OAR 436-060-0011
Insurer Reporting Requirements

(1) General. The insurer must process and file claims and reports required by the director in compliance with ORS chapter 656, OAR chapter 436, and orders of the director.
(a) All forms must be legible and include all information required by this rule.
(b) The insurer may not submit forms, or their electronic equivalents, by email, facsimile, electronic data interchange (EDI), or other electronic means, without the director’s prior authorization.
(c) Electronic forms, when allowed, must include the same fields and elements as their paper counterparts.
(2) Misdirected claims. If an insurer receives a claim and did not provide coverage for the worker’s employer on the date of injury, the insurer must forward the claim to either the correct insurer or the director within three days of the date it determined it was not responsible for the claim.
(3) Identification of insurer. All workers’ compensation forms generated by the insurer must include:
(a) The insurer’s name;
(b) The service company’s name, if applicable; and
(c) The mailing address and phone number of the location responsible for processing the claim.
(4) Claims status and activity reporting. The insurer must report all disabling claims status and activity to the director using Form 1502, “Insurer’s Report.”
(a) The insurer must file a Form 1502 with the director within 14 days of:
(A) The date of the insurer’s initial decision to accept or deny the claim;
(B) The date of any reopening of the claim, except voluntary reopening under ORS 656.278 (Board has continuing authority to alter earlier action on claim);
(C) The date of a change in the acceptance or classification of the claim following the initial Form 1502;
(D) The date of a litigation order or insurer’s decision that changes the acceptance or classification of the claim, or causes the claim to be reopened;
(E) The date a worker is enrolled in a managed care organization that occurs after the initial Form 1502 has been filed;
(F) The date the insurer has knowledge that a previously filed Form 1502 contained erroneous information;
(G) The date of a denial that occurs after the initial Form 1502 has been filed; or
(H) The date first payment of temporary disability is issued, if the date was not included in the initial Form 1502.
(b) Each Form 1502 the insurer files must include the following information:
(A) The worker’s legal name;
(B) The worker’s Social Security number as provided by the worker or employer, or a statement that the insurer is unable to obtain the worker’s Social Security number;
(C) The insurer’s claim number;
(D) The date of injury;
(E) The employer’s legal name;
(F) The employer’s policy number, unless the employer is self-insured or the claim is a noncomplying employer claim;
(G) The status of the claim;
(H) The reason for filing; and
(I) The wrap-up project name, if the claim is from a wrap-up project.
(c) The Form 1502 reporting the insurer’s initial decision to accept or deny a claim must also include:
(A) If the first payment of compensation was made within the time frame required under OAR 436-060-0150 (Timely Payment of Compensation), if applicable;
(B) If the claim was accepted or denied within the time frame required under OAR 436-060-0140 (Acceptance or Denial of a Claim); and
(C) For a worker enrolled in a managed care organization:
(i) The date of enrollment; and
(ii) The managed care organization number, unless the number was reported on a prior Form 1502 on the claim.
(5) Filing the first Form 1502 on a claim. The first Form 1502 the insurer files on a claim must be accompanied by:
(a) Copies of all acceptance and denial notices not previously submitted to the director; and
(b) A signed Form 801, or its electronic equivalent, except when a Form 801 is not available for timely filing.
(A) The Form 801 must be completed by the employer and worker, unless:
(i) The Form 801 cannot be obtained from the employer or worker because the employer or worker cannot be located, refuses to cooperate, or is physically unable to complete the form; or
(ii) The Form 801 was prepared using an electronic form that required it to be prepared by the insurer based upon information obtained from the employer and worker.
(B) If a Form 801 is not available for timely filing:
(i) The Form 1502 may be accompanied by a signed Form 827 to satisfy the initial reporting requirement; and
(ii) The Form 801 must be submitted within 30 days of the date the insurer filed the first Form 1502.
(6) Nondisabling claims. The insurer is not required to report a nondisabling claim to the director, except:
(a) The insurer must report a nondisabling claim that is denied in part or whole to the director within 14 days of the date of denial; and
(b) The insurer must report a nondisabling claim that is reclassified as disabling to the director within 14 days of the date of the status change.
(7) Voluntarily reopened own motion claims. The insurer must file a Form 3501, “Notice of Voluntary Reopening Own Motion Claim,” with the director within 14 days of the date the insurer voluntarily reopens a qualified claim under ORS 656.278 (Board has continuing authority to alter earlier action on claim).
(8) New condition reopening. If the insurer reopens a claim due to a new medical condition, and the claim:
(a) Is not closed within 14 days, the insurer must file Form 1502 with the director within 14 days of the earliest of:
(A) The date the new condition is accepted; or
(B) The date the insurer has knowledge that interim temporary disability compensation is due and payable; or
(b) Is closed within 14 days, the insurer must report the reopening on the Form 1503, “Insurer Notice of Closure Summary.” Form 1503 must be filed with the director at the time the insurer closes the claim, and accompanied by the “Modified Notice of Acceptance” and “Updated Notice of Acceptance at Closure” sent to the worker.
(9) Claim withdrawal. The insurer must file a Form 1502 with the director if it receives written communication from the worker stating the worker never intended to file a claim and wants the claim withdrawn after the claim has been reported to the director. The Form 1502 must be accompanied by a copy of the worker’s communication.
(10) Failure to report. The director may issue a civil penalty against any insurer that does not file required notices and forms within the time frames of these rules.
(11) Reporting of legal service costs. Insurers must make an annual report to the director reporting attorney fees, attorney salaries, and all other costs of legal services paid under ORS chapter 656. The report must be submitted on forms provided by the director for that purpose. Reports for each calendar year must be filed by March 1 of the following year.
(12) Election of payment of supplemental disability. If an insurer elects to not process and pay supplemental disability benefits under ORS 656.210 (Temporary total disability)(5)(a) and OAR 436-060-0035 (Supplemental Disability for Workers with Multiple Jobs at the Time of Injury):
(a) The insurer must submit a Form 3530, “Supplemental Disability Election Notification,” to the director. The insurer is not required to inform the director if it elects to process and pay supplemental disability unless the insurer has previously provided notice otherwise.
(b) The insurer must use a Form 3504, “Supplemental Disability Benefits Quarterly Reimbursement Request,” to request reimbursement under OAR 436-060-0500 (Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury) for each quarter the insurer processed and paid supplemental disability benefits.

