(1)
Insurer or provider may issue. The insurer is responsible for
mailing all notices and warnings required by these rules but may delegate that
responsibility to the provider that is providing vocational assistance to the
worker.
(2)
Required
content. All notices and warnings to the worker issued under these rules
must:
(a) Use the applicable heading. If a
notice is used for more than one purpose, it must include all the headings that
apply;
(b) Be in writing, signed,
and dated;
(c) State the basis for
the decision;
(d) Include the
effective date of each action in the heading;
(e) Cite the relevant rules;
(f) Include the telephone number of the
Ombuds Office for Oregon Workers: 800-927-1271; and
(g) Include the worker's appeal rights. All
notices and warnings except those notifying a worker of entitlement to training
or deferral of vocational assistance eligibility must contain the worker's
appeal rights:
(A) In bold text, as follows:
"If you disagree with this decision, you should contact
[insert the person's name and the insurer name] within five days of receiving
this letter to discuss your concerns. If you are still dissatisfied, you must
contact the Workers' Compensation Division within 60 days of receiving this
letter or you will lose your right to appeal this decision. A consultant with
the division can talk with you about the disagreement and, if necessary, will
review your appeal. The address and telephone number of the division are:
Employment Services Team, Workers' Compensation Division, P.O. Box 14480,
Salem, Oregon 97309-0405; 1-800-452-0288."; and
(B) Effective no later than Oct. 1, 2024, the
text in (g)(A) of this section must be replaced with the following language in
bold and formatted as follows:
If you disagree with this decision, you should contact
[Claims examiner's name and the insurer name] within five days of receiving
this letter to discuss your concerns.
If you are still dissatisfied:
- Contact the Workers' Compensation Division within 60
days of receiving this letter. After 60 days you will lose your right to appeal
this decision.
- A consultant with the division can talk with you about
the disagreement and review your appeal, if necessary.
- To contact the division:
Workers' Compensation Division
Employment Services Team
350 Winter Street NE
PO Box 14480
Salem OR 97309-0405
800-452-0288 (toll-free)
(3)
Mailing and
copies. All notices and warnings must:
(a) Be mailed to the worker's last known address by both regular
and certified mail; and
(b) Be
copied to the division and worker's attorney, if any, at the same time the
notice or warning is mailed to the worker.
(4)
Effective date. A notice is
not effective until it is sent to all required parties including the worker's
attorney.
(5)
Requirements
for warning letters.
(a) A warning
letter can be issued at any time during the vocational eligibility evaluation
or vocational assistance process.
(b) Warning letters do not require specific language in the
headings but must include a heading clearly indicating the purpose of the
warning.
(c) A warning letter must
state what the worker must do, and by when, to avoid ineligibility or the
ending of eligibility or training.
Notes
Or. Admin. Code §
436-120-0012
WCD 6-2000, f.
4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0600, 436-120-0610 &
436-120-0620; WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88; WCD 10-1994, f.
11-1-94, cert. ef. 1-1-95; WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96; WCD 7-2002,
f. 5-30-02, cert. ef. 7-1-02; WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04; WCD
6-2005, f. 6-9-05, cert. ef. 7-1-05; WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07;
WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10; Renumbered from 436-120-0004; WCD
5-2010, f. 9-15-10, cert. ef. 11-15-10; WCD 5-2012, f. 10-3-12, cert. ef.
11-1-12;
WCD
4-2016, f. 11-28-16, cert. ef.
1/1/2017; WCD 5-2020, minor correction filed
3/11/2020, effective 3/11/2020;
WCD
14-2022, amend filed 12/20/2022, effective
1/1/2024;
WCD
15-2024, amend filed 06/07/2024, effective
7/1/2024
Statutory/Other Authority: ORS
656.340(9)
& ORS 656.726(4)
Statutes/Other Implemented: ORS
656.340
