The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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DEPARTMENT OF CONSUMER AND BUSINESS SERVICES,

WORKERS' COMPENSATION DIVISION










 

DIVISION 100

WORKERS’ COMPENSATION BENEFITS OFFSET
436-100-0001
Authority for Rules
These rules are promulgated under the Director’s author?ity contained in ORS 656.726 and 656.727.
Stat. Auth.: ORS 656

Stats. Implemented: ORS 656.209, 656.726 & ORS 656.727

Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983 (Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0001, 5-1-85
436-100-0002
Purpose of Rules
The purpose of these rules is to establish
requirements and procedures for offsetting permanent total disability benefits against
social security disability benefits.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983 (Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered to 436-057-0004, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16
436-100-0003
Applicability of Rules
(1) These rules are effective January
1, 2016, to carry out the provisions of ORS 656.209 and 656.727.
(2) These rules apply to:
(a) Those workers receiving
awards for permanent total disability and eligible for and receiving federal social
security disability benefits; and
(b) Injured workers whose
period of disability under the Social Security Administration began on or after
June 1, 1965.
(3) The director may waive
procedural rules as justice requires, unless otherwise obligated by statute.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0003, 5-1-85; WCD 15-1997, f. 12-4-97,
cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16
436-100-0005
Definitions
(1) “Authorization” means
an order issued by the Workers’ Compensation Division directing the paying
agent to offset the worker’s permanent total disability benefits by the amount
specified in the order.
(2) “Beneficiary”
means an injured worker, and the spouse, child or dependent of a worker, who is
entitled to receive payments under ORS 656.001 through 656.794.
(3) “Department”
means the Department of Consumer and Business Services.
(4) “Director”
means the director of the Department of Consumer and Business Services or the director’s
designee.
(5) “Division”
means the Workers’ Compensation Division.
(6) “Federal Disability
Benefit Limitation” means the amount determined under 42 USC 224(a) and Social
Security Administration rules.
(7) “Offset”
means a reduction of permanent total disability benefits based on the amount of
federal social security disability benefits received by a worker.
(8) “Paying agency”
or “paying agent” means the self-insured employer or insurer paying
benefits to the worker or beneficiaries.
(9) “Performance Section”
means the Performance Section of the Workers’ Compensation Division.
(10) “Permanent total
disability benefits” means compensation to an injured worker awarded permanent
total disability compensation under ORS 656.206.
(11) “Worker”
means any worker receiving permanent total disability benefits.
Stat. Auth.: ORS 656.726
Stats. Implemented: ORS 656.209
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin). f.
& ef. 2-22-84; Renumbered from 436-057-0005, 5-1-85; WCD 15-1997, f. 12-4-97,
cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16
436-100-0006
Administration of Rules
In administration of these rules, orders
of the Workers’ Compensation Division are deemed orders of the director.
Stat. Auth.: ORS 656.726
Stats. Implemented: ORS 656.209
& 656.726
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0007, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16
436-100-0008
Administrative Review
(1) Any worker aggrieved by any offset
authorization of the division may apply to the Workers’ Compensation Division
for a reconsideration of that authorization before requesting a hearing.
(2) Any party aggrieved may
request a hearing under ORS 656.283.
Stat. Auth.: ORS 656.726 & 656.727
Stats. Implemented: ORS 656.209
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0998, 5-1-85; WCD 15-1997, f. 12-4-97,
cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16
436-100-0010
Criteria for Eligibility
(1) Permanent total disability benefits
must be offset by the workers’ social security disability benefits. However,
the total combined benefit, permanent total disability benefits plus social security
disability benefits, must not be offset to an amount less than the greater of:
(a) The amount the worker
would have received under ORS chapter 656; or
(b) The Federal Disability
Benefit Limitation.
(2) Permanent total disability
benefits must not be paid by the paying agent in an amount greater than authorized
by ORS Chapter 656.
(3) Offset of permanent total
disability benefits must be made by a paying agent only in an amount and as authorized
by the director.
(4) Offset of permanent total
disability benefits will be authorized by the director only upon actual receipt
of federal social security disability benefits by the injured worker.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0100, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16
436-100-0020
Requirements of Workers
(1) Workers entitled to receive permanent
total disability benefits must make application for federal social security disability
benefits.
(2) Workers and eligible
beneficiaries must, upon department request, execute a release form authorizing
the Social Security Administration to make disclosure to the department of such
information regarding the injured workers as will enable the department to carry
out the provisions of ORS 656.209 and these rules.
(3) Whenever there is a change
in the federal social security beneficiary eligibility, the worker must notify the
Performance Section.
(4) Upon request of the department,
the worker may be required at any time to furnish additional information regarding
social security disability benefits.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
& 656.727
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0115, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16
436-100-0030
Authorization of Offset; Effective
Date
(1) Authorization issued by the department
will be directed to the paying agent with a copy to the injured worker.
(2) A paying agent making
payment of permanent total disability benefits will be entitled to social security
disability offset only as authorized by the department.
(3) The department will review
the social security offset calculation when notified of a change in the status of
a worker subject to social security offset. An amended authorization will be issued,
if necessary.
(4) Whenever there is a change
in eligibility status of the worker or any one of the worker’s beneficiaries
receiving benefits for permanent total disability subject to offset, the paying
agent must notify the Performance Section.
(5) The paying agent must,
immediately upon the death of a worker, terminate payment of previously authorized
permanent total disability benefits offset and begin payment of other compensation
due under ORS Chapter 656, if any.
(6) The effective date of
offset must be the effective date established in the authorization.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
& 656.727
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0130, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16
436-100-0040
Sanctions Against Worker for Failure
to Cooperate with the Department
(1) Any worker entitled to receive permanent
total disability benefits who fails to comply with these rules will be subject to
suspension of benefits until the worker has complied.
(2) If a worker fails to
comply with these rules, the director will make a written demand upon the worker
by personal service or registered mail. If the worker fails to comply within 20
days of receipt of the demand, the director may authorize suspension of benefits
until the worker complies.
(3) An order of suspension
of benefits will continue in force from the date issued until the date the worker
actually complies with these rules.
(4) No compensation will
become due or be payable during a period of suspension of benefits.
Stat. Auth.: ORS 656.209 & 656.727
Stats. Implemented: ORS 656.209
& 656.727
Hist.: WCB 7-1978, f. 6-5-78,
ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f.
& ef. 2-22-84; Renumbered from 436-057-0150, 5-1-85; WCD 7-2015, f. 10-12-15,
cert. ef. 1-1-16

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