Or. Admin. Code § 436-060-0200 - Assessment of Civil Penalties
(1)
Penalties for inducing failure to report claims. The director will
assess a civil penalty under ORS
656.745(1)
against an employer or insurer that intentionally or repeatedly induces workers
to fail to report accidental injuries, causes employees to collect accidental
injury claims as off-the-job injury claims, persuades workers to accept less
than the compensation due or makes it necessary for workers to resort to
proceedings against the employer to secure compensation due. For the purpose of
this section:
(a)
"Intentionally" means the employer or insurer acted with a
conscious objective to engage in the conduct or cause any result described in
this section; and
(b)
"Repeatedly" means more than once in any 12-month
period.
(2)
Penalties for failure to comply with statutes, rules, and orders.
The director may assess a civil penalty under ORS
656.745(2)
against an employer or insurer that violates ORS chapter 656, OAR chapter 436,
or orders of the director regarding reports or other requirements necessary to
carry out the purposes of ORS chapter 656. Except as provided in ORS
656.780, the director may assess
a civil penalty against a service company only for claims processing violations
identified in the director 's annual audits of claims processing performance.
The director may assess only one penalty for each separate violation by an
employer , insurer , or service company identified in an annual audit.
(3)
Penalties for failure to meet time
frame requirements. The director may assess a civil penalty under ORS
656.745(2)
against an employer or insurer that does not meet the time frame requirements
in OAR 436-060-0010,
436-060-0011,
436-060-0017,
436-060-0018,
436-060-0030,
436-060-0060,
436-060-0140,
436-060-0147,
436-060-0155 and
436-060-0180. The director may
assess a civil penalty under ORS
656.745(2)
against a service company that does not meet the time frame requirements, only
for violations identified in the director 's annual audits of claims processing
performance. The director may assess only one penalty for each separate
violation by an employer , insurer , or service company identified in an annual
audit.
(4)
Penalties for use
of sight draft to pay compensation. The director may assess a civil
penalty under ORS 656.745(2)
against an insurer that willfully violates OAR
436-060-0160.
(5)
Penalties for inaccurate reporting
of first payment timeliness. The director may assess a civil penalty
under ORS 656.745(2)
against an insurer that does not accurately report timeliness of first payment
information to the division . The director may assess this civil penalty against
the service company processing the insurer 's claims if the violations were
identified in the director 's annual audits of claims processing performance.
The director may assess only one penalty for each separate violation by an
insurer or service company identified in an annual audit. For the purposes of
this section, a violation consists of each situation in which a first payment
was reported to have been made timely, but was found upon audit to have
actually been late.
(6)
Penalties for failure to comply with claims processing
requirements. Notwithstanding section (3) of this rule, the director may
assess civil penalties under ORS
656.745(2)
against an employer , insurer , or service company for each violation of the
claims processing requirements of ORS chapter 656, OAR chapter 436, or orders
of the director . For the purpose of this section, the statutory claims
processing requirements include but are not limited to, ORS
656.202,
656.210,
656.212,
656.228,
656.234,
656.236,
656.245,
656.262,
656.263,
656.264,
656.265,
656.268,
656.273,
656.307,
656.313,
656.325, and
656.331.
(7)
Penalties for misrepresentation to
obtain claims records. The director may assess a civil penalty of $1,000
against any employer or insurer that misrepresents itself in any manner to
obtain workers' compensation claims records from the director , or that uses
such records in a manner contrary to these rules. In addition, the director may
suspend or revoke:
(a) An employer 's or
insurer 's access to workers' compensation claims records for such time as the
director may determine; or
(b) Any
other person's access to workers' compensation claims records if the director
determines they have misrepresented themselves or used records in a manner
contrary to these rules.
(8)
Performance audits. Insurers
will be subject to periodic performance audits. Civil penalties may be issued
for each area where the insurer 's performance falls below the acceptable
standards set forth in the rules and orders of the director .
(9)
Considerations for assessing
penalties. In arriving at the amount of penalty under this rule, the
director may consider, but is not limited to:
(a) The ratio of the volume of violations to
the volume of claims reported;
(b)
The ratio of the volume of violations to the average volume of violations for
all insurers; and
(c) Prior
performance in meeting the requirements outlined in this section.
(10)
Penalty to worker's
attorney for failure to cooperate with insurer 's investigation. The
director may assess a civil penalty not to exceed $1,000 against a worker's
attorney that is unreasonably unwilling or unavailable to participate in an
insurer 's interview as required by ORS
656.262(14).
Notes
Appendices referenced are not included in rule text. Click here for PDF copy of appendices.
Statutory/Other Authority: ORS 656.704 & ORS 656.726(4)
Statutes/Other Implemented: ORS 656.704, ORS 656.726(4), ORS 656.202, ORS 656.210, ORS 656.212, ORS 656.228, ORS 656.234, ORS 656.236, ORS 656.245, ORS 656.262, ORS 656.263, ORS 656.264, ORS 656.265, ORS 656.268, ORS 656.273, ORS 656.307, ORS 656.313, ORS 656.325, ORS 656.331 & ORS 656.745
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