OAR 436-075-0030
Permanent Total Disability Benefit
(1)
Permanent total disability benefits must be paid under ORS 656.206 (Permanent total disability) and the benefit schedules in the Retroactive Program bulletin.(2) Benefits payable for a partial month must be calculated by dividing the monthly benefit by the actual number of days in the month and multiplying that result by the number of days payable.
(3) Benefits for beneficiaries must be paid to the date of any status change.
(4) Any Social Security offset determined under ORS 656.209 (Offsetting permanent total disability benefits against Social Security benefits) must first be applied against the statutory portion of the permanent total disability benefit. Any amount of the Social Security offset that exceeds the statutory benefit must be applied against the Retroactive Program benefit. The insurer may request reimbursement only for that portion of the Retroactive Program benefit that has not been offset.
(5) At least once every two years, the insurer must verify that all beneficiaries receiving benefits for which the insurer may request reimbursement from the Retroactive Program are alive and remain eligible for those benefits. Such “status checks” of beneficiaries may occur at the same time the insurer re-examines the permanent total disability claim under OAR 436-030-0065 (Review of Permanent Total Disability Awards)(1). Insurers’ questions regarding beneficiaries’ status must be reasonably pertinent to the continuing eligibility of those persons for benefits.
Source:
Rule 436-075-0030 — Permanent Total Disability Benefit, https://secure.sos.state.or.us/oard/view.action?ruleNumber=436-075-0030.