OAR 137-076-0037: Payment of Catastrophic Injury Claims

(1) For the purpose of ORS 147.035(10), a victim has suffered a catastrophic injury if the victim is eligible for an award of compensation under 147.005 to 147.367 and has sustained a severe and debilitating long term or lifelong personal injury as a direct result of the compensable crime. (2) In order to be eligible for catastrophic injury compensation the victim also must satisfy the following criteria: (a) The victim has suffered significant and sustained reduction of the victim's previous functioning of physical abilities, and that reduction significantly alters the victim's ability to interact with others or carry on the normal functions of life; (b) There has been a material reduction in the victim's ability to work; and (c) There has been a physical or neuro-physical impairment such that no fundamental or marked improvement in the victim's crime-related condition reasonably can be expected. (3) In determining whether the victim has suffered a catastrophic injury, the Department may also consider the following factors: (a) The severity and debilitating nature of the personal injury. Severe and debilitating personal injury includes, but is not limited to, conditions such as quadriplegia, paraplegia, loss of sight in both eyes, loss of hearing in both ears, or amputation of a major portion of any extremity; and (b) Whether the injury is permanent or long term. (4) If the Department determines the victim's injuries to be catastrophic in nature and that determination does not change upon reevaluation pursuant to OAR 137-076-0037(5) or 137-076-0037(6), then compensation payments under this rule will continue until payments reach the full amount of compensation awarded by the Department or the victim requests closure of the claim. (5) The burden of proof is on the applicant to establish eligibility as a catastrophically injured crime victim for the award of compensation and the continuation of compensation payments under this rule. Speculation and conjecture as to the following are not sufficient to meet the burden of proof: (a) A potential increase in disability; (b) Loss of earnings; (c) Cumulative injuries that are minor in nature; and (d) Statements of the victim without substantiation of the catastrophic nature of the injury by an objective medical examination and report from a licensed medical practitioner. (6) Once compensation has been granted pursuant to this rule, the Department may at any time, at its discretion, request information from the victim relevant to the victim’s continuing eligibility. (7) If the victim ceases to meet the criteria for catastrophic injury, the victim shall immediately notify the Department.