OAR 438-012-0001
Definitions
(1)
“Own Motion Board” and “Board” mean the Workers’ Compensation Board acting under its authority pursuant to ORS 656.278 (Board has continuing authority to alter earlier action on claim) and these rules.(2)
“Own Motion Claim” means:(a)
A written request, including such a request related to an injury occurring before January 1, 1966, by or on behalf of a claimant for temporary disability compensation or claim reopening regarding a worsened condition that has been determined to be compensable and that was initiated after the rights under ORS 656.273 (Aggravation for worsened conditions) expired (i.e., a “post-aggravation rights” “worsened condition” claim);(b)
A new medical condition or an omitted medical condition, including such a condition related to an injury occurring before January 1, 1966, that is related to an initially accepted claim that has been determined to be compensable and that was initiated after the rights under ORS 656.273 (Aggravation for worsened conditions) expired (i.e., a “post-aggravation rights” new medical condition or omitted medical condition claim); or(c)
A written request by or on behalf of a claimant for medical benefits for a compensable injury that occurred before January 1, 1966, unless the injury occurred from August 5, 1959 through December 31, 1965 and resulted in an award of permanent total disability.(3)
For a “post-aggravation rights” “worsened condition” claim, “determined to be compensable” means:(a)
The insurer does not dispute compensability of or responsibility for the claim or condition; i.e., the insurer has not issued a denial within the time period prescribed under ORS 656.262 (Processing of claims and payment of compensation) or 656.308 (Responsibility for payment of claims)(2); or(b)
An order from an Administrative Law Judge, the Board, or the court has found the claim or condition compensable and the responsibility of the insurer.(4)
For a “post-aggravation rights” new medical condition or omitted medical condition claim, “determined to be compensable” means:(a)
The insurer has issued a notice of acceptance under ORS 656.262 (Processing of claims and payment of compensation)(7)(a); or(b)
The insurer’s denial under ORS 656.262 (Processing of claims and payment of compensation)(7) or 656.308 (Responsibility for payment of claims)(2) or de facto denial has been set aside by an order from an Administrative Law Judge, the Board, or the court.(5)
“Own Motion Insurer,” “Insurer” and “Paying Agent” mean a guaranty contract insurer or self-insured employer that is or may be responsible for payment of compensation under the provisions of ORS 656.278 (Board has continuing authority to alter earlier action on claim).(6)
“Own Motion Order” means an order of the Own Motion Board.
Source:
Rule 438-012-0001 — Definitions, https://secure.sos.state.or.us/oard/view.action?ruleNumber=438-012-0001.