OAR 436-060-0135
Injured Worker, Worker’s Attorney Responsible to Assist in Investigation; Suspension of Compensation and Notice to Worker

(1) Worker’s responsibility to assist in investigation. A worker must submit to and fully cooperate with in person or telephone interviews and other formal or informal information gathering techniques reasonably requested by the insurer. Interviews may be recorded on audio or video by one or more of the parties if prior written notice is given of the intent to record an interview.
(2) Request to suspend compensation. The insurer may request for the director to suspend compensation by order when the worker refuses or fails to cooperate in an investigation of an initial claim for compensation, a claim for a new medical condition, a claim for an omitted medical condition, or an aggravation claim as required by ORS 656.262 (Processing of claims and payment of compensation)(14), under the following conditions:
(a) The insurer must notify the worker in writing that an interview or deposition has been scheduled, or of other investigation requirements:
(A) The notice must be sent to the worker and copied to the worker’s attorney, if any, and must contain the following:
(i) The date, time, and place of the interview or deposition, if scheduled;
(ii) Any other reasonable investigation requirements;
(iii) That the interview, deposition, or any other investigation requirements are related to the worker’s compensation claim; and
(iv) The following statement in prominent or bold face type:
(B) If the insurer contracts with a third party to investigate the claim, the notice must be on the insurer’s stationery and must meet the requirements of this section; and
(C) The worker must be given 14 days to cooperate with the notice.
(b) The director will consider requests to authorize suspension of benefits only after the worker has been given at least 14 days to cooperate with the notice under subsection (a) of this rule; and under the following conditions:
(A) The director will only consider requests in claims on which no acceptance or denial has been issued;
(B) The worker must have the opportunity to submit information disputing the insurer’s request for suspension of compensation before the director will issue an order;
(C) The director may determine whether special circumstances exist that would not warrant suspension of compensation for failure to cooperate with an investigation;
(D) The insurer must make the request to suspend benefits to the director in writing, and must send a copy of the request, including all attachments, simultaneously to the worker and the worker’s attorney, if any by registered or certified mail or by personal service;
(E) The insurer’s request must include the following information sufficient to show the worker’s failure to cooperate:
(i) That the insurer requests suspension of benefits under ORS 656.262 (Processing of claims and payment of compensation)(15) and this rule;
(ii) Documentation of the specific actions of the worker or worker’s attorney that prompted the request;
(iii) Any reasons given by the worker for failure to comply, or a statement that the worker has not given any reasons;
(iv) A copy of the notice required in section (2) of this rule; and
(v) All other pertinent information, including, but not limited to, a copy of the claim for a new or omitted condition when that is what the insurer is investigating;
(c) After receiving the insurer’s request to suspend benefits, the director will notify all parties that:
(A) The worker’s benefits will be suspended in five business days unless:
(i) The worker or the worker’s attorney contacts the division by telephone or mails a letter documenting that the failure to cooperate was reasonable; or
(ii) The insurer notifies the division that the worker is now cooperating;
(B) The insurer’s obligation to accept or deny the claim within 60 days is suspended unless the insurer’s request is filed with the division after the 60 days to accept or deny the claim has expired;
(d) If the worker cooperates within five business days of the director’s notice under subsection (c), the insurer must notify the director immediately to withdraw the suspension request. Upon receiving the insurer’s notification:
(A) The director will notify all the parties of the withdrawal; and
(B) The director may issue an order identifying the dates during which the insurer’s obligation to accept or deny the claim was suspended;
(e) If the worker contacts the division and documents the failure to cooperate was reasonable within five business days of the director’s notice under subsection (c), the director will not suspend payment of compensation. However, an order may be issued identifying the dates during which the insurer’s obligation to accept or deny the claim was suspended; and
(f) If the worker has not cooperated with the investigation, or has not documented that the failure to cooperate was reasonable within five business days of the director’s notice under subsection (c), the director will issue an order suspending all or part of the payment of compensation to the worker:
(A) The suspension of compensation will be effective from the fifth business day after the date of the director’s notice under subsection (c), and will remain in effect until the worker reasonably cooperates with the investigation;
(B) If the worker reasonably cooperates with the investigation, the insurer must reinstate the worker’s benefits immediately; or
(C) If the worker makes no effort to cooperate within 30 days of the date of the notice, the insurer may deny the claim under ORS 656.262 (Processing of claims and payment of compensation)(15) and OAR 436-060-0140 (Acceptance or Denial of a Claim)(8).
(3) Request for penalty against worker’s attorney. An insurer that believes that a worker’s attorney’s unwillingness or unavailability to participate in an interview is unreasonable may notify the director in writing and the director will consider assessment of a civil penalty against the attorney of not more than $1,000.
(a) The worker’s attorney must have the opportunity to dispute the allegation before a penalty is assessed.
(b) A copy of the notice must be sent simultaneously to the worker and the worker’s attorney. Notice to the division by the insurer must contain the following information:
(A) What specific actions of the attorney prompted the request;
(B) Any reasons given by the attorney for failing to participate in the interview; and
(C) A copy of the request for interview sent to the attorney.
(4) Failure to comply with this rule. Failure to comply with the requirements of this rule will be grounds for denial of the insurer’s request. Any delay in requesting suspension under section (2) of this rule may result in authorization being denied.

Source: Rule 436-060-0135 — Injured Worker, Worker’s Attorney Responsible to Assist in Investigation; Suspension of Compensation and Notice to Worker, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0135.

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 436-060-0135’s source at or​.us