OAR 836-080-0250: Workers’ Compensation Insurance Unfair Claim Settlement Practices Standards

For the purposes of ORS 746.230(1)(d), the following applies to a workers’ compensation insurer: (1) The insurer is required to conduct a “reasonable” investigation based on all available information in ascertaining whether to deny a claim. A reasonable investigation is whatever steps a reasonably prudent person with knowledge of the legal standards for determining compensbility would take in a good faith effort to ascertain the facts underlying a claim, giving due consideration to the cost of the investigation and the likely value of the claim. (2) In determining whether an investigation is reasonable, the Director will only look at information contained in the claim record at the time of denial. The insurer may not relay on any fact not documented in the claim record at the time of denial to establish that an investigation was reasonable.