OAR 436-120-0175: Redetermining Eligibility for Vocational Assistance

(1) If the worker was previously determined ineligible for vocational assistance or the worker’s eligibility for vocational assistance ended, the insurer must redetermine eligibility within 30 days of notification of a change of any of these circumstances: (a) The worker, for reasonable cause, was unavailable for vocational assistance and is now available; (b) The worker’s lack of suitable employment could not be resolved by providing vocational assistance. The insurer may require the worker to provide evidence that circumstances have changed; (c) The worker declined vocational assistance to accept modified or new employment that resulted from an employer at injury activated use of preferred worker benefits under OAR 436-110. If the job was not suitable, the worker must request redetermination within 30 days of termination of the employment for which preferred worker benefits were provided; (d) The worker was not available for vocational assistance in Oregon or within commuting distance of Oregon. The worker must request redetermination within six months of receiving the insurer’s notice that the worker was not eligible for this reason; (e) Before claim closure, the worker’s limitations due to the injury became more restrictive; (f) Before claim closure, the insurer accepts a new condition that was not considered in the original determination of the worker’s eligibility; or (g) The worker’s average weekly wage is redetermined and increased. (2) The insurer must redetermine eligibility when the insurer determined the worker ineligible or ended eligibility solely on the basis that the worker was not authorized to work in the United States: (a) Within 30 days of July 1, 2024, if the worker received the insurer’s notice of ineligibility or end of eligibility on or after Dec. 30, 2023; or (b) Within 30 days of receipt of the worker’s second request for redetermination if the worker: (A) Received the insurer’s notice of ineligibility or end of eligibility before Dec. 30, 2023; (B) Requested redetermination within six months of the date they received the insurer’s notice of ineligibility or end of eligibility; (C) Submitted evidence to the insurer within six months of the date the worker received the insurer’s notice of ineligibility or end of eligibility that the worker had applied for authorization to work in the United States and was awaiting a decision by the U.S. Citizenship and Immigration Services (USCIS); and (D) Submitted a second request for redetermination on or after July 1, 2024. (3) A worker who requests redetermination under (2)(b) of this rule is not required to be authorized to work in the United States. However, the worker may not request redetermination after the 30th day from receipt of any decision by USCIS.