OAR 436-060-0190
Monetary Adjustments among Parties and Department of Consumer and Business Services

(1) General. An order of the director under ORS 656.307 (Determination of issues regarding responsibility for compensation payment) and OAR 436-060-0180 (Designation and Responsibility of a Paying Agent) applies only to the period before the order of the administrative law judge determining the responsible paying party. Payment of compensation made after the order may not be recovered from the Consumer and Business Services Fund, unless the director concludes payment was made before the administrative law judge’s order was received by the paying agent designated under OAR 436-060-0180 (Designation and Responsibility of a Paying Agent). After the administrative law judge’s order, any necessary monetary adjustments must be made under OAR 436-060-0195 (Miscellaneous Monetary Adjustments Among Insurers).
(2) Determination of benefits paid. When all litigation on the issue of responsibility is final, the insurer ultimately held to be responsible must, before paying any compensation, contact any nonresponsible insurer to determine what compensation has already been paid. When contacted by the responsible insurer, the nonresponsible insurer must provide the requested information necessary for the responsible insurer to make a timely payment to the worker, medical providers or others, but in any case no later than 20 days after the date of contact. Failure to respond to the responsible insurer’s inquiry in a timely manner may result in nonreimbursement otherwise due from the responsible insurer or from the Consumer and Business Services Fund.
(3) Reimbursement of nonresponsible insurers. The responsible insurer must reimburse any nonresponsible insurers for compensation the nonresponsible insurer paid that the responsible insurer is responsible for, but has not already paid, within 30 days of receiving enough information to determine the benefits paid and the relationship to the conditions involved. Any balance remaining due to the worker, medical providers or others must be paid in a timely manner under OAR 436-009 and 436-060-0150 (Timely Payment of Compensation). Payment of compensation that results in duplicate payment to the worker, medical providers or others as a result of failing to contact the nonresponsible insurer does not release the responsible insurer from the requirement to reimburse any nonresponsible insurers for its costs.
(4) Direction of unresolved adjustments. The director may direct any necessary monetary adjustment between the parties that is not otherwise ordered by the administrative law judge or voluntarily resolved by the parties. The director will not order an insurer to pay compensation above that required by law, as it relates to the insurer’s claim, except in the situation described in section (3) of this rule. Any insurer that fails to make monetary adjustments within 30 days of an order by the director may be subject to civil penalties under OAR 436-060-0200 (Assessment of Civil Penalties). Only compensation paid as a result of an order by the director under OAR 436-060-0180 (Designation and Responsibility of a Paying Agent) and consistent with this rule is recoverable from the Consumer and Business Services Fund when such compensation is not reimbursed to the nonresponsible insurer by the responsible insurer.
(5) Unnecessary costs. When the director determines improper or untimely claim processing by the designated paying agent has resulted in unnecessary costs, the director may deny reimbursement from the responsible insurer and the Consumer and Business Services Fund.

Source: Rule 436-060-0190 — Monetary Adjustments among Parties and Department of Consumer and Business Services, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0190.

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 436-060-0190’s source at or​.us