Oregon Administrative Code

438-009-0022 Required Information in a Claim Disposition Agreement (1) If a claim disposition agreement involves more than one claim, the disposition shall contain all of the information required by this rule for each claim including a separate first page of the claim disposition…

438-009-0023 Notice to Claimant Required Each claimant shall, at the time of execution of a Claim Disposition Agreement, be given a written notice, separate from the agreement, in the form prescribed by the Board pursuant to OAR 438-009-0022. Statutory/Other Authority: ORS 656.72…

438-009-0025 Claim Disposition Agreements; Processing (1) The parties shall file the claim disposition agreement with the Board for approval by the Administrative Law Judge who mediated the agreement or the Board Members. Any claim disposition agreement may be filed in accordance…

438-009-0028 Announcement of CDA Approval Order (1) Except as provided in section (2) of this rule, the announcement that a Claim Disposition Agreement has received approval by the Administrative Law Judge who mediated the agreement or the Board may be provided in the following m…

438-009-0030 Claim Disposition Agreements; Stay of Other Proceedings; Payment of Proceeds (1) Notwithstanding OAR 438-006-0081, 438-006-0091, 438-011-0020 and 438-011-0025, the receipt of a claim disposition agreement by the Administrative Law Judge who mediated the agreement or …

438-009-0035 Reconsideration of Claim Disposition Agreements (1) A motion for reconsideration of final orders issued under ORS 656.236 and these rules shall be filed within 10 days of the date of mailing of the order. (2) The Administrative Law Judge who mediated the agreement or…

438-010-0010 Effective Date for Applying Disability Standards In applying the disability rating standards at hearing and on review, the Administrative Law Judge and the Board shall apply the disability rating standards as required by OAR 436-035-0003. Statutory/Other Authority: O…

438-011-0005 Request for Board Review (1) The time for and manner of filing a request for Board review of a Administrative Law Judge's order are set forth in ORS 656.289, 656.295, and OAR 438-005-0046. (2) Copies of a request for Board review of an Administrative Law Judge's orde…

438-011-0010 Applicability These rules apply to all cases in which a party or parties request Board review of an order of an Administrative Law Judge pursuant to ORS 656.289, 656.291, 656.295 and 656.307 and to cases in which a party requests a decision of the Board under the thi…

438-011-0015 Scope of Board Review (1) Review by the Board is de novo upon the entire record. The Board may remand a matter to the Hearings Division to take additional evidence, report findings to the Board or to enter an Opinion and Order on remand. (2) The Board will not ordina…

438-011-0020 Briefs and Other Documents (1) Filing of briefs is not jurisdictional; however, the Board views briefs as a significant aid to the review process. Briefs submitted for consideration by the Board shall comply with this section. (2) The party requesting Board review sh…

438-011-0022 Expedited Review (1) For purposes of OAR chapter 438, division 011, compensation is deemed stayed under ORS 656.313 if the employer/insurer has filed a request for Board review on or after July 1, 1990 of an Administrative Law Judge’s order and compensation is due an…

438-011-0023 Request for Recusal of Board Member A request by a party that a Board member not participate in the review of a case shall be made in writing and filed with the Board not later than the due date of the party’s first brief. The request shall state specifically why the…

438-011-0025 Motions that Toll Time Unless otherwise ordered by the Board, the filing of a motion to dismiss a request or cross-request for review or to remand a case to the Hearings Division tolls the time for the next event in the review process. Statutory/Other Authority: ORS …

438-011-0030 Motion for Waiver of Rules Except as otherwise prohibited by law, the Board may waive any provision of OAR 438-011 upon motion of a party. A motion for waiver of rules shall include a statement of the facts and circumstances relied upon and shall be simultaneously se…

438-011-0031 Request for Oral Argument (1) At any time before expiration of the briefing schedule, a party may request that the Board entertain oral argument. (2) The Board may grant a request under section (1) of this rule or, on its own motion, at any time prior to issuance of …

438-011-0032 Procedure at Oral Argument (1) In those cases where the Board has granted oral argument under OAR 438-011-0031, each party shall have 30 minutes to present its argument, unless the Board member who is presiding at the argument designates a longer or shorter period. (…

