Oregon Administrative Code

436-035-0375 Abdomen Use the following classifications when impairment has resulted from a permanent and palpable defect in the supporting structures of the abdominal wall: (1) Class 1: 5% for a slight protrusion at the site of the defect with increased abdominal pressure that is…

436-035-0380 Cardiovascular System (1) Impairments of the cardiovascular system are determined based on objective findings that result in the following conditions: valvular heart disease, coronary heart disease, hypertensive cardiovascular disease, cardiomyopathies, pericardial d…

436-035-0385 Respiratory System (1) For the purpose of this rule, the following definitions apply: (a) FVC is forced vital capacity. (b) FEV1 is forced expiratory volume in the first second. (c) Dco refers to diffusing capacity of carbon monoxide. (d) VO2 Max is measured exercise…

436-035-0390 Cranial Nerves/Brain (1) Impairment of the first cranial nerve (olfactory) resulting in either complete inability to detect odors or alteration of the sense of smell is 3% impairment. (2) Ratings given for impairment of the second cranial nerve (optic) are rated base…

436-035-0395 Spinal Cord (1) The spinal cord is concerned with sensory, motor, and visceral functions. Permanent impairment can result from various disorders affecting these functions. Spinal cord impairment is determined under the following classes: (a) Class 1: 15% when the wor…

436-035-0400 Mental Illness (1) Accepted mental disorders resulting in impairment must be diagnosed by a psychiatrist or other mental health professional as provided for in a managed care organization certified under OAR chapter 436, Division 015. (2) Diagnoses of mental disorder…

436-035-0410 Hematopoietic System (1) Anemia can be impairing when the cardiovascular system cannot compensate for the effects of the anemia. The following values are given for workers who become anemic: (a) Class 1: 0% when there are no complaints or evidence of disease and the …

436-035-0420 Gastrointestinal and Genitourinary Systems (1) Impairments in mastication (chewing) and deglutition (swallowing) are determined based on the following criteria: (a) Diet limited to semi-solid or soft foods — 8% (b) Diet limited to liquid foods — 25% (c) Eating requir…

436-035-0430 Endocrine System (1) The assessment of permanent impairment from disorders of the hypothalamic-pituitary axis requires evaluation of (1) primary abnormalities related to growth hormone, prolactin, or ADH; (2) secondary abnormalities in other endocrine glands, such as…

436-035-0440 Integument and Lacrimal System (1) If the worker has developed an immunologic reaction to physical, chemical or biological agents, impairment will also be valued under OAR 436-035-0450. (2) Impairments of the integumentary system may or may not show signs or symptoms…

436-035-0450 Immune System (1) When exposure to physical, chemical, or biological agents has resulted in the development of an immunological response, impairment of the immune system is valued as follows: (a) Class 1: 3% when the reaction is a nuisance but does not prevent most r…

436-035-0500 Rating Standard for Individual Claims (1) This rule applies to the rating of permanent disability under ORS chapter 656 in individual cases under ORS 656.726(4)(f) which requires the director to determine the rating standard in cases where the director finds that the…

436-040-0001 Authority for Rules These rules are promulgated under the Director’s authority contained in ORS 656.726 and 656.628. Statutory/Other Authority: ORS 656 Statutes/Other Implemented: ORS 656.628 & 656.726 History: WCD 6-1983, f. 12-20-83, ef. 1-1-84, Renumbered from 436…

436-040-0002 Purpose The purpose of these rules is to establish guidelines for the administration of the Workers with Disabilities Program established to encourage the employment or re-employment of workers with disabilities. Statutory/Other Authority: ORS 656 Statutes/Other Impl…

436-040-0003 Applicability of Rules (1) These rules are effective July 1, 2008, and apply to all applications for relief submitted prior to May 1, 1990 and all requests for reimbursement from the Workers with Disabilities Program filed with the director on or after July 1, 2008 f…

436-040-0005 Definitions Except where the context requires otherwise, these rules are governed by the following definitions: (1) “Compensation” means all benefits, including medical services and attorney fees, provided for a compensable injury to a subject worker or the worker’s …

436-040-0006 Administration of Rules For the purpose of administration of the Workers with Disabilities Program, orders of the division are deemed orders of the director. Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.628, §286, ch. 70 & OL 2007 Histor…

436-040-0008 Administrative Review (1) If a paying agency or employer is aggrieved by a decision of the division, the director may be petitioned for reconsideration. (2) The director shall examine the application and such further evidence filed, and enter an order. Copies of the …

436-040-0010 Criteria for Eligibility (1) The criteria used to determine eligibility for relief from the Workers with Disabilities Program are: (a) Without regard to employer knowledge, a worker must have a permanent physical or mental impairment, whether congenital or due to an …

436-040-0020 Limitation of Program (1) Reimbursement is limited to the monies available in the Workers’ Benefit Fund . (2) In the event of insufficient reserves in the Workers’ Benefit Fund, the director shall have final authority to determine an equitable distribution which will…

436-040-0030 Application for Determination of Relief From the Workers with Disabilities Program (1) The paying agency must provide the director adequate evidence to establish eligibility for determination of relief from the Workers with Disabilities Program. (2) When the deductib…

436-040-0040 Eligibility Determination (1) The division shall determine whether a claim qualifies for reimbursement, and the percentage of the reimbursement. (2) The division shall issue a determination order accepting or denying the application within 30 calendar days after rece…

436-040-0050 Reimbursement (1) Reimbursement will be made to the paying agency based on the percentage of reimbursement ordered by the division. (2) Request for reimbursement shall not be made until the deductible has been met. (3) Requests for reimbursement are not to include: c…

436-040-0060 Effects on Rates; Reporting (1) Where an order of acceptance has established the percentage of reimbursement to an insured, the incurred claim cost above $1,000, prior to reimbursement, shall be reduced by that percentage. The net incurred cost after such reduction s…

436-040-0070 Settlements (1) Any settlement of the claim by the parties is not eligible for reimbursement from the Workers with Disabilities Program unless made with the prior written approval of the division. (2) Requests for written approval of proposed settlements should inclu…

436-040-0080 Third Party Recoveries (1) If a third party recovery is made prior to a claim qualifying for Workers with Disabilities Program relief, compensation recovered shall be credited against the compensation of the claim prior to any request for reimbursement. (2) The Worke…

436-040-0090 Assessment of Civil Penalties The director, through the division and pursuant to ORS 656.745, may assess a civil penalty against an insurer. When the division imposes a penalty under this section, the order shall be issued in accordance with ORS 656.447, 656.704 and …

436-045-0001 Authority for Rules These rules are promulgated under the Director’s authority contained in ORS 656.726 and 656.625. Statutory/Other Authority: ORS 656 Statutes/Other Implemented: ORS 656.625 & 656.726 History: WCD 8-1987, f. 12-18-87, ef. 1-1-88

436-045-0002 Purpose The purpose of these rules is to establish guidelines for administering disbursements made from the Reopened Claims Program established to reimburse compensation paid as a result of awards made by the Board or voluntary claim reopenings pursuant to ORS 656.27…

436-045-0003 Applicability of Rules (1) These rules are effective July 1, 2008, and apply to all requests for reimbursement from the Reopened Claims Program. (2) These rules apply to all awards ordered on claims opened by the Board under ORS 656.278 on or after January 1, 1988 an…

436-045-0005 Definitions As used in OAR 436-045-0001 through 436-045-0030 unless the context requires otherwise: (1) "Board" means the Workers’ Compensation Board of the Department of Consumer and Business Services. (2) "Compensation" includes all benefits payable as a result of …

436-045-0006 Administration of Rules Any orders issued by the divisions in carrying out the director’s authority to enforce ORS Chapter 656 and these rules are considered orders of the director. Statutory/Other Authority: ORS 656.704 & 656.726 Statutes/Other Implemented: ORS 656.…

436-045-0008 Administrative Review (1) Any party as defined by ORS 656.005 aggrieved by a proposed order or proposed assessment of civil penalty of the director or division issued pursuant to ORS 656.745 may request a hearing by the Hearings Division of the Workers’ Compensation …

436-045-0010 Criteria for Eligibility (1) In order to qualify for reimbursement from the Reopened Claims Program there must be: (a) An order or award issued by the Board upon its own motion pursuant to ORS 656.278 and as provided by OAR chapter 438, division 12 or a voluntary cla…

436-045-0020 Limitation of Program (1) Reimbursement shall be limited to the monies available in the Workers’ Benefit Fund. (2) In the event of insufficient funds in the Workers’ Benefit Fund, the director shall have final authority to determine an equitable distribution which wi…

436-045-0025 Dispositions (1) In order for a disposition of a claim by the parties to be considered for reimbursement eligibility under the Reopened Claims Program, it must be submitted to the director during the period of time in which the claim remains open under the Board’s Ow…

436-045-0030 Reimbursement (1) Reimbursement shall be made by Compliance quarterly after receipt and approval of documentation of compensation paid by the paying agent. (2) The director, by bulletin, shall prescribe the form and format for requesting reimbursement from the Progra…

436-050-0003 Purpose and Applicability (1) Purpose. These rules carry out the workers’ compensation law related to employers’ and insurers’ responsibilities to cover subject workers for compensable injuries and illnesses. (2) Applicability. (a) These rules apply to employers, sel…

436-050-0005 Definitions Unless a term is defined elsewhere in these rules, the definitions of ORS chapter 656 are incorporated by reference and made a part of these rules. For the purpose of these rules, unless the context requires otherwise: (1) “Assigned claims agent” means an…

436-050-0008 Requests for Hearings or Administrative Review (1) Request for hearing on an action concerning a worker’s right to compensation. Any party, or assigned claims agent, that disagrees with an action taken under these rules that concerns a worker’s right to compensation,…

436-050-0015 Suspension and Revocation of Authorization to Issue Workers’ Compensation Insurance Policies (1) General. The director may suspend or revoke an insurer’s authorization to issue or renew workers’ compensation insurance policies upon a determination that: (a) The insur…

436-050-0025 Service of the Notice of Civil Penalty Orders When the director issues a civil penalty order, it will be served by certified mail, return receipt requested, or in any other manner provided by Oregon Rules of Civil Procedure (7)(D) available at: https://www.oregonlegi…

436-050-0040 Responsibility for Providing Coverage When a Contract is Awarded (1) If a person, including a person that is a sole proprietorship, that is responsible to provide coverage for an individual performing labor under ORS 656.029, fails to comply with ORS 656.017, that pe…

436-050-0045 Nonsubject Workers For the purposes of clarifying terms used in ORS 656.027: (1) “Casual” refers only to employments where the work in any 30-day period, without regard to the number of workers employed, involves a total labor cost lower than the dollar amount publis…

436-050-0050 Corporate Officers, Limited Liability Company Members, Partners; Subjectivity (1) A corporation, limited liability company, or partnership may elect to provide workers’ compensation coverage for otherwise nonsubject workers. (a) A carrier-insured employer must make t…

436-050-0055 Extraterritorial Coverage (1) For the purposes of determining whether a worker is temporarily in or out of state under ORS 656.126, the director will use criteria including, but not limited to, the following: (a) The extent to which the worker’s work within the state…

436-050-0110 Notice of Insurer’s or Service Company’s Place of Business in State; Records Insurer Must Maintain (1) Oregon claims processing location required. Except as described in section (4) of this rule, every insurer that is authorized to issue workers’ compensation policie…

436-050-0120 Records Insurers Must Maintain; Removal and Disposition (1) Records insurers must maintain. Each insurer is required to maintain the following records of Oregon workers’ compensation claims, to make the records available at an Oregon claims processing location, and t…

436-050-0150 Qualifications of a Self-Insured Employer (1) General qualifications. To qualify as a self-insured employer, the employer must: (a) Establish proof that the employer has an adequate staff qualified to process claims; (b) Establish proof of the financial ability to ma…

436-050-0160 Applying for Certification as a Self-Insured Employer (1) Required information. An employer applying for certification as a self-insured employer must submit: (a) A completed Form 1868, “Application for Self-Insurance;” (b) Proof of an adequate staff qualified to pro…