OAR 436-120-0710: Direct Worker Purchases: Categories

The insurer must provide the direct worker purchases listed in this rule if necessary for the worker to participate in vocational assistance or to meet the requirements of a suitable job. The insurer may not require the worker to submit a financial statement in order to qualify for direct worker purchases. (1) Tuition, fees, books, and supplies. Payment for tuition, fees, books, and supplies for training or studies is limited to those items identified as mandatory by the instructional facility, trainer, or employer. The insurer must pay the cost in full, and may not require the worker to apply for grants to pay for tuition, books, or other expenses associated with training. (2) Wage reimbursement. The amount of wage reimbursement for on-the-job training must be agreed to in a contract between the training employer and the insurer. (3) Travel expenses. Travel expenses for transportation, meals, and lodging that are required for participation in vocational assistance, including but not limited to job search, required meetings with the counselor, and meetings with employers or at training sites as required by the plan or plan development. The conditions and rates for payment of travel expenses are as follows: (a) Transportation costs will be paid at public transportation rates when public transportation is available; otherwise, mileage will be paid at the rate published in Bulletin 112. Costs incidental to mileage, such as parking fees, also will be paid. For workers receiving temporary total disability or equivalent income, private car mileage will be paid only for mileage in excess of the miles the worker traveled to and from work at the time of injury. Mileage payment in conjunction with moving expenses will be allowed only for one vehicle and for a single one-way trip. To receive reimbursement for private car mileage, the worker must provide the insurer with a copy of the driver's valid driver's license and proof of insurance coverage. (b) For overnight travel, meal and lodging expenses will be reimbursed at the rate published in Bulletin 112. (c) Payment for special travel costs will be made in excess of the amounts specified in this section when special transportation or lodging is necessary because of the physical needs of the worker, or when the insurer finds prevailing costs in the travel area are substantially higher than average. (4) Tools and equipment. Payment for tools and equipment for training or employment is limited to items identified as mandatory for the training or initial employment, such as starter sets. Purchases may not include what the trainer or employer ordinarily would provide to all employees or trainees in the training or employment, or what the worker already owns. (5) Moving expenses. Payment for moving expenses is limited to workers with employment or training outside reasonable commuting distance. In determining the necessity of paying moving expenses, the insurer may consider the availability of employment or training that does not require moving, or that requires less than the proposed moving distance. Payment is limited to moving household goods weighing not more than 10,000 pounds. If necessary, payment includes reasonable costs of meals and lodging for the worker’s family and mileage under section (3) of this rule. (6) Second residence allowance. The purpose of the second residence allowance is to enable the worker to participate in training outside reasonable commuting distance. The allowance must equal the rental expense reasonably necessary, plus not more than $500 a month toward all other expenses of the second residence, excluding refundable deposits. In order to qualify for second residence allowance, the worker must maintain a permanent residence. (7) Primary residence allowance. The primary residence allowance applies when the worker must change residence for training or employment. Payment includes the first month’s rent and the last month’s rent only if required before moving in. (8) Medical and psychological examinations. Payment for medical examinations and psychological examinations must be for conditions not related to the compensable injury when necessary for determining the worker’s ability to participate in vocational assistance. (9) Physical or work capacities evaluations. (10) Living expense allowance. Payment for living expenses is limited to workers involved in an on-the-job vocational evaluation at least 20 hours in a period of seven consecutive days, and not receiving temporary disability payments. The amount of the allowance is equivalent to the amount that would be paid for temporary total disability for the duration of the evaluation if the worker’s claim were reopened. (11) Work adjustment, on-the-job evaluation, or situational assessment costs. (12) Membership fees and occupational certifications, licenses, and related testing costs. Payment for membership fees, occupational certifications and licenses, and related testing costs is limited to $500. (13) Clothing. Clothing purchases may not include items the trainer or employer would provide or the worker already possesses. (14) Child or disabled adult care services. Child or disabled adult care services are payable when required to enable the worker to participate in vocational assistance at rates prescribed by the Oregon Department of Human Services. For workers receiving temporary total disability compensation or equivalent income, these costs will be paid only when in excess of what the worker paid for such services at the time of injury, adjusted using the cost-of-living matrix in Bulletin 124. (15) Dental work, eyeglasses, hearing aids, and prosthetic devices. Payment for dental work, eyeglasses, hearing aids, and prosthetic devices is required even if not related to the compensable injury if they will enable the worker to obtain suitable employment or participate in training. (16) Union dues and fees. Payment for labor union dues and fees is limited to initiation fees, or back dues and one month’s current dues. (17) Vehicle rental or lease. Payment for vehicle rental or lease is required when there is no reasonable alternative enabling the worker to participate in vocational assistance or accept an available job. The worker must provide the insurer with proof of a valid driver’s license and insurance coverage. Payment is limited to $3,300. (18) Other purchases. Payment for other purchases the insurer considers necessary for the worker’s participation in vocational assistance is limited to $2,600.