OAR 436-080-0070: Reimbursement of Assigned Claims Agent for Claims Costs for Injured Workers of Noncomplying Employers

(1) Reimbursement of incurred claims costs. The director will reimburse the assigned claims agent for all claims costs the assigned claims agent incurs under ORS 656.054, under the terms of the contract between the assigned claims agent and the director. To request reimbursement, the assigned claims agent must report all claims costs to the director, subject to the following: (a) Claims costs for which reimbursement will be allowed include, but are not limited to: (A) All compensation provided to a subject worker or beneficiary; (B) Attorney fees and sums assessed under ORS 656.382(3), but not fees and sums paid under ORS 656.262(11) and 656.382(1); and (C) A reasonable amount for administrative costs at a rate proposed by the assigned claims agent and approved by the director. The assigned claims agent must propose the rate before June 30 of each year. Late proposals for a rate increase, if approved, will be effective on the date the request was received by the director; (b) If the assigned claims agent is the paying agency in any action to recover damages from a noncomplying employer or third party under ORS 656.576 to 656.595, the assigned claims agent must report to the director: (A) The commencement and termination of each action; (B) The status of all pending actions at the end of each calendar year; and (C) The amount of the recovery retained by the assigned claims agent under ORS 656.593(1)(c), within 30 days after an action is settled or damages are recovered; and (c) The amount reported under paragraph (1)(b)(C) will be offset against the amount of incurred costs reported under subsection (a). (2) Approval or denial of request. The director will review the request and will approve or disapprove the reimbursement from the Workers’ Benefit Fund under the terms of the contract between the assigned claims agent and the director. (3) Audit of reimbursed amounts. The director will annually audit the noncomplying employer claim files processed by the assigned claims agent to validate the amount reimbursed under section (2) of this rule. The director will disapprove reimbursement if any of the conditions described under ORS 656.054(3) are found to apply upon audit. (4) Review of disapproval. The assigned claims agent may request review of any disapproval of reimbursement made by the director under ORS 656.704(2) and OAR 436-001. (5) Collection of reimbursed costs. The director will collect all costs reimbursed from the Workers’ Benefit Fund under this rule from the responsible noncomplying employer. The director will inform each noncomplying employer of its liability and advise the employer of costs incurred by the assigned claims agent.