OAR 471-070-1250: Benefits: Claimant Designated Representative

(1) A claimant may designate as a claimant designated representative an individual, 18 years of age or older, who is authorized by the claimant to represent the claimant by exchanging information with the Paid Leave Oregon program on behalf of the claimant as specified in section (2) of this rule. The Paid Leave Oregon program will recognize only one individual representative for a claimant at a given time. (2) A claimant designated representative, or an individual specified in section (7) of this rule, is authorized to do the following: (a) Receive information submitted to the Paid Leave Oregon program by the claimant; (b) Receive information about Paid Leave Oregon benefits that the claimant has received or will receive; (c) Receive information about pending or issued decisions made on the claimant’s Paid Leave Oregon claim; (d) Provide information to the Paid Leave Oregon program on behalf of the claimant, including information required to complete a Paid Leave Oregon claim for benefits; (e) File a Paid Leave Oregon claim for benefits on behalf of the claimant; and (f) Request a hearing to obtain review of a final decision of the director regarding any of the matters listed in ORS 657B.410(1)(b) and appear in a hearing conducted before the Office of Administrative Hearings on behalf of the claimant, as described in OAR 471-070-8050. (3) Except for individuals specified in section (7) of this rule, to designate a representative, the claimant must complete and submit the department’s Designated Representative Form, electronically or by mail. In order for the representative to be approved by the department to exchange information, the form must be complete. At a minimum, it must include the following: (a) Claimant information: (A) First and last name; (B) Social Security Number or Individual Taxpayer Identification Number; (C) Date of birth; and (D) Contact information, including mailing address and telephone number; (b) Claimant designated representative information: (A) First and last name; (B) Relationship to claimant; and (C) Contact information, including mailing address, and telephone number; (c) Authorization beginning and end dates; (d) A dated attestation with a handwritten signature by the claimant declaring that the claimant understands the purpose of the authorization, that the claimant has not been pressured to sign the authorization, and that the designation can be revoked at any time; and (e) A dated attestation with a handwritten signature by the claimant designated representative declaring that they are acting in the best interest of the claimant. (4) The claimant may revoke the authorization at any time by providing written notification to the department. (5)(a) The authorization to represent will automatically end on the last day of the claimant’s current benefit year. In the event that the claimant dies before the end of the benefit year, the designation will end on the date of death. (b) If no application for benefits is submitted within 30 days of the department approving the designation, the authorization will end . If a claimant’s application for benefits is submitted more than 30 calendar days after the designation has been approved, the claimant must submit a new form to designate a representative. (6) The claimant designated representative must maintain the confidentiality of any information they receive from the department on behalf of the claimant. The department is not responsible for any disclosure of the claimant’s information by the claimant designated representative. (7) In addition to the individuals referenced in section (1) of this rule, an individual granted power of attorney by the claimant to act as the claimant’s ‘agent’ or ‘attorney-in-fact’ with respect to the claimant’s Paid Leave Oregon benefits or contributions, is authorized to provide information to and receive information from the department, if the individual with the power of attorney provides documentation satisfactory to the department to demonstrate that the individual has been granted authority to act on behalf of the claimant. (8) The documentation referenced in section (7) of this rule, at a minimum, must: (a) Show that the individual has specific authority to act on behalf of the claimant for Paid Leave Oregon purposes; (b) Provide dates that establish the period the individual has the authority to act on behalf of the claimant; and (c) Include the name of the claimant and the name of the individual with granted power of attorney. (9) Individuals listed in section (7) of this rule must also provide documentation approved by the department for this purpose that is sufficient to establish the identity of the claimant and the individual with the granted power of attorney. (10) If the claimant designated representative, or the individual granted power of attorney by the claimant do not provide information required in this rule or provide inaccurate information to the department, the claimant is responsible for any resulting delay, denial, overpayment, or disqualification of Paid Leave Oregon benefits. (11) If the claimant dies, the authority of the individual with a power of attorney with respect to the claimant’s Paid Leave Oregon benefits or contributions will expire automatically on the claimant’s date of death. [Publications: Contact the Oregon Employment Department for information about how to obtain a copy of the publication referred to or incorporated by reference in this rule.]