OAR 436-030-0125: Reconsideration Form and Format

A request for reconsideration may be in the form and format the director provides in Bulletin 227. A reconsideration request should include at least the following: (1) Worker’s name; (2) Date of injury; (3) Date of the closure being appealed; (4) Any specific issues regarding the Notice of Closure; (5) The name of the worker’s attorney, if any; (6) The name of the insurer’s attorney, if any; (7) If the request is made by a beneficiary of the worker or the worker’s estate, the identity and name of the requester, the name of the requester’s attorney, if any, and contact information; (8) Any special language needs; (9) Whether there is disagreement with the specific impairment findings used to determine permanent disability at the time of claim closure; (10) Any information and documentation deemed necessary to correct or clarify any part of the claim record believed to be erroneous; and (11) Any medical evidence that should have been but was not submitted at the time of the claim closure including clarification or correction of the medical record based on the examination(s) at, before, or pertaining to claim closure.