OAR 436-120-0755: Reimbursement from the Workers’ Benefit Fund

(1) Reimbursement. The director will reimburse the insurer for costs associated with providing vocational benefits when: (a) The director issues an order overturning the insurer’s denial of vocational benefits; and (b) The insurer’s denial is later upheld by a final order. (2) Required documentation. To receive reimbursement from the Workers’ Benefit Fund, the insurer must provide the division with the following documentation, within one year from the date of the final order: (a) Worker’s name and Workers’ Compensation Division’s claim file number; (b) Date and order number of the director’s order appealed; (c) Itemized listing with dates of service for all costs incurred after the date of the director’s order that was reversed. All costs, in order to be reimbursed, must meet all conditions set forth in these rules, and reimbursement requests must: (A) Use terms, “direct employment” or “training” to show the category of vocational assistance provided; (B) List provider costs by category of “professional services”; (C) List direct worker purchases by the categories in OAR 436-120-0710, and include purchase dates and costs; (D) Show temporary total disability paid between the start and end dates of the return to work plan; and (E) List any other costs incurred in providing vocational benefits as a result of the order that was appealed. (d) Signed statement certifying that the requested reimbursement amount was actually paid; and (e) The insurer’s name and address where reimbursement is to be sent. (3) Administrative costs not reimbursable. No reimbursement is allowed for the insurer’s administrative costs.