OAR 436-060-0500
Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury

(1) General. When an insurer elects to pay supplemental disability due a worker with multiple jobs at the time of injury, the director will reimburse the supplemental amount quarterly, after receipt and approval of documentation of compensation paid by the insurer or service company. The director will reimburse the insurer, in care of the service company, if applicable.
(2) Requests for reimbursement. Requests for reimbursement must be submitted on Form 3504, “Supplemental Disability Benefits Quarterly Reimbursement Request,” and must include at least:
(a) Identification and address of the insurer responsible for processing the claim;
(b) The worker’s name, WCD file number, date of injury, Social Security number (if known), and the insurer claim number;
(c) Whether the claim is disabling or nondisabling;
(d) The primary and secondary employers’ legal names;
(e) The primary and secondary employers’ policy numbers;
(f) The weekly wage of all jobs at the time of the injury separated by employer;
(g) The start and end dates for the periods of supplemental disability due and payable to the worker;
(h) The amount of supplemental disability paid for the periods in subsection (g);
(i) The quarter and year in which the payment was made;
(j) A signed payment certification statement verifying the payments; and
(k) Any other information the director requires.
(3) Administrative fee. In addition to the supplemental disability reimbursement, the director will pay the insurer an administrative fee based on the annual claim processing administrative cost factor, as published in Bulletin 316.
(4) Repayment of invalid or incorrect payments. The director may require the insurer to repay reimbursements made for invalid or incorrect payments.
(a) The director may periodically audit the insurer’s files to validate the amount reimbursed.
(b) Invalid amounts include, but are not limited to:
(A) Payments exceeding statutory amounts due to the insurer, excluding reasonable overpayments, as determined by the director;
(B) Compensation paid as a result of untimely or inaccurate claims processing;
(C) Payments of compensation that were not documented as required by OAR 436-050; or
(D) Amounts in a third-party recovery that result in overpayment.
(5) Benefits due workers of a noncomplying employer. Supplemental disability benefits due subject workers of a noncomplying employer as defined in ORS 656.052 (Prohibition against employment without coverage) are not eligible for separate reimbursement under this rule, but remain a cost recoverable from the employer as provided by ORS 656.054 (Claim of injured worker of noncomplying employer)(2).
(6) Claim disposition agreements and stipulated claims settlements. Claim dispositions agreements or stipulated claims settlements, under ORS 656.236 (Compromise and release of claim matters except for medical benefits) or 656.289 (Orders of Administrative Law Judge), that include amounts for supplemental disability benefits due to multiple jobs, are not eligible to receive reimbursement from the Workers’ Benefit Fund unless they receive written confirmation from the director before the disposition or settlement is approved by the Worker’s Compensation Board.
(a) To receive written confirmation of a proposed disposition or settlement, the insurer must submit a request to the division. The request for written confirmation must include:
(A) A copy of the proposed disposition or settlement that specifies the exact amount of the proposed contribution to be made from the Workers’ Benefit Fund;
(B) A statement from the insurer indicating how the amount of the contribution was calculated; and
(C) Any other information required by the director.
(b) The director will not confirm the disposition for reimbursement if the proposed contribution exceeds a reasonable projection of that claim’s future liability to the Workers’ Benefit Fund.

Source: Rule 436-060-0500 — Reimbursement of Supplemental Disability for Workers with Multiple Jobs at the Time of Injury, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-060-0500.

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 436-060-0500’s source at or​.us