438-011-0035 Review; Board Order; Reconsideration (1) The Board order on review shall set forth: (a) The parties; (b) The issues; (c) The reviewing members; (d) The Board’s decision and (e) Shall advise all parties of appeal rights. (2) A request for reconsideration of a Board or…

438-011-0045 Third Party Orders (1) Any party requesting the Board's resolution of a controversy arising under the third party law, ORS 656.576 through 656.596, shall petition the Board for relief. The party requesting relief is the petitioner and all other parties are respondent…

438-011-0055 Third Party Election Letter (1) If a self-insured employer or insurer (hereafter “paying agency”) intends to require the claimant or other beneficiaries or the legal representative of a deceased worker (hereafter “the claimant”) to exercise the right of election prov…

438-012-0001 Definitions (1) "Own Motion Board" and "Board" mean the Workers' Compensation Board acting under its authority pursuant to ORS 656.278 and these rules. (2) "Own Motion Claim" means: (a) A written request, including such a request related to an injury occurring before…

438-012-0016 Communication with Board and Parties in Own Motion Cases A copy of any document in an Own Motion proceeding, including correspondence, directed to the Board or to a party in the claim shall be simultaneously mailed or delivered to all other parties involved in the cl…

438-012-0017 Written Argument and Other Documents (1) Timely compliance with Board requests for written argument and/or timely responses to inquiries from the Board is necessary to the Board’s decision making process. (2) Unless otherwise allowed by the Board, extensions of time …

438-012-0018 Applicability of Rules; Effective Date (1) These rules apply to claims in which a request for compensation under the Board's Own Motion jurisdiction is in existence or arose on or after the effective date of these rules. (2) These rules in OAR chapter 438, division 0…

438-012-0020 Insurer to Process Own Motion Claim: Notice and Contents of Claim; Worsened Condition Claim; "Post-aggravation Rights" New Medical Condition or Omitted Medical Condition Claim; Pre-1966 Injury Claim (1) All Own Motion claims, including "post-aggravation rights" new m…

438-012-0030 Insurer Recommendation of Reopening or Denial of Claim Voluntarily Reopening (1) Except as provided in section (3) of this rule, for “worsened condition” claims that have been determined to be compensable as defined under OAR 438-012-0001(3) and "post-aggravation rig…

438-012-0031 Notification of Pending Proceedings Parties to an Own Motion proceeding shall notify the Board of any pending proceeding involving a contested case under ORS 656.283 through 656.298, 656.307, or 656.308, an arbitration or mediation proceeding under ORS 656.307, a man…

438-012-0032 Consent to Designation of Paying Agent (1) Except as provided in section (2) of this rule, when the Workers’ Compensation Division notifies the Board that it is prepared to issue an order designating a paying agent under ORS 656.307 and OAR 436-060-0180 if the Board …

438-012-0035 Temporary Disability Compensation (1) The insurer may pay temporary disability compensation in accordance with the provisions of ORS 656.210, 656.212(2) and 656.262(4) from the time the attending physician authorizes temporary disability compensation for the hospital…

438-012-0036 Permanent Disability Compensation (1) Where a new medical condition or an omitted medical condition claim has been determined to be compensable as defined under OAR 438-012-0001(4) and the claim was initiated after the aggravation rights under ORS 656.273 expired, th…

438-012-0037 Payment of Medical Benefits Except as otherwise provided in OAR 438-012-0020(7), for every condition resulting from a compensable injury occurring before January 1, 1966, the Own Motion insurer may pay for reasonable and necessary medical services when: (1) Undertake…

438-012-0040 Action by Board after Insurer Recommendation Except as provided in OAR 438-012-0050, within a reasonable time after receipt of the insurer’s recommendation and supporting evidence and any additional evidence and argument from the claimant the Board may: (1) Issue its…

438-012-0050 Board Will Act Unless Claimant Has Not Exhausted Other Available Remedies (1) The Board will act promptly upon a request for relief under the provisions of ORS 656.278 and these rules unless: (a) The claimant has available administrative remedies under the provisions…

