Or. Admin. Code § 436-060-0150 - Timely Payment of Compensation
(1)
General. Benefits are considered paid when addressed to the last
known address of the worker or beneficiary and deposited in the U.S. Mail, or
when funds are transferred to a financial institution for deposit in the
worker's or beneficiary's account by approved electronic equivalent.
(2)
Saturday, Sunday, or legal
holidays. Payments due on a Saturday, Sunday, or legal holiday under ORS
187.010 and
187.020 may be paid on the last
working day before, or the first working day after, the Saturday, Sunday, or
legal holiday. Subsequent payments may revert back to the payment schedule in
place before the Saturday, Sunday, or legal holiday.
(3)
Withheld compensation.
Compensation withheld under ORS
656.268(13) and
(14), and ORS
656.596(2),
will not be considered late if the insurer notifies the worker in writing why
benefits are being withheld and the amount that must be offset before any
further benefits are payable.
(4)
Timely payment of temporary disability. Insurers must timely
process the first payment of temporary disability compensation. The first
payment of temporary disability on a claim must also include all temporary
disability benefits due as of the date of payment, unless there is a reasonable
basis to exclude those benefits at the time the payment issued. The director
may assess a penalty under OAR
436-060-0200 against an insurer
that does not make the first payment of temporary disability under the time
frames of this section, or does not accurately report timeliness of first
payment information.
(a) The payment of
temporary disability benefits must be made no later than the 14th day after:
(A) The date of the employer 's notice or
knowledge of the claim and of the worker's disability, if the attending
physician or authorized nurse practitioner has authorized temporary disability
compensation. Temporary disability accrued before the date of the employer 's
notice or knowledge of the claim is due within 14 days of claim
acceptance;
(B) The date the
attending physician or authorized nurse practitioner authorizes temporary
disability, if the authorization is more than 14 days after the date of the
employer 's notice or knowledge of the claim and of the worker's
disability;
(C) The start of
authorized vocational training under ORS
656.268(10), if
the insurer has previously closed the claim;
(D) The date the insurer receives medical
evidence supported by objective findings that shows the worker is unable to
work due to a worsening of the compensable condition under ORS
656.273;
(E) The date of any director 's order,
including, but not limited to, a reconsideration order, that orders payment of
temporary disability. If the insurer has appealed a reconsideration order, the
appeal stays payment of temporary disability benefits except those that accrue
from the date of the order, under ORS
656.313;
(F) The date of a notice of claim closure
issued by the insurer that finds the worker entitled to temporary
disability;
(G) The date a notice
of closure is set aside by a reconsideration order;
(H) The date any litigation authorizing
retroactive temporary disability becomes final. Temporary disability accruing
from the date of the order must begin no later than the 14th day after the date
the order is filed. For the purpose of this rule, the "date the order is filed"
for litigation from the board is the signature date, and from the courts, it is
the date of the appellate judgment;
(I) The date the director refers a claim to
the insurer for processing under ORS
656.029;
(J) The date the director refers a
noncomplying employer claim to an assigned claims agent under ORS
656.054;
(K) The date a claim disposition agreement is
disapproved by the Worker's Compensation Board or administrative law judge, if
temporary disability benefits are otherwise due;
(L) The date the director designates a paying
agent under ORS 656.307;
(M) The date a claim is reclassified from
nondisabling to disabling, if temporary disability is due and payable;
or
(N) The date an insurer
voluntarily rescinds a denial of a disabling claim.
(b) Subsequent payments of temporary
disability benefits must be made:
(A) At least
once each 14 days and include all benefits due for the period ending no more
than seven days before the payment date; or
(B) In accordance with the employer 's payroll
schedule and pay period. If temporary disability benefits are paid under this
paragraph, the insurer 's claim file must include written documentation of the
payroll schedule and pay period before the payments are issued.
(5)
Timely payment
of permanent disability.
(a) The first
payment of permanent disability must be paid no later than the 30th day after:
(A) The date of a notice of claim closure
issued by the insurer ;
(B) The date
of any litigation order that orders payment of permanent total disability.
