Oregon Administrative Code

436-150-0003 Applicability of Rules (1) These rules carry out the provisions of ORS 656.445. (2) Applicable to this chapter, the director may, unless otherwise obligated by statute, in the director’s discretion waive any procedural rules as justice so requires. Statutory/Other Au…

436-150-0005 Definitions As used in OAR 436-150-0001 through 436-150-0040, unless the context requires otherwise: (1) “Compensation,” for the purposes of this program, means temporary and permanent disability due injured workers pursuant to ORS chapter 656, and out-of-pocket expe…

436-150-0006 Administration of Rules Any orders issued by the division 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 656.445 & 656.726(4) Statutes/Other Implemented: ORS 65…

436-150-0008 Administrative Review (1) Any party as defined by ORS 656.005, and including the Oregon Insurance Guaranty Association, 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 hear…

436-150-0010 Criteria for Eligibility (1) In order for the director to authorize expenditures from the Workers’ Benefit Fund Claims Program there must be: (a) Verification from an authority from the insurer’s state of domicile that the insurer responsible for payment of compensat…

436-150-0020 Limitation of Program (1) Payment of compensation shall be limited to the amount of securities on deposit for the insurer pursuant to ORS 731.628 and only to the extent the monies are available in the Workers’ Benefit Fund. (2) Payments for individual claims shall be…

436-150-0030 Payment of Benefits (1) Payment of compensation may be made by the director after receipt of documentation that compensation is due and payable. (2) Documentation to support payment from the Workers’ Benefit Fund Claims Program shall be submitted by the paying agent …

436-150-0040 Accounting and Repayment of Payment of Benefits (1) The director shall establish an account of record to monitor all expenditures and transactions relating to the Workers’ Benefit Fund Claims Program and these rules. The accounting shall provide a detailed record of …

436-160-0001 Authority, Applicability, Purpose, and Administration of these Rules (1) These rules are promulgated under the director's authority contained in ORS 656.726(4). (2) These rules apply to workers’ compensation related transactions filed with the director by electronic …

436-160-0004 Adoption of Standards (1)(a) The director adopts, by reference, IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 2.0, dated Feb 1, 2014. (b) The director adopts, by reference, the ASC X12 Implementation Acknowledgment for Health Care Insuranc…

436-160-0005 General Definitions For the purpose of these rules, unless it conflicts with statute or rule: (1) “ANSI” means the American National Standards Institute. (2) “ASC X12” means the Accredited Standards Committee chartered by the American National Standards Institute (ht…

436-160-0040 Recognized Received Date An electronic record is received when: (1) The record enters the division’s designated information processing system; (2) All the required data elements and electronic records are in the form and format specified in these rules in the proper …

436-160-0060 Testing Procedures and Requirements Testing and transition to production: (1) Before testing can begin, or the division can accept medical billing data, the trading partner must submit a completed Medical Billing Data EDI Trading Partner Profile (Form 4015) to the di…

436-160-0405 Insurers’ Reporting Responsibilities (1) Insurers with an average of at least 100 accepted disabling claims per year, based on the average accepted disabling claim volume for the previous three calendar years, are required to electronically submit detailed medical bi…

436-160-0410 Electronic Medical Bill Data Transmission and Format Requirements (1) The transmission data and format requirements are included in the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 2.0 (Feb 1, 2014), and Appendices A and B of these rules.…

436-160-0415 Oregon ASC X12 837 Medical Bill Data Reporting Requirements (1) Event reporting requirements: (a) Medical bills, including interpreter bills under OAR 436-009, must be reported within 60 days of the date paid. (b) Denied medical bills for accepted claims must be repo…

436-160-0420 Medical Bill Acknowledgement (1)(a) The sender is expected to retrieve both TA1 and 999 interchange and functional acknowledgements (as defined by ASC X12) for each medical bill file submitted, unless technical errors in the file prevent 999 processing. In addition, …

