With the approval of the director, an insurer may modify the appearance, wording, or font size ofa paper form referenced in OAR 436-060. Any insurer modified paper form must:
Obtain information equivalent to the division’s current form;
Usethe same form number as the division’s current form;
Have an appearance and format substantially similar to the division’s current form; and(D)Have an asterisk after the form name with the following statement at the bottom “*This form was modified by [INSERT INSURER’S NAME], and has been approved for use by the Oregon Workers’ Compensation Division.”
The director may revoke approval of an insurer modified paper form when the director determines the form does not comply with current federal or state law, or if the director finds the form no longer meets the requirements of (3)(b) of this rule.
To request approval of a modified paper form, the insurer must send or hand deliver the proposed form, along with a cover letter requesting approval to use the form, to the Forms and Bulletins Coordinator at [email protected] or 350 Winter Street NE, P.O. Box 14480, Salem OR 97309-0405.