichever is appropriate;
(E) If applicable, confirmation that the
director has approved the evaluation;
(F) Notice to the worker that the reasonable
cost of public transportation or use of a private vehicle will be reimbursed;
when necessary, reasonable cost of child care, meals, lodging and other related
services will be reimbursed; a request for reimbursement must be accompanied by
a sales slip, receipt or other evidence necessary to support the request;
should an advance of costs be necessary for attendance, a request for
advancement must be made in sufficient time to ensure a timely appearance;
and
(G) The following notice:
(i) In prominent or bold text:
"You must attend this vocational evaluation. If there is
any reason you cannot attend, you must tell the insurer as soon as possible
before the date of the evaluation. If you do not attend or do not cooperate, or
do not have a good reason for not attending, your compensation benefits may be
suspended in accordance with the workers' compensation law and rules, ORS
656.206 and OAR 436-060. If you
have questions about your rights or responsibilities, you may call the Workers'
Compensation Division at 1-800-452-0288 or the Ombuds Office for Oregon Workers
at 1-800-927-1271."
(ii) Effective no later than Oct. 1, 2024,
the text in (G)(i) of this subsection must be replaced with the following
language in bold and formatted as follows:
You must attend this evaluation.
If there is any reason you cannot attend, you must tell
us as soon as possible before the date of the evaluation.
Your workers' compensation benefits may be suspended
under Oregon laws and rules* if you:
- Do not attend the evaluation,
- Do not cooperate with the evaluation, or
- Do not have good reason for not
attending.
If you have any questions you may call:
- [Insurer] at [Insurer phone number]
- Workers' Compensation Division at 800-452-0288
(toll-free) or 503-947-7585
- Ombuds Office for Oregon Workers at 800-927-1271
(toll-free).
*Oregon Revised Statute 656.206 and Oregon Administrative
Rules Chapter 436, division 60
(b) The insurer may contract with a third
party to schedule vocational evaluations. If the third party notifies the
worker of a scheduled evaluation on behalf of the insurer, the third party must
send the notice on the insurer's stationery and the notice must meet the
requirements of this section.
(4)
Reimbursements of costs. The
insurer must pay the costs of the vocational evaluation and related services
necessary to allow the worker to attend the evaluation, including a reasonable
cost of public transportation or use of a private vehicle, and when necessary,
a reasonable cost of child care, meals, lodging and other related services.
Child care costs reimbursed at the rate prescribed by the State of Oregon
Department of Human Services, comply with this rule.
(5)
Suspension of compensation.
When the worker refuses or fails to attend, or otherwise obstructs, a
vocational evaluation reasonably requested by the insurer or the director, the
director may suspend the worker's compensation by order, under the following
conditions:
(a) The insurer must send the
request for suspension to the division. A copy of the request, including all
attachments, must be sent simultaneously to the worker and the worker's
attorney by registered or certified mail or by personal service;
(b) The request must include the following
information:
(A) That the insurer requests
suspension of benefits under ORS
656.206 and OAR
436-060-0137;
(B) What specific actions of the worker
prompted the request;
(C) The dates
of any prior vocational evaluations the worker has attended and the names of
the vocational assistance provider or facilities, or a statement that there
have been no prior evaluations, whichever is appropriate;
(D) A copy of any approvals given by the
director for more than three vocational evaluations, or a statement that no
approval was necessary, whichever is appropriate;
(E) Any reasons given by the worker for
failing to attend, whether or not the insurer considers the reasons invalid, or
a statement that the worker has not given any reasons, whichever is
appropriate;
(F) The date and with
whom failure to comply was verified. Any written verification of the worker's
refusal to attend the vocational evaluation received by the insurer from the
worker or the worker's attorney will be sufficient documentation with which to
request suspension;
(G) A copy of
the letter required in section (3) of this rule and a copy of any written
verification received under paragraph (F) of this subsection;
(H) Any other information that supports the
request; and
(I) The following
notice:
(i) In prominent or bold text:
"Notice to worker: If you think this request to suspend
your compensation is wrong, you should immediately write to the Workers'
Compensation Division, 350 Winter Street NE, PO Box 14480, Salem, Oregon
97309-0405. Your letter must be mailed within 10 days of the date this request
was mailed or personally served on you. If the division grants this request,
you may lose all or part of your benefits."
(ii) Effective no later than Oct. 1, 2024,
the text in (I)(i) of this subsection must be replaced with the following
language in bold and formatted as follows:
Notice to worker:
If the Workers' Compensation Division grants this
request, you may lose all or part of your benefits.
If you think this request to suspend your compensation is
wrong, write to the Workers' Compensation Division immediately.
- Your letter must be mailed within 10 days of the date
this request was mailed or personally served on you.
- Address your letter to:
Workers' Compensation Division
350 Winter Street NE
PO Box 14480
Salem OR 97309-0405
If you have any questions, you may call:
- [Insurer] at [Insurer phone number]
- Workers' Compensation Division at 800-452-0288
(toll-free) or 503-947-7585
- Ombuds Office for Oregon Workers at 800-927-1271
(toll-free)
(c) If the director suspends compensation:
(A) The suspension will be effective from the
date the worker fails to attend a vocational evaluation or such other date the
director determines is appropriate until the date the worker attends the
evaluation;
(B) The worker is not
entitled to compensation during or for the period of suspension;
(C) The insurer must assist the worker to
meet requirements necessary for the resumption of compensation payments. When
the worker has attended the vocational evaluation, the insurer must verify the
worker's participation and resume compensation effective the date of the
worker's compliance;
(D) The
director may modify or set aside the suspension order before or after filing of
a request for hearing;
(E) The
director may order payment of compensation previously suspended where the
director finds the suspension to have been made in error; and
(F) The director may re-evaluate the
necessity of continuing a suspension;
(d) If the insurer fails to comply with this
rule, the director may deny the request for suspension. Any delay in requesting
suspension may result in suspension being denied or the date of suspension
being modified; and
(e) A
suspension order becomes final unless, within 60 days after the date of mailing
of the order, a party files a request for hearing on the order with the
board.
Notes
Or. Admin. Code §
436-060-0137
WCD 8-2005, f.
12-6-05, cert. ef. 1-1-06; WCD 5-2008, f. 12-15-08, cert. ef. 1-1-09; WCD
3-2009, f. 12-1-09, cert. ef. 1-1-10;
WCD
6-2016, f. 11-28-16, cert. ef.
1/1/2017; WCD 7-2020, amend filed 3/13/2020,
effective 4/1/2020;
WCD
14-2022, amend filed 12/20/2022, effective
1/1/2024;
WCD
14-2024, amend filed 06/07/2024, effective
7/1/2024
Statutory/Other Authority: ORS
656.726(4)
Statutes/Other Implemented: ORS
656.206