Permanent total disability benefits accruing from the date of the order must
begin no later than the 30th day after the date the order is filed. For the
purpose of this rule, the "date the order is filed" for litigation from the
board is the signature date, and from the courts, it is the date of the
appellate judgment;
(C) The date of
any director 's order, including, but not limited to, a reconsideration order,
that orders payment of compensation for permanent disability;
(D) The date any litigation order authorizing
permanent partial disability becomes final;
(E) The date a claim disposition agreement is
disapproved by the board or administrative law judge, if permanent disability
benefits are otherwise due; or
(F)
The date authorized training ends if the worker is medically stationary and any
previous award remains unpaid, under ORS
656.268(10) and
OAR 436-060-0040(3).
(b) Subsequent payments of permanent
disability must be made on a regular and predictable monthly schedule.
(A) The insurer may adjust the monthly
payment schedule, but must inform the worker or beneficiary before making the
adjustment.
(B) No payment period
may exceed one month without the director 's
approval.
(6)
Timely payment of death benefits.
(a) Payment of bills submitted under OAR
436-060-0075(1)
must be made no later than the 30th day after the date of the insurer 's receipt
the bill, or the date of claim acceptance, whichever is later.
(b) The first payment of monthly benefits to
eligible beneficiaries under OAR
436-060-0075 must be paid no
later than the 30th day after:
(A) The date
of a notice of acceptance issued by the insurer ; or
(B) The date of any litigation order that
orders death benefits. Death benefits accruing from the date of the order must
begin no later than the 30th day after:
(i)
The signature date of an order from the board ; or
(ii) The date of an appellate judgment from
the courts.
(c)
Subsequent payments of monthly benefits to eligible beneficiaries under OAR
436-060-0075 must be made on a
regular and predictable schedule, subject to the following:
(A) The insurer may adjust the monthly
payment schedule, but must inform the beneficiary before making the adjustment;
and
(B) No payment period may
exceed one month without the director 's approval.
(d) Notwithstanding subsection (c), the
insurer may make a payment in advance with the consent of the
beneficiary.
(e) Payment of monthly
benefits due to a worker's death during a period of permanent total disability
under OAR 436-060-0075(7)
must follow the monthly schedule established under subsection (5)(b) of this
rule.
(7)
Notice to
worker or beneficiary regarding payments. The insurer must provide an
explanation in writing to the worker or beneficiary when the benefit amount,
time period covered, or payment schedule changes, and must:
(a) Notify the worker or beneficiary in
writing of the specific purpose and the time period covered by each payment of
temporary disability benefits; and
(b) Notify the worker or beneficiary in
writing of the specific purpose of the payment, the schedule of future
payments, and the time period each payment will cover with the first payment of
permanent disability or death benefits. The insurer is not required to provide
an explanation in writing with each subsequent permanent disability or death
benefit payment.
(8)
Maintenance of records. The insurer must maintain records of
compensation paid for each claim in which benefits are due and
payable.
(9)
Request for
reimbursement. If the worker submits a request for reimbursement, the
insurer must respond as required under OAR
436-009-0025(1).
(10)
Claim disposition
agreements. Any amounts due under a claim disposition agreement must be
paid no later than the 14th day after the board or administrative law judge
provides notice of its approval under OAR
438-009-0028, unless otherwise
stated in the agreement.
(11)
Claims under other jurisdictions. When a worker has a claim under
the workers' compensation law of another state, territory, province or foreign
nation for the same injury or occupational disease as the claim filed in
Oregon:
(a) The worker is entitled to the
full amount of compensation due under Oregon law;
(b) The total amount paid or awarded under
the other jurisdiction's law must be credited against the compensation due
under Oregon law;
(c) If Oregon
compensation is more than the compensation paid or awarded under the other
jurisdiction's law, or compensation paid the worker under another law is
recovered from the worker, the insurer must pay any unpaid compensation to the
worker up to the amount required by the claim under Oregon law;
(d) Upon learning that the worker has a claim
under the jurisdiction of another workers' compensation law, the insurer must
request written documentation of the amount paid or awarded to the worker;
and
(e) Payment under this section
is due within 14 days of receipt of written documentation supporting the
underpayment of Oregon compensation.
Notes
Statutory/Other Authority: ORS 656.726(4)
Statutes/Other Implemented: ORS 656.126, ORS 656.204, ORS 656.208, ORS 656.262(4), ORS 656.268(10), ORS 656.273, ORS 656.278, ORS 656.289, ORS 656.307 & ORS 656.313
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