Or. Admin. Code § 471-070-1250

Current through Register Vol. 63, No. 12, December 1, 2024

Section 471-070-1250 - Benefits: Claimant Designated Representative and Representation of Incapacitated Claimants

(1) A claimant may designate as a claimant designated representative an individual, 18 years of age or older, who is authorized by the claimant to represent the claimant by exchanging information with the Paid Family and Medical Leave Insurance (PFMLI) program on behalf of the claimant as specified in section (2) of this rule.

(2) A claimant designated representative, or an individual otherwise approved by the department to represent a claimant, is authorized to do the following:

(a) Receive information submitted to the PFMLI program by the claimant;

(b) Receive information about PFMLI benefits that the claimant has received or will receive;

(c) Receive information about pending or issued decisions made on the claimant's PFMLI claim;

(d) Provide information to the PFMLI program on behalf of the claimant, including information required to complete a PFMLI claim for benefits; and

(e) File a PFMLI claim for benefits on behalf of the claimant.

(3) Except as otherwise specified in this rule, to designate a representative, the claimant must complete and submit the department's Designated Representative Form, electronically or by mail. In order for the representative to be approved by the department to exchange information, the form must be complete. At a minimum, it must include the following:

(a) Claimant information:

(A) First and last name;

(B) Social Security Number or Individual Taxpayer Identification Number;

(C) Date of birth; and

(D) Contact information, including mailing address and telephone number;

(b) Claimant designated representative information:

(A) First and last name;

(B) Relationship to claimant; and

(C) Contact information, including mailing address, and telephone number;

(c) Authorization beginning and end dates;

(d) A dated attestation with a handwritten signature by the claimant declaring that the claimant understands the purpose of the authorization, that the claimant has not been pressured to sign the authorization, and that the designation can be revoked at any time; and

(e) A dated attestation with a handwritten signature by the claimant designated representative declaring that they are acting in the best interest of the claimant.

(4) The claimant may revoke the authorization at any time by providing written notification to the department.

(5) The authorization will automatically end on the last day of the claimant's current benefit year. If no application for benefits is submitted, authorization will end 30 days after the department has issued an approval of the designation. If a claimant's application for benefits is submitted more than 30 calendar days after the designation has been approved, the claimant must submit a new form to designate a representative.

(6) The claimant designated representative must maintain the confidentiality of any information they receive from the department on behalf of the claimant. The department is not responsible for any disclosure of the claimant's information by the claimant designated representative.

(7) If a claimant is incapacitated due to a serious health condition as defined in OAR 471-070-1000 and is physically or mentally unable to designate a representative by filling out the department's Designated Representative Form, an individual who has a family relationship to the claimant as defined in ORS 657B.010 may request to represent the claimant as described in section (8) of this rule to exchange information with the PFMLI program on behalf of the claimant as specified in section (2) of this rule. For the purposes of this rule, 'incapacitated' has the meaning given that term in ORS 125.005.

(8) To request representation of a claimant who is incapacitated due to a serious health condition as provided in section (7) of this rule, the requesting individual must submit:

(a) The completed Designated Representative Form referenced in section (3) of this rule. At a minimum, the form must include:

(A) The information listed in section (3)(a) and (b) of this rule;

(B) An authorization beginning date;

(C) A dated certification with a handwritten signature from a health care provider as defined in OAR 471-070-1000 attesting, within the scope of their license, that the claimant is incapacitated and unable to complete the requirements for filing or providing information on a PFMLI claim and unable to independently designate a representative; and

(D) A dated attestation with a handwritten signature from the individual requesting to represent the incapacitated claimant, declaring that they will:

(i) Act in the best interest of the claimant;

(ii) Maintain claimant confidentiality, as outlined in section (6) of this rule; and

(iii) Inform the department within three calendar days of learning that the claimant is no longer incapacitated;

(b) One or more of the following documents that show the individual's family relationship to the claimant:

(A) Certified Declaration of Domestic Partnership;

(B) Legal marriage certificate;

(C) Legal birth certificate; or

(D) At the discretion of the department, other documents issued by an independent and verifiable third party that establish marriage, domestic partnership, parenthood, or other family relationship between the individual and claimant; and

(c) Documentation approved by the department for this purpose that is sufficient to establish the identity of the claimant and the individual requesting approval to represent the claimant.

(9) The authorization referenced in section (7) of this rule will automatically end on the date the department is informed that the claimant is no longer incapacitated, or on the last day of the claimant's current benefit year, whichever is earliest. The claimant may choose to continue the authorization by independently designating the representative as described in section (3) of this rule. If no application for benefits is submitted for the claimant, authorization will end 30 calendar days after the date the department has approved the individual to represent the incapacitated claimant.

(10) In addition to individuals referenced in sections (1) and (7) of this rule, the following individuals are authorized to provide information to and receive information from the PFMLI program as specified in section (2) of this rule:

(a) An individual who was court-appointed as a claimant's legal guardian or conservator with the authority to make decisions on the claimant's behalf, if the authorized individual provides a copy of the guardianship or conservatorship documentation to the department; or

(b) An individual with granted power of attorney by the claimant to act as the claimant's 'agent' or 'attorney-in-fact' with respect to the claimant's PFMLI benefits or contributions, if the authorized individual provides documentation to the department.

(11) The documentation referenced in section (10) of this rule, at a minimum, must:

(a) Show that the individual has specific authority to act on behalf of the claimant for PFMLI purposes;

(b) Provide dates that establish the period the individual has the authority to act on behalf of the claimant; and

(c) Include the name of the claimant and the name of the claimant's legal guardian or conservator or the individual with granted power of attorney.

(12) Individuals listed in section (10) of this rule must also provide documentation approved by the department for this purpose that is sufficient to establish the identity of the claimant and the identity of the court-appointed legal guardian or conservator or the individual with granted power of attorney.

(13) If the claimant designated representative, the representative of an incapacitated claimant, the claimant's court-appointed legal guardian or conservator, or the individual with granted power of attorney by the claimant do not provide information required in this rule or provide inaccurate information to the department, the claimant is responsible for any resulting delay, denial, overpayment, or disqualification of PFMLI benefits.

Or. Admin. Code § 471-070-1250

ED 6-2023, temporary adopt filed 08/09/2023, effective 8/9/2023 through 2/4/2024; ED 1-2024, adopt filed 01/04/2024, effective 1/12/2024; ED 2-2024, temporary amend filed 03/13/2024, effective 3/15/2024 through 9/10/2024; ED 5-2024, amend filed 07/30/2024, effective 8/1/2024

Publications: Contact the Oregon Employment Department for information about how to obtain a copy of the publication referred to or incorporated by reference in this rule.

Statutory/Other Authority: ORS 125.025, ORS 127.002 to 127.045 & ORS 657B.400

Statutes/Other Implemented: ORS 657B.400