438-012-0055 Closure of Claims Reopened Under ORS 656.278 When a claim has been voluntarily reopened or ordered reopened by the Board and the medical reports indicate to the insurer that the claimant's condition has become medically stationary, the claim shall be closed by the in…

438-012-0060 Board Review of Insurer Closure; Referral for Medical Arbiter Evaluation (1) The request for Board review of the insurer's claim closure pursuant to OAR 438-012-0055 shall be in writing, signed by the claimant or the claimant's attorney, and should include, but is no…

438-012-0061 Board Review of Voluntary Reopening of an Own Motion Claim (1) If a dispute arises out of a voluntary reopening of a claim under ORS 656.278(5), a party may file a written request for Board review, with copies to the other party. (2) Within 14 days after notification…

438-012-0062 Referral of Request for Enforcement of Board's Own Motion Order to Hearings Division (1) The Board may refer a request to enforce an Own Motion order to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions. (2) The Board s…

438-012-0065 Reconsideration of Own Motion Orders (1) All final orders issued by the Board under the provisions of ORS 656.278 shall set forth the parties, the request for relief, the Board’s decision and shall advise all parties of appeal rights. (2) A motion for reconsideration…

438-012-0110 Penalty for Unreasonable Failure to Comply or Untimely Compliance with Board Own Motion Rules (1) Failure to comply with the Board’s Own Motion rules by the insurer, if found unreasonable or unjustified, may result in the imposition of penalties and attorney fees pur…

438-013-0005 Expedited Claims Service Established Pursuant to the mandate of 1987 Oregon Laws, Chapter 884, Section 18, there is established within the Hearings Division the Expedited Claims Service. The purpose of the Expedited Claims Service is to provide for prompt, informal d…

438-013-0010 Referral of Request for Hearing to Expedited Claim Service (1) A request for hearing shall be referred to the Expedited Claims Service if: (a) The request does not involve the compensability of or responsibility for a claim, and the total amount in controversy, exclu…

438-013-0015 Determination of Amount in Controversy For the purpose of referral to the Expedited Claims Service, the total amount in controversy shall be presumed to be $1,000 or less if the party requesting the hearing so states on a form prescribed by the Board or in the reques…

438-013-0020 Representation of Parties in Expedited Claims (1) A claimant need not be represented by any other person in proceedings before the Expedited Claims Service. (2) A claimant may be represented by an attorney or by an individual who is not an attorney in proceedings bef…

438-013-0025 Notice of Hearing Date The Hearings Division shall distribute a notice of hearing date to all parties and to all other individuals who represent the parties. The hearing shall be scheduled for a date that is not less than 15 days from the distribution of the notice o…

438-013-0030 Hearings in Expedited Claims; Informal Dispute Resolution (1) OAR 438-007-0018 does not apply to the Expedited Claim Service. The insurer’s representative shall bring all medical and vocational reports, records of compensation paid, and all other documents pertaining…

438-013-0035 Postponements and Continuances (1) A hearing under the Expedited Claims Service shall not be postponed except upon a showing of extraordinary circumstances beyond the control of the party requesting the postponement. “Extraordinary circumstances” shall be as defined …

438-013-0040 Order of Administrative Law Judge; Review (1) The Administrative Law Judge shall issue an order deciding the case not later than ten days after the closing of the record. The order may adopt by reference findings and conclusions stated on the oral record. (2) The Adm…

438-015-0003 Authority for Adoption These rules are adopted pursuant to ORS 656.236, 656.388, and 656.593, under the general rulemaking authority of the Board pursuant to 656.726(5). Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.236(4), 656.388(3),…

438-015-0005 Definitions In addition to the definitions set forth in OAR 438-005-0040: (1) “Approved fee” means an attorney fee paid out of a claimant’s compensation. (2) “Assessed fee” means an attorney fee paid to a claimant’s attorney by an insurer or self-insured employer in …

438-015-0010 General Principles (1) Attorney fees for an attorney representing a claimant before the Board or its Hearings Division shall be authorized only if an executed attorney retainer agreement has been filed with the Administrative Law Judge or Board. (2) Attorney fees for…