OAR 436-060-0195
Miscellaneous Monetary Adjustments Among Insurers

(1)

General. The director may order monetary adjustments between insurers when a worker has a right to compensation, but there is a dispute between insurers that does not fall under the director’s authority in ORS 656.307 (Determination of issues regarding responsibility for compensation payment) and OAR 436-060-0190 (Monetary Adjustments among Parties and Department of Consumer and Business Services).

(a)

When any litigation on the issues in question is final, insurers must make any necessary monetary adjustments between themselves, consistent with the determination of coverage for compensation paid to the worker, medical providers, and others for which they are responsible, within 30 days of receiving enough information to determine the benefits paid and the relationship to the conditions involved.

(b)

Any balance due after making such adjustments must be paid in a timely manner to the worker, medical providers and other parties under OAR 436-009 and 436-060-0150 (Timely Payment of Compensation).

(c)

Any failure to obtain reimbursement from an insurer under this rule is not recoverable from the Consumer and Business Services Fund.

(2)

Obligation to process claims. The director may direct any necessary monetary adjustment between parties, but will not order an insurer to pay compensation above that required by law, as it relates to the insurer’s claim, except when an insurer unduly compensates a worker while having knowledge such compensation has already been paid by another insurer. However, each insurer has its own independent obligation to process its claim and pay compensation due until the claim is either accepted or denied. When notified by the director that a dispute over monetary adjustment exists the insurer must provide a written response to questions or issues raised, including supporting documentation, to the division, the other insurers involved and other interested parties within 21 days of the mailing date of the notification.

(3)

Failure to make adjustments. Failure to respond to the director’s inquiries or make monetary adjustments within 30 days of an order by the director will subject the insurer to civil penalties under OAR 436-060-0200 (Assessment of Civil Penalties).

(4)

Unnecessary costs. When the director determines improper or untimely claim processing by an insurer resulted in unnecessary costs, the director may deny monetary adjustment between the insurers.

Source: Rule 436-060-0195 — Miscellaneous Monetary Adjustments Among Insurers, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0195.

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 436-060-0195’s source at or​.us