436-160-0430 Medical Bill Data Changes (1) Changes to medical bill information must be submitted according to the standards referenced in OAR 436-160-0004. (2) The Unique Bill ID will be used to match cancellations, corrections, and replacements to the original bill. Failure to m…

436-160-0440 Monitoring and Auditing Insurers (1) The director may monitor and conduct periodic audits of medical bill data to ensure compliance with ORS chapter 656 and these rules. (2) All records maintained or required to be maintained must be disclosed upon request by the dir…

436-160-0445 Assessment of Civil Penalties (1) Under ORS 656.745, the director may assess a civil penalty against an insurer that fails to comply with ORS Chapter 656 or the director’s rules and orders. (2) The insurer is responsible for its own actions as well as the actions of …

436-162-0001 Authority, Applicability, Administration, and Purpose of these Rules (1) These rules are promulgated under the director's authority contained in ORS 656.726(4). (2)(a) These rules apply to workers’ compensation proof of coverage transactions filed with the director b…

436-162-0004 Adoption of Standards (1) The director adopts, by reference, IAIABC EDI Implementation Guide for Proof of Coverage, Release 2.1, dated July 1, 2010. (2) The form, format, and delivery of data elements reported and definitions will conform to these standards, unless o…

436-162-0005 General Definitions For the purpose of these rules: (1) "Director" means the director of the Department of Consumer and Business Services or the director's designee for the matter. (2) "Division" means the Workers' Compensation Division of the Department of Consumer …

436-162-0030 Retention of Electronic Records Insurers and self-insured employers must retain workers' compensation records under OAR 436-050-0120 and OAR 436-050-0220. Records may be retained in electronic format if the records can be reproduced. Statutory/Other Authority: ORS 65…

436-162-0035 General Filing Information (1) Senders must follow United States Postal Service guidelines for reporting all addresses. (2) Transactions will be rejected if Mandatory or Mandatory/Conditional data elements are omitted or submitted in a form or format the division is …

436-162-0038 Acknowledgement (1) The division will respond to submitted transmissions by providing either a Transaction Accepted (TA) or a Transaction Rejected (TR) acknowledgement. (2) Transaction rejected acknowledgements will be generated for transactions with errors, includin…

436-162-0040 Recognized Filing Date (1) An electronic record is considered filed on the date it is delivered to the director only if the division issues a Transaction Accepted acknowledgment. (2) Rejected transactions are not considered filed and do not satisfy proof of coverage …

436-162-0310 Electronic Filing Requirements (1) Unless otherwise provided in these rules, insurers must transmit proof of coverage by EDI, and either use an approved vendor, or be approved as a sender. (2) Unless otherwise provided in these rules, the data elements have the meani…

436-162-0335 Testing Procedures and Transaction Accuracy Standards (1) An insurer that wants to self report proof of coverage must report through an approved vendor until the insurer completes all of the testing requirements in this rule and receives approval from the director to…

436-162-0340 Changes or Corrections (1) Changes or corrections to proof of coverage information must be submitted under the standards referenced in OAR 436-162-0004(1). (2) To report changes or corrections of an insured employer's name or address, or other data elements, the insu…

436-162-0370 Proof of Coverage Terminations When the insurer cancels coverage before the expiration of the policy term, the insurer must: (1) Provide written notice to the employer under ORS 656.427(1) and (3); (2) Retain a record of the written notice sent to the employer under …

436-162-0380 Cancellation of Coverage by the Employer When the employer cancels coverage before the expiration of the policy term, the insurer must: (1) Retain a record of the written or verbal notice provided by the employer to the insurer under ORS 656.423, including proof of d…

436-162-0400 Monitoring and Auditing Insurers (1) The director may monitor and conduct periodic audits of proof of coverage reporting data to ensure compliance with ORS chapter 656 and these rules. If the director finds violations of the reporting requirements of these rules the …

436-162-0440 Assessment of Civil Penalties (1) Under ORS 656.745, the director may assess a civil penalty against an insurer that fails to comply with ORS chapter 656 or the director’s rules and orders. (2) The insurer is responsible for its own actions as well as the actions of …

