(1) Every notice of
claim acceptance shall include all of the information prescribed by ORS
656.262(6)(b)
and OAR
436-001-0600 (including Bulletin
No. 379).
(2) In the event that the
insurer or self-insured employer disagrees with all or any portion of a
worker's objections to a notice of claim acceptance under ORS
656.262(6)(d),
the insurer's or self-insured employer's written response shall specify the
reasons for the disagreement, and shall contain a notice, in prominent or
bold-face type, as follows:
"IF YOU DISAGREE WITH THIS DECISION, YOU MAY FILE A REQUEST FOR
HEARING BY ANY OF THE FOLLOWING MEANS:
(1) MAIL A LETTER TO THE WORKERS'
COMPENSATION BOARD, 2601 25TH STREET SE, SUITE 150, SALEM, OREGON 97302-1280;
(2) SEND AN E-MAIL TO:
request.wcb@oregon.gov;
(3) SEND A
FAX TO: 503-373-1600; OR
(4)
PHYSICAL DELIVERY OF A LETTER TO A WORKERS' COMPENSATION BOARD OFFICE (IN
SALEM, PORTLAND, EUGENE, OR MEDFORD). YOUR LETTER, E-MAIL, OR FAX SHOULD STATE
THAT YOU WANT A HEARING, YOUR ADDRESS, THE DATE OF YOUR INJURY, AND YOUR CLAIM
NUMBER.
"IF YOUR CLAIM QUALIFIES, YOU MAY RECEIVE AN EXPEDITED HEARING
WITHIN 30 DAYS. YOUR REQUEST CANNOT, BY LAW, AFFECT YOUR EMPLOYMENT. YOU MAY BE
REPRESENTED BY AN ATTORNEY OF YOUR CHOICE AT NO COST TO YOU FOR ATTORNEY FEES.
IF YOU HAVE QUESTIONS YOU MAY CALL THE WORKERS' COMPENSATION DIVISION TOLL FREE
AT 1-800-452-0288 OR THE OMBUDSMAN FOR INJURED WORKERS TOLL FREE AT
1-800-927-1271."
Notes
Or. Admin. Code §
438-005-0050
WCB 1-1984, f. 4-5-84, ef.
5-1-84; WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1995, f. 11-13-95, cert. ef.
1-1-96; WCB 1-1999, f. 8-24-99, cert. ef. 11-1-99; WCB 1-2004, f. 6-23-04 cert.
ef. 9-1-04; WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06; WCB 2-2007, f. 12-11-07,
cert. ef. 1-1-08; WCB 1-2012, f. 8-22-12, cert. ef. 11-1-12;
WCB
1-2019, amend filed 04/02/2019, effective
6/1/2019;
WCB
22-2022, amend filed 07/11/2022, effective
10/1/2022
Statutory/Other Authority: ORS
656.307,
656.388,
656.593 &
656.726(5)
Statutes/Other Implemented: ORS
656.262(6)
