Or. Admin. Code § 436-120-0012

Current through Register Vol. 63, No. 10, October 1, 2024

Section 436-120-0012 - General Requirements For Notices and Warnings

(1)Insurer or provider may issue. The insurer is responsible for mailing all notices and warnings required by these rules but may delegate that responsibility to the provider that is providing vocational assistance to the worker.

(2)Required content. All notices and warnings to the worker issued under these rules must:

(a) Use the applicable heading. If a notice is used for more than one purpose, it must include all the headings that apply;

(b) Be in writing, signed, and dated;

(c) State the basis for the decision;

(d) Include the effective date of each action in the heading;

(e) Cite the relevant rules;

(f) Include the telephone number of the Ombuds Office for Oregon Workers: 800-927-1271; and

(g) Include the worker's appeal rights. All notices and warnings except those notifying a worker of entitlement to training or deferral of vocational assistance eligibility must contain the worker's appeal rights:

(A) In bold text, as follows:

"If you disagree with this decision, you should contact [insert the person's name and the insurer name] within five days of receiving this letter to discuss your concerns. If you are still dissatisfied, you must contact the Workers' Compensation Division within 60 days of receiving this letter or you will lose your right to appeal this decision. A consultant with the division can talk with you about the disagreement and, if necessary, will review your appeal. The address and telephone number of the division are: Employment Services Team, Workers' Compensation Division, P.O. Box 14480, Salem, Oregon 97309-0405; 1-800-452-0288."; and

(B) Effective no later than Oct. 1, 2024, the text in (g)(A) of this section must be replaced with the following language in bold and formatted as follows:

If you disagree with this decision, you should contact [Claims examiner's name and the insurer name] within five days of receiving this letter to discuss your concerns.

If you are still dissatisfied:

- Contact the Workers' Compensation Division within 60 days of receiving this letter. After 60 days you will lose your right to appeal this decision.

- A consultant with the division can talk with you about the disagreement and review your appeal, if necessary.

- To contact the division:

Workers' Compensation Division

Employment Services Team

350 Winter Street NE

PO Box 14480

Salem OR 97309-0405

800-452-0288 (toll-free)

(3)Mailing and copies. All notices and warnings must:

(a) Be mailed to the worker's last known address by both regular and certified mail; and

(b) Be copied to the division and worker's attorney, if any, at the same time the notice or warning is mailed to the worker.

(4)Effective date. A notice is not effective until it is sent to all required parties including the worker's attorney.

(5)Requirements for warning letters.

(a) A warning letter can be issued at any time during the vocational eligibility evaluation or vocational assistance process.

(b) Warning letters do not require specific language in the headings but must include a heading clearly indicating the purpose of the warning.

(c) A warning letter must state what the worker must do, and by when, to avoid ineligibility or the ending of eligibility or training.

Or. Admin. Code § 436-120-0012

WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00, Renumbered from 436-120-0600, 436-120-0610 & 436-120-0620; WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88; WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95; WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96; WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02; WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04; WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05; WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07; WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10; Renumbered from 436-120-0004; WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10; WCD 5-2012, f. 10-3-12, cert. ef. 11-1-12; WCD 4-2016, f. 11-28-16, cert. ef. 1/1/2017; WCD 5-2020, minor correction filed 3/11/2020, effective 3/11/2020; WCD 14-2022, amend filed 12/20/2022, effective 1/1/2024; WCD 15-2024, amend filed 06/07/2024, effective 7/1/2024

Statutory/Other Authority: ORS 656.340(9) & ORS 656.726(4)

Statutes/Other Implemented: ORS 656.340