OAR 436-105-0540
Employer-at-Injury Program Reimbursement Procedures

The following provisions apply when the insurer requests reimbursement from the division under the Employer-at-Injury Program:
(1) Reimbursable benefits. Reimbursements may include wage subsidy, Employer-at-Injury Program purchases, and worksite modification.
(2) Program administrative costs. The insurer is entitled to a program administrative cost of $120 for the first approved reimbursement request for an Employer-at-Injury Program. Subsequent requests for reimbursement, including amended requests, for the same Employer-at-Injury Program are not entitled to additional program administrative costs.
(3) Minimum reimbursement request. The first reimbursement request for an Employer-at-Injury Program must be for a minimum of $100. Subsequent requests, including amended requests, may be for less than $100.
(4) Required documentation. The insurer must have all documentation required for reimbursement in its possession at the time reimbursement is requested. The insurer must stamp or display evidence of the initial date of receipt on each document as required under OAR 436-060-0017 (Release of Claim Documents)(2).
(5) Timeframe for submitting a reimbursement request and required documentation.
(a) The employer must submit all required documentation for reimbursement to the insurer within one year from the end of the Employer-at-Injury Program.
(b) The insurer must submit to the division within one year and 30 days from the end of the Employer-at-Injury Program:
(A) Form 2360, “Employer-at-Injury Program (EAIP) Reimbursement Request Form.” The form is published with Bulletin 260, both of which are available on the division’s website at wcd.oregon.gov; and
(B) For EAIP purchases and worksite modifications:
(i) Documentation of the transitional work that includes the start date, wage and hours, and a description of the job duties;
(ii) The corresponding medical release that the transitional work was based on;
(iii) A legible copy of proof of any purchase showing the item was ordered during the Employer-at-Injury Program period and proof of payment for the item; and
(iv) Documentation of the insurer’s approval of any worksite modifications.
(6) Corrected request forms. If the reimbursement request form is incomplete or contains an error, the division may return the form to the insurer for correction. The insurer has 60 days from the date it receives the returned reimbursement request form from the division, or one year and 30 days from the end of Employer-at-Injury Program eligibility, whichever is later, to make the corrections and return the corrected form to the division.
(7) Amended requests.
(a) Amended reimbursement requests must be submitted to the division within one year and 30 days from the end of the Employer-at-Injury Program eligibility except as otherwise permitted in this rule.
(b) An amended reimbursement request must clearly state that it is an amendment and clearly state the corrected information.
(8) Denied claims.
(a) The insurer may request reimbursement when a claim that was initially denied is subsequently accepted after the Employer-at-Injury Program eligibility ended and more than one year and 30 days have passed. In that case, the insurer must submit a completed Form 2360, “Employer-at-Injury Program (EAIP) Reimbursement Request Form,” with the documentation specified in (5)(b) of this rule to the division within 60 days of the first litigation order or stipulation and order accepting the claim. A copy of the order or stipulation must be attached to the reimbursement request form.
(b) The insurer may request reimbursement for a qualifying Employer-at-Injury Program that took place before a claim denial even if the claim is denied at the time the insurer submits the request to the division.
(9) Effect on rates, dividends, premiums, or assessments. The insurer may not use Employer-at-Injury Program costs subject to reimbursement for rate making, individual employer rating, dividend calculations, or in any manner that would affect the employer’s insurance premiums or premium assessments under ORS 656.612 (Assessments for department activities) and OAR 436-085 with the present or a future insurer. The insurer must be able to document that Employer-at-Injury Program costs do not affect the employer’s rates or dividend.
(10) Claim costs. If a preferred worker employed by an eligible employer with active premium exemption under OAR 436-110-0325 (Premium Exemption) incurs a new injury, the claim is subject to claim costs reimbursement under OAR 436-110-0330 (Claim Cost Reimbursement). If the worker subsequently begins an Employer-at-Injury Program, program costs must be separated from claim costs and will not be reimbursed as claim costs.

Source: Rule 436-105-0540 — Employer-at-Injury Program Reimbursement Procedures, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-105-0540.

Last Updated

Jun. 8, 2021

Rule 436-105-0540’s source at or​.us