OAR 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 Program. Documentation to support the reimbursement request shall include but not be limited to:(a)
Net temporary disability compensation paid, net permanent disability paid, and net medical compensation paid for dates of injury prior to January 1, 1966. For purposes of this section, “net” compensation paid means the total compensation paid less any recoveries, including but not limited to, third party recovery, Retroactive Program reimbursement, and Workers with Disabilities Program reimbursement.(b)
Payment certification statement.(c)
Any other information deemed necessary by the director.(3)
Periodically Compliance shall audit the physical file of the paying agent to validate the amount reimbursed and to verify that the closing report is correct. Reimbursement shall not be approved if, upon such audit, it is found:(a)
Payments were not authorized in the Board’s Own Motion order or voluntary claim reopening; or(b)
Payments of temporary disability compensation were made for periods of time during which the worker did not qualify as a “worker” pursuant to ORS 656.005 (Definitions)(30); or(c)
Compensation has been paid as a result of untimely, inaccurate, or improper claims processing; or(d)
The separate payments of compensation have not been documented, as required under generally accepted accounting procedures; or(e)
Medical payments for claims with injury dates prior to January 1, 1966 are in excess of what should have been paid if paid in accordance with OAR 436-009-0030 (Insurer’s Duties and Responsibilities) and properly audited as required by OAR 436-009-0020 (Hospitals); or(f)
Permanent disability payments were made in claims reopened for other than a new medical or omitted condition.
Source:
Rule 436-045-0030 — Reimbursement, https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-045-0030.