Or. Admin. Code § 436-105-0500 - Insurer Participation in the Employer-at-Injury Program
(1)
Insurer
participation. An insurer must be an active participant in providing
re-employment assistance under the Employer-at-Injury Program with the
employer's consent. Participation includes issuing notices of the available
assistance and administering the Employer-at-Injury Program as specified in
these rules.
(2)
Notice of
assistance available. The insurer must notify the worker and employer at
injury in writing of the assistance available from the Employer-at-Injury
Program. A notice must be issued:
(a) Upon
acceptance or reopening of a claim; and
(b) Within five days of a worker's first
release for work after claim opening unless the release is for regular
work.
(3)
Required
notice language.
(a) The notice to the
worker required by section (2) of this rule must be in bold type and contain
the following language:
The Employer-at-Injury Program provides Oregon's qualified injured workers help with staying on the job or getting back to work. Because of your injury, your employer may be eligible for assistance to return you to transitional work through this program while your claim is open. Your employer may contact [insurer name and phone number].
(b) The notice to the employer at injury
required by section (2) of this rule must be in bold type and contain the
following language:
Because of your worker's injury, you may be eligible for assistance through the Employer-at-Injury Program to return the worker to transitional work while the worker's claim is open. To learn more about the assistance available from the program, please call [insurer name and phone number].
(4)
Insurer administration of
program. The insurer must administer the Employer-at-Injury Program
according to these rules. The insurer must assist an employer to:
(a) Get a medical release from the medical
service provider that meets the requirements of section (5) of this
rule;
(b) Identify a transitional
work position:
(A) The transitional work
position must be within the worker's injury-caused limitations and may be
created through modification of the worker's regular work, job restructuring,
assistive devices, worksite modification, reduced hours, or reassignment to
another job;
(B) Unless the
transitional work is skills building, the position must be within the
employer's course and scope of trade or profession; and
(C) When skills building is the transitional
work, the worker must agree in writing to take the class or course of
instruction;
(c) Process
employer wage subsidy requests as specified in OAR
436-105-0520(2);
(d) Make worksite modification purchases as
specified in OAR 436-105-0520(3);
(e) Make Employer-at-Injury Program purchases
as specified in OAR 436-105-0520(4);
and
(f) Request Employer-at-Injury
Program reimbursement from the division as specified in OAR
436-105-0540.
(5)
Medical releases.
(a) Medical releases are required for
purposes of the Employer-at-Injury Program.
(b) A medical release must be related to the
compensable injury or occupational disease or, if the claim has not been
accepted or denied, the claimed workers' compensation injury or occupational
disease.
(c) A medical release
must:
(A) State the worker's specific current
or projected restrictions; or
(B)
Indicate the worker is not released to regular work and be accompanied by an
approval of a job description that includes the job duties and physical demands
required for the transitional work.
(d) A medical release that releases the
worker to part-time work or fewer hours than the worker normally worked before
the injury must specify the worker's hourly restrictions.
(e) A medical release must be dated and cover
any period of time for which benefits are requested.
(A) The date a medical release is issued is
considered the effective date if an effective date is not otherwise
specified.
(B) A medical release,
and any restrictions it contains, remains in effect until another medical
release is issued.
(C) If a medical
release does not specify an end date or follow-up date and no subsequent
medical release is issued, and there is no indication that the worker followed
up with the medical service provider, the medical release is effective for no
more than 30 days.
(f)
An employer or insurer may get clarification about a medical release from the
medical service provider who issued the release any time before submitting the
reimbursement request.
(6)
Required documentation. The
insurer must maintain all records and documentation of the Employer-at-Injury
Program for a period of three years from the date of the last
Employer-at-Injury Program reimbursement request. All documentation must be
prepared before reimbursement is requested from the division. The insurer must
maintain the following information at an authorized claim processing location:
(a) The worker's claim file;
(b) Documentation from the worker's medical
service provider that the worker is unable to perform regular work due to the
injury and dated copies of all work releases from the worker's medical service
provider;
(c) Documentation of the
transitional work that includes the start date, wage and hours, and a
description of the job duties;
(d)
A legible copy of the worker's payroll records for the wage subsidy period;
(A) Payroll records must include:
(i) The date of payment;
(ii) The dates of work covered by the
payment;
(iii) The rate or rates of
pay;
(iv) Gross wages;
(v) Whether the worker is paid by the hour,
shift, day, or week or on a salary, piece, or commission basis;
(vi) The regular hourly rate or rates of pay,
the number of regular hours worked, and pay for those hours;
(vii) The number of overtime hours worked, if
any, and pay for those hours; and
(viii) The overtime rate or rates of
pay;
(B) Payroll records
may be supplemented with documentation of how the worker's earnings were
calculated for the wage subsidy. Supplemental documentation may be used to
determine a worker's work schedule, wages earned on a particular day, dates of
paid leave, or to clarify any other necessary information not fully explained
by the payroll record; and
(C) If
neither the payroll records nor supplemental documentation show the amount of
wages earned by the worker for reimbursable partial payroll periods, the
allowable reimbursement amount may be calculated as follows:
(i) Divide the gross wages by the number of
days in the payroll period for the daily rate; and
(ii) Multiply the daily rate by the number of
eligible days;
(e) Documentation of the time of the
appointment and hours and wages of transitional work for any days for which a
partial day's reimbursement is requested after the worker is released for
transitional work, or before returning from a medical appointment with a
regular work release;
(f) A legible
copy of proof of purchase that shows an item for a worksite modification or
Employer-at-Injury Program purchase was ordered during the Employer-at-Injury
Program period, and proof of payment;
(g) Documentation of the insurer's approval
of worksite modifications;
(h)
Documentation that payments for a home care worker or personal support worker
were made to the Oregon Department of Human Services or Oregon Health
Authority, if applicable;
(i)
Written acceptance by the worker when skills building is the transitional work;
and
(j) Documentation, including
course title and curriculum for a class or course of instruction, when
Employer-at-Injury Program purchases are requested.
Notes
Statutory/Other Authority: ORS 656.622 & 656.726(4)
Statutes/Other Implemented: ORS 656.622
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