Or. Admin. Code § 436-075-0070

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

Section 436-075-0070 - Reimbursement

(1) Reimbursement from the Retroactive Program will be authorized by the Workers' Compensation Division on a quarterly basis.

(2) Requests for reimbursement must be mailed or delivered to the Workers' Compensation Division within 30 days after the end of each calendar quarter to be processed in that quarterly disbursement.

(3) Requests for reimbursement mailed or delivered to the Workers' Compensation Division more than 30 days after the end of the quarter will be processed with the next quarterly disbursement.

(4) A separate request for reimbursement must be submitted for each insurer and include a signed certification that the payments reported on the request have been made in the amounts reported.

(5) The insurer must use Form 3285, "Request for Reimbursement from the Retroactive Program," or an equivalent form, to request reimbursement from the Retroactive Program.

(a) If an equivalent form is used, it must include all of the data elements on Form 3285; and

(b) Each request must accurately reflect the marital and dependency status in effect and eligible for reimbursement in the period requested.

(6) The director will not process any request that does not meet the requirements of section (4) and (5) of this rule.

(7) The department will recover any overpayment made to an insurer as a result of an insurer reporting error or incorrect information submitted on a quarterly request form.

(8) If a denied claim is found to be compensable by an administrative law judge, the Workers' Compensation Board, or the Court of Appeals, and that decision is subsequently reversed by a higher level of appeal, the insurer will receive reimbursement for Retroactive Program benefit payments required to be made while the claim was in an accepted status.

Or. Admin. Code § 436-075-0070

WCD 4-1989, f. 12-22-89, cert. ef. 1-1-90; WCD 14-1997, f. 12-4-97, cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1/1/2016; WCD 6-2017, amend filed 12/14/2017, effective 1/1/2018

Statutory/Other Authority: ORS 656.506 & ORS 656.726(4)

Statutes/Other Implemented: ORS 656.506