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The Compliance Section
is one of five sections within Workers' Compensation Division: Policy & Communications,
Compliance, Medical, Benefit Services, and Operations. The section is comprised of
four units and one team.
Benefits & Certifications Unit responds to inquiries from injured workers,
insurers, employers, medical providers, and attorneys in an effort to resolve misunderstandings
and differences which could otherwise result in sanctions or litigation, and provides
information to parties about their rights and responsibilities. Reviews and authorizes
reimbursements to insurers and self-insured employers from the Workers' Benefit fund.
Coordinates claim payments to insured workers from the Self-Insured Employer Adjustment
Reserve or security deposits of self-insured employers who are insolvent. Coordinates
and ensures continued claim payments to injured workers when a workers' compensation
insurance company is bankrupt until the accounts can be transferred to the Oregon Insurance
Guarantee Association. Certifies employers to become self-insured for workers' compensation
purposes. Monitors certified self-insured employers to ensure appropriate levels and
types of security are maintained and that excess insurance policies are in place.
Contested Cases Team represents the division at administrative hearings before
the Workers' Compensation Board, negotiates settlements between the division and interested
parties, and advises internal staff on issues being contested.
Employer Compliance Unit provides initial employer indexing information, investigates
reports of employers not carrying workers' compensation insurance on their employees,
assesses sanctions against non-complying employers, initiates proceedings to permanently
enjoin a non-complying employer from employing without workers' compensation insurance,
assesses sanctions against insurers when coverage filings are not timely, and provides
education on Oregon workers' compensation coverage requirements. Certifies and monitors
worker leasing companies.
Field Audit Unit determines if compensation benefits are paid and claim reports
are submitted timely and accurately, assesses penalties, validates that expenditures
from the Workers' Benefit Fund meet eligibility requirements, determines if self-insurers
are maintaining adequate security deposits to meet liabilities, and determines self-insurer
loss experience and accurate payments of assessments.
Investigations & Sanctions Unit sanctions insurers or self-insured employers
who unreasonably delay or refuse to pay compensation to workers, or unreasonably delay
acceptance or denial of a claim. Ensures the worker's cooperation with insurer investigation,
medical examinations or medical requirements essential to their recovery. Ensures compliance
with medical reporting requirements by medical providers. Ensures compliance with claim
processing requirements and coverage reporting requirements. Conducts investigation
of system abuse in response to complaints of rule and statute violations. If indicated
during the investigation process, the unit will arrange onsite audits of health care
providers, employers, vocational rehabilitation counselors and others.
For
more information contact:
Compliance
Section: 503-947-7652
FAX: 503-947-7725
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