OAR 436-120-0755
Reimbursement from the Workers’ Benefit Fund

(1)

Reimbursement. The director will reimburse the insurer for costs associated with providing vocational benefits when:

(a)

The director issues an order overturning the insurer’s denial of vocational benefits; and

(b)

The insurer’s denial is later upheld by a final order.

(2)

Required documentation. To receive reimbursement from the Workers’ Benefit Fund, the insurer must provide the division with the following documentation, within one year from the date of the final order:

(a)

Worker’s name and Workers’ Compensation Division’s claim file number;

(b)

Date and order number of the director’s order appealed;

(c)

Itemized listing with dates of service for all costs incurred after the date of the director’s order that was reversed. All costs, in order to be reimbursed, must meet all conditions set forth in these rules, and reimbursement requests must:

(A)

Use terms, “direct employment” or “training” to show the category of vocational assistance provided;

(B)

List provider costs by category of “professional services”;

(C)

List direct worker purchases by the categories in OAR 436-120-0710 (Direct Worker Purchases: Categories), and include purchase dates and costs;

(D)

Show temporary total disability paid between the start and end dates of the return to work plan; and

(E)

List any other costs incurred in providing vocational benefits as a result of the order that was appealed.

(d)

Signed statement certifying that the requested reimbursement amount was actually paid; and

(e)

The insurer’s name and address where reimbursement is to be sent.

(3)

Administrative costs not reimbursable. No reimbursement is allowed for the insurer’s administrative costs.

Source: Rule 436-120-0755 — Reimbursement from the Workers’ Benefit Fund, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-120-0755.

436–120–0003
General Provisions 436–120–0005
Definitions 436–120–0008
Administrative Review and Hearings 436–120–0012
General Requirements For Notices and Warnings 436–120–0115
Vocational Eligibility Evaluation 436–120–0117
Deferral of Eligibility Evaluation 436–120–0145
Vocational Assistance Eligibility 436–120–0147
Establishing the Adjusted Weekly Wage 436–120–0157
Determining Substantial Handicap to Employment 436–120–0165
End of Eligibility for Vocational Assistance 436–120–0175
Redetermining Eligibility for Vocational Assistance 436–120–0177
Selection of Category of Vocational Assistance 436–120–0185
Choosing a Counselor 436–120–0187
Optional Services 436–120–0197
Direct Employment 436–120–0410
Determining a Vocational Goal 436–120–0443
Training — General 436–120–0445
Training Requirements 436–120–0500
Training: Development and Implementation 436–120–0510
Training Plan Support 436–120–0520
Responsibilities of the Worker and the Counselor 436–120–0523
Re-evaluating a Training Plan 436–120–0527
Ending a Training Plan 436–120–0530
Director Review of Return-to-Work Plan 436–120–0700
Direct Worker Purchases 436–120–0710
Direct Worker Purchases: Categories 436–120–0720
Fee Schedule 436–120–0755
Reimbursement from the Workers’ Benefit Fund 436–120–0800
Registration of Providers 436–120–0810
Certification and Classification of Provider Staff 436–120–0820
Renewal of Certification 436–120–0840
Professional Standards for Providers and Counselors 436–120–0900
Audits, Penalties and Sanctions 436–120–0915
Sanctions of Providers and Counselors
Last Updated

Jun. 8, 2021

Rule 436-120-0755’s source at or​.us