Or. Admin. Code § 436-050-0120

Current through Register Vol. 63, No. 11, November 1, 2024

Section 436-050-0120 - Records Insurers Must Maintain; Removal and Disposition

(1)Records insurers must maintain. Each insurer is required to maintain the following records of Oregon workers' compensation claims, to make the records available at an Oregon claims processing location, and to provide the director access to the records upon request:

(a) Written records used and relied upon in processing each claim;

(b) A written record of all payments made as a result of any claim including documentation of:

(A) The amount of the payment;

(B) The date the payment was issued;

(C) The date the payment was mailed or delivered; and

(D) An explanation of the time period between the date the payment was issued and the date the payment was mailed or delivered, if any;

(c) Written records of the approval or denial of claims for supplemental temporary disability benefits under ORS 656.210(5);

(d) Written records that show its insured employers have complied with ORS 656.017; and

(e) Written records, or copies of records, of claims processed by prior service companies.

(2)Availability of records. An insurer must make records available by one or more of the following methods:

(a) By making the records electronically accessible from an Oregon claims processing location in real time.

(b) By keeping physical copies of the records at an Oregon claims processing location; or

(c) By archiving physical copies of the records at a location other than an Oregon claims processing location, under the following conditions:

(A) Records of a denied claim may be archived after all appellate procedures have been exhausted and the denial is final by operation of law; and

(B) Records of any claim for a compensable injury, including a denied claim that is found to be compensable, may be archived after the expiration of the aggravation rights or not less than one year following the final payment of compensation, whichever is the last to occur.

(3)Destruction of claims records. The insurer may destroy claims records when the insurer can verify that all potential for benefits to the worker or the worker's beneficiaries is gone.

(4)Proof of coverage records insurer must keep in Oregon. The records relating to proof of coverage that insurers are required to make available in Oregon include:

(a) A written record of each workers' compensation insurance policy and related endorsements, reinstatements, or cancellations issued as required under the workers' compensation law;

(b) Written records of premiums due and premiums collected by the insurer from its insured employers as a result of coverage issued under the workers' compensation law; and

(c) Written records that segregate and show specifically for each employer the amounts due from the employer and all money collected and paid by the insurer for premiums for insurance coverage, premium assessments, and any other moneys due the director or required to be paid to the director.

(5)Disposal of proof of coverage records. If all payments have been made, proof of coverage records may be disposed of after the later of:

(a) The next examination of the insurer by the Division of Financial Regulation under ORS 731.300; or

(b) January 1 of the year following three calendar years after the cancellation or nonrenewal of the workers' compensation insurance policy.

Or. Admin. Code § 436-050-0120

WCB 18-1975(Admin), f. 12-19-75, ef. 1-1-76; WCD 3-1980(Admin), f. & ef. 4-2-80; WCD 4-1982(Admin), f. 2-10-82, ef. 2-15-82; WCD 7-1983(Admin), f. 12-22-83, ef. 12-27-83; WCD 5-1985(Admin), f. 12-10-85, cert. ef. 1-1-86; Renumbered from 436-051-0215; WCD 9-1985(Admin), f. 12-12-85, ef. 1-1-86; WCD 9-1987, f. 12-18-87, ef. 1-1-88; WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90; WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01; WCD 12-2001, f. 12-7-01, cert. ef. 1-1-02; WCD 12-2003, f. 12-4-03, cert. ef. 1-1-04; WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08; WCD 4-2008, f. 9-17-08, cert. ef. 7-1-09; WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13; WCD 5-2016, f. 11-28-16, cert. ef. 1/1/2017; WCD 20-2018, amend filed 11/15/2018, effective 1/1/2019; WCD 18-2021, amend filed 12/13/2021, effective 1/1/2022

Statutory/Other Authority: ORS 731.475 & ORS 656.726(4)

Statutes/Other Implemented: ORS 731.475