Source: Rule 436-060-0011 — Insurer Reporting Requirements, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0011.

436–060–0003
Purpose, Applicability, Forms, and Bulletins 436–060–0005
Definitions 436–060–0008
Administrative Review and Contested Cases 436–060–0010
Employer Responsibilities 436–060–0011
Insurer Reporting Requirements 436–060–0012
Notices and Correspondence Following the Death of a Worker 436–060–0015
Required Notice and Information 436–060–0017
Release of Claim Documents 436–060–0018
Nondisabling and Disabling Claim Reclassification 436–060–0019
Determining and Paying the Three Day Waiting Period 436–060–0020
Payment of Temporary Total Disability Compensation 436–060–0025
Worker’s Weekly Wage Calculation and Rate of Temporary Disability Compensation 436–060–0030
Payment of Temporary Partial Disability Compensation 436–060–0035
Supplemental Disability for Workers with Multiple Jobs at the Time of Injury 436–060–0040
Payment of Permanent Partial Disability Compensation 436–060–0045
Payment of Compensation During Worker Incarceration 436–060–0055
Payment of Medical Services on Nondisabling Claims 436–060–0060
Lump Sum Payment of Permanent Partial Disability Awards 436–060–0075
Payment of Death Benefits 436–060–0095
Medical Examinations 436–060–0105
Suspension of Compensation for Insanitary or Injurious Practices, Refusal of Treatment or Failure to Participate in Rehabilitation 436–060–0135
Injured Worker, Worker’s Attorney Responsible to Assist in Investigation 436–060–0137
Vocational Evaluations for Permanent Total Disability Benefits 436–060–0140
Acceptance or Denial of a Claim 436–060–0141
Claims for COVID-19 or Exposure to SARS-CoV-2 436–060–0147
Worker Requested Medical Examination 436–060–0150
Timely Payment of Compensation 436–060–0153
Electronic Payment of Compensation 436–060–0155
Penalty to Worker for Untimely Processing 436–060–0160
Use of Sight Draft to Pay Compensation Prohibited 436–060–0170
Recovery of Overpayment of Benefits 436–060–0180
Designation and Responsibility of a Paying Agent 436–060–0190
Monetary Adjustments among Parties and Department of Consumer and Business Services 436–060–0195
Miscellaneous Monetary Adjustments Among Insurers 436–060–0200
Assessment of Civil Penalties 436–060–0400
Penalty and Attorney Fee for Untimely Payment of Disputed Claims Settlement 436–060–0500
Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury 436–060–0510
Reimbursement of Permanent Total Disability Benefits from the Workers’ Benefit Fund
Last Updated

Jun. 8, 2021

Rule 436-060-0011’s source at or​.us