Oregon Department of Consumer and Business Services, Workers' Compensation Division
Payment of Temporary Total Disability Compensation
(1) Employer payment of temporary disability. An employer may pay temporary disability compensation with the approval of the insurer. If the insurer approves an employer to make such payment:(a) The insurer continues to be responsible for determining the worker’s entitlement to compensation, and ensuring timely payment of compensation;(b) The employer must provide the insurer with payment documentation that is adequate to meet the insurer’s responsibilities; and(c) The insurer must reimburse the employer for any temporary disability compensation paid to the worker under this section.(2) Persons who have withdrawn from the workforce. No temporary disability is due and payable for any period of time in which the person has withdrawn from the workforce. For the purpose of this rule, a person who has withdrawn from the workforce, includes, but is not limited to:(a) A person who, before a claim reopening under ORS 656.267 (Claims for new and omitted medical conditions), 656.273 (Aggravation for worsened conditions) or 656.278 (Board has continuing authority to alter earlier action on claim), was not working and made no reasonable efforts to obtain employment, unless such efforts would be futile as a result of the compensable injury.(b) A person who was a full-time student for at least six months in the 52 weeks before the date of injury who elects to return to school full time, unless the person can establish a prior customary pattern of working while attending school. For purposes of this subsection, “full time” is defined as twelve or more quarter hours or the equivalent.(3) Authorization of temporary disability compensation. No compensation is due and payable after the worker’s attending physician or authorized nurse practitioner ceases to authorize temporary disability, or for any period of time when temporary disability benefits are not authorized by a medical service provider under ORS 656.245 (Medical services to be provided)(2)(b). Temporary disability compensation is authorized when:(a) The medical service provider provides the insurer or employer with oral or written verification of the worker’s inability to work;(b) Documents in the insurer’s possession at claim closure reasonably reflect the worker’s inability to work. For the purposes of this rule “documents” and “possession” have the same meaning as in OAR 436-060-0017 (Release of Claim Documents)(1); or(c) The director determines, at reconsideration of claim closure, there is sufficient contemporaneous medical documentation to reasonably reflect the worker’s inability to work under ORS 656.268 (Claim closure).(4) Lack of verification of inability to work. No temporary disability is due and payable for any period of time during which the insurer has requested from the worker’s attending physician or authorized nurse practitioner verification of the worker’s inability to work and the physician or authorized nurse practitioner cannot verify it, unless the worker has been unable to receive treatment for reasons beyond the worker’s control.(a) Before withholding temporary disability under this section, the insurer must ask the worker whether a reason beyond the worker’s control prevented the worker from receiving treatment.(A) If no valid reason is found or the worker does not respond or cannot be located, the insurer must document its file regarding those findings.(B) The insurer must provide the director a copy of the documentation within 20 days, if requested.(b) If the attending physician or authorized nurse practitioner is unable to verify the worker’s inability to work, the insurer may stop temporary disability payments and, in place of the scheduled payment, must send the worker an explanation for stopping the temporary disability payments.(c) When verification of temporary disability is received from the attending physician or authorized nurse practitioner, the insurer must pay temporary disability within 14 days of receiving the verification of any authorized period of temporary disability, unless otherwise denied.(5) Suspension of benefits. An insurer may suspend temporary disability benefits without authorization from the director when all of the following circumstances apply:(a) The worker missed a regularly scheduled appointment with the attending physician or authorized nurse practitioner;(b) The insurer sent a letter by certified mail to the worker and a letter to the worker’s attorney, at least 10 days in advance of a rescheduled appointment, stating that the appointment has been rescheduled with the worker’s attending physician or authorized nurse practitioner; stating the time and date of the appointment; and giving the following notice, in prominent or bold face type:(c) The insurer verifies that the worker has missed the rescheduled appointment; and(d) The insurer sends a letter to the worker, the worker’s attorney and the division giving the date of the regularly scheduled appointment that was missed, the date of the rescheduled appointment that was missed, the date of the letter being the day benefits are suspended, and the following notice, in prominent or bold face type:(6) Verbal release to work. If temporary disability benefits end because the insurer or employer negotiates a verbal release of the worker to return to any type of work with the worker’s attending physician or authorized nurse practitioner, and the worker has not been informed of the release by the attending physician or authorized nurse practitioner or returned to work, the insurer must:(a) Document the facts;(b) Communicate the release to the worker by mail within seven days. The communication to the worker of the negotiated return-to-work release may be contained in an offer of modified employment; and(c) Advise the worker of their reinstatement rights under ORS chapter 659A.(7) Temporary disability from two or more claims. When a worker is due concurrent temporary disability under ORS 656.210 (Temporary total disability) or ORS 656.212 (Temporary partial disability) as a result of two or more accepted claims:(a) The director may order one of the insurers to pay the entire amount of temporary disability due; or make a pro rata distribution between two or more of the insurers;(b) The insurers may request for the director to make a pro rata distribution of compensation due. The request must be in writing, and the insurer must provide a copy to the worker and the worker’s attorney, if any;(c) The director’s pro rata order does not apply to:(A) Any periods of interim compensation payable under ORS 656.262 (Processing of claims and payment of compensation); or(B) Any benefits due under ORS 656.214 (Permanent partial disability) or 656.245 (Medical services to be provided);(d) Claims subject to the pro rata order must be closed under OAR 436-030 and ORS 656.268 (Claim closure), when appropriate;(e) The pro rata distribution ordered by the director only applies to benefits due as of the date all claims involved are in an accepted status. The order pro rating compensation will not apply to periods where any claim involved is in a deferred status;(f) The insurers may not prorate temporary disability without the approval of the director, except when the claims involve the same worker, the same employer, and the same insurer. When the insurer prorates temporary disability under this subsection the worker must receive compensation at the highest temporary disability rate of the claims involved.(8) Premature closure. If a closure under ORS 656.268 (Claim closure) has been found to be premature and there was an open ended authorization of temporary disability at the time of closure, the insurer must begin payments under ORS 656.262 (Processing of claims and payment of compensation), including retroactive periods, and pay temporary disability for as long as authorization exists or until there are other lawful bases to terminate temporary disability.(9) Incorrectly denied claims. If a denied claim has been determined to be compensable by final order, the insurer must begin temporary disability payments under ORS 656.262 (Processing of claims and payment of compensation), including retroactive periods, if the authorization for temporary disability was open ended at the time of denial, and there are no other lawful bases to terminate temporary disability.