436-170-0002 Purpose of Rule The Landscape Contractors Board, Department of Revenue, Department of Consumer and Business Services, Employment Department, and Construction Contractors Board must adopt rules together to carry out ORS 670.600. 670.600 defines “independent contractor…

436-170-0100 Statutory Context (1) ORS 670.600 generally establishes three requirements for “independent contractors.” One requirement is that an “independent contractor” must be engaged in an “independently established business.” Another requirement is related to licenses and ce…

436-170-0200 Direction and Control Test (1) ORS 670.600 states that an "independent contractor" must be "free from direction and control over the means and manner" of providing services to others. The agencies that have adopted this rule will use the following definitions in thei…

436-170-0300 Application of “Direction and Control” Test in Construction and Landscape Industries (1) The provisions of this section apply to: (a) Architects licensed under ORS 671.010 to 671.220; (b) Landscape architects licensed under ORS 671.310 to 671.479; (c) Landscaping bus…

436-180-0003 Administration of Rules (1) Purpose. These rules carry out the provisions of ORS 656.403(4); 656.850; and 656.855 related to worker leasing companies. (2) Director’s discretion. The director may waive procedural rules as justice requires, unless otherwise obligated b…

436-180-0005 Definitions Unless a term is defined elsewhere in these rules, the definitions of ORS 656.005 and 656.850 are incorporated by reference and made a part of these rules. For the purpose of these rules, unless the context requires otherwise: (1) “Board” means the Worker…

436-180-0008 Requests for Hearings or Administrative Review (1) Request for hearing on proposed sanctions or civil penalties. Any person that disagrees with a proposed order or assessment of a civil penalty under ORS 656.735, or 656.745 may request a hearing by the board. To requ…

436-180-0100 Responsibility for Providing Coverage under a Lease Arrangement (1) General. Every worker leasing company providing workers to a client must satisfy the requirements of ORS 656.017 and 656.407. (2) When the worker leasing company must provide coverage. Except when th…

436-180-0110 Notice of Client Coverage; Changes to Coverage Information; Termination; Reinstatements (1) Notice of client coverage. When a worker leasing company provides coverage to a client under OAR 436-180-0100(2), the worker leasing company must file written notice with the …

436-180-0120 Temporary Worker Distinguished from Leased Worker (1) Temporary service providers. A person that provides a worker to a client by contract and for a fee will be considered a temporary service provider if the worker is provided on a temporary basis, subject to the fol…

436-180-0140 Qualifications, Applications, and Renewals for License as a Worker Leasing Company (1) Prohibition against leasing workers without a license. No person may perform services as a worker leasing company in Oregon without a valid license. (2) Qualification for license. …

436-180-0150 Recordkeeping and Reporting Requirements (1) Required records. A worker leasing company must maintain and make the following records available for review by the director, upon request: (a) Copies of and documentation of filing for signed forms and notices required un…

436-180-0155 Reporting Requirements of a Self-Insured Worker Leasing Company (1) Reporting of client statistical data. A self-insured worker leasing company must maintain and report to the National Council on Compensation Insurance (NCCI) separate statistical data for each client…

436-180-0160 Suspension or Revocation of License (1) General. The director may suspend or revoke a worker leasing license for reasons including, but not limited to: (a) Failure to comply with the provisions of ORS chapters 654, 656, 659, 659A, 731 or 737; or these rules; (b) Deni…

436-180-0170 Monitoring and Auditing (1) Generally. The director will monitor and conduct periodic audits of employers as necessary to ensure compliance with the worker leasing company licensing and performance requirements. (2) Disclosure of worker leasing records. A worker leas…

436-180-0200 Assessment of Civil Penalties (1) Failure to comply with statutes, rules, and orders of the director. The director may assess a civil penalty against a worker leasing company that fails to comply with the requirements of ORS 656.850 or 656.855, OAR 436-180